Here is an excerpt from his post, "The Specialist Wall":
If you are unfamiliar with EMTALA or our take on it you can read about it here, but to be brief, EMTALA is an unfunded federal mandate passed in 1986, which, de facto, has made it a crime to tell anyone 'no' in the ER. Because of this, the specialists on call have learned to hate the ER. The ER is no longer a place from which one can build a practice, it is, rather, a place that compels you lose sleep, and money. It compels consultants to expose themselves to full malpractice liability EVERY SINGLE TIME they accept a patient from us whether they ever get paid or not.(Read the full text of "The Specialist Wall".)
No doubt there is a strong tradition in western medicine to treat first and seek payment later. This dates to Hippocrates and is part of the original oath. My question is this. How far should this obligation extend, AND, should it be extended by force of law rather than by individual choice?
...[T]he specialists are fed up, and they have figured out how to fight city hall. For years their battle has been against the system or even the ER doc downstairs. But now (oh the genius!) they have turned the bureaucrats game against them. EMTALA and the bylaws, policies, and rules that it has generated are being followed to the letter.
For instance, almost all hospitals have an on-call policy for specialists that require them, if the ER doc requests it, to come in to the ER and evaluate the patient. Well, they can be forced to do this, but in many cases they CAN NOT be forced to treat the patient. Unheard of twenty years ago and before EMTALA, but specialists are now routinely coming in, evaluating the patient, and finding reasons why this particular case is out of their area of expertise, or not appropriate for their care, or not in need of surgery immediately, and the specialists are going home.
Recently, a child came in to the ER after sustaining a facial laceration. Two different surgeons were called to fix the cosmetically sensitive but clearly non-emergent laceration. Both came in, and both told the ER doc, "No issue, you can do this." And that's exactly what happened -- the ER doc sewed it up (I hope he did it well). And that's exactly what EMTALA means, and exactly what Obamacare means, and it ends up hurting people who do not deserve it, and it ends up rewarding those that do not deserve it. And yes, I said "DESERVE", and yes, I mean it. Punishing the doers eventually causes them to slip the yoke.
This is a tragic (and predictable) consequence of the notion of an automatic "right" to health care. Attempting to create such a right necessarily enslaves those who must be compelled to provide such care. Many doctors will refuse to work under such terms, recognizing the gross injustice of such attempted automatic claim upon their time and expertise -- especially when it only brings them medico-legal risk with no compensation.
I thank for "911doc" for analyzing this important issue at a deeper moral level (rather than at simply the economic level), for showing how bad ideas will have real-life consequences for patients and doctors, and for speaking his conscience.
