Category Archives: Legal systems and issues

Mar 4 2014
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The Emergency Medical Treatment and Active Labor Act: Past, Present and Future

An interview with Sara Rosenbaum, JD, the Hirsh Professor in the School of Public Health and Health Services at the George Washington University, in Washington, DC, and a Robert Wood Johnson Foundation (RWJF) Investigator Awards in Health Policy Research recipient. She is the author of “The Enduring Role of the Emergency Medical Treatment and Active Labor Act,” published in the December 2013 issue of Health Affairs, which focused on the future of emergency medicine. The interview is part of a series of posts  featuring RWJF Scholars who authored articles in the issue.

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Human Capital Blog: Your article discusses the past, present, and future of the Emergency Medical Treatment and Active Labor Act (EMTALA), adopted in 1986. Could you tell us a little about what moved Congress and the President to create the law, and what its purpose was?

Sara Rosenbaum: The law had several roots. To begin, it was the outgrowth of a good deal of law that came before it, embracing the notion that hospitals should provide emergency care, even without the expectation of payment. So that idea wasn’t unique to EMTALA, but by the early 1970s the expectation that hospitals would provide the community benefit of emergency services had revved up, partly because states had adopted that expectation under their own common law and statutes. So EMTALA was the culmination of a lot of legal precedent. But what prompted passage of the law in 1986 was two things: First, a substantial number of news stories about patient-dumping, particularly in California; and second, on the heels of Medicare payment reform a few years earlier, there was a lot of concern that hospitals would start discharging Medicare patients in an unstable state – sicker and quicker, as the saying went.

HCB: What are the law’s key components?

Rosenbaum: The one everybody knows best is the screening component: If somebody comes to an emergency department and requests an examination, hospitals must examine the patient to determine if there's an emergency medical condition. And if they find one, they must provide stabilization treatment. Or, if the patient has an emergency condition that the hospital is unable to stabilize, it can seek the cooperation of another hospital with more specialized capabilities, and transfer the patient. And then that second hospital has a separate obligation; it can’t just say “no.”

HCB: What’s your sense of how the law operates in the daily life of a hospital?

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Nov 1 2012
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Thoughts on the APHA Closing Session: In the End, It is All About Power

Robert Otto Valdez, PhD, is the Robert Wood Johnson Foundation (RWJF) professor of family & community medicine and economics at the University of New Mexico. He serves as executive director of the RWJF Center for Health Policy at the University of New Mexico, a national program office for increasing diversity in health and health care leadership. This post is part of a series in which RWJF scholars, fellows and alumni who are attending the American Public Health Association annual meeting reflect on the experience.

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The 140th Annual Meeting of the American Public Health Association (APHA), the nation’s oldest gathering of public health professionals in the world, concluded yesterday as the San Francisco region celebrated the World Series victory of their beloved Giants.  Close to 13,000 public health professionals came together around the theme, Prevention and Wellness Across the Life Span.

The closing session focused on incarceration, justice, and health with a keynote speech by Angela Davis.  Our society has used mandatory sentencing and incarceration of Black and Latino young men and, more recently, immigrants as a form of social control that not only maintains the current social order but also contributes to the inequalities in health that result from inequitable society.

The kinds of mass incarceration costing some $70 to $100 billion a year has produced social inequalities that can be readily seen in the lives and families of the formerly incarcerated.  Bruce Western and Becky Pettit offered an insightful article in the Summer 2010 Daedalus that describes the creation of a group of social outcasts “who are joined by the shared experience of incarceration, crime, poverty, racial minority, and low education.”  These are all characteristics that contribute to social and economic disadvantage not only for those who were incarcerated but also their families.

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