why and how can people abuse the ER?

Altra, BSN, RN · Feb 7, 2012

One word: EMTALA

OK, it's actually seven words: Emergency Medical Treatment & Active Labor Act.

In a nutshell, an emergency department must perform a medical screening exam on all patients who present, no matter no minor their presenting symptoms or whether or not they have any ability to pay for treatment. Note that the law does not require treatment for non-emergency conditions, but few hospitals have the intestinal fortitude to deny treatment.

No, it's not free. Patients get billed. But those who consider it free (and utilize it accordingly) do not have the same considerations regarding payment or damage to credit rating that you may consider.

Yes, it is unquestionably much more expensive to go to the ER than to go to a physician office, clinic or urgent care. In the ER you are paying for the immediate availability of all the resources of the hospital. Quite an expensive and inefficient way to deal with cold symptoms. But the ER doesn't ask for payment on the spot. The other options do.

sharpeimom · Feb 7, 2012

in addition to the above, not all areas have the "minute" clinics, and in many rural areas there isn't any public transportation such as busses, taxis, or whatever. the poor who are stranded in ill-located public housing must walk everywhere, including grocery shopping, errands etc.

SpaceCoastRN · Feb 7, 2012

The interesting thing too, is that some of the most abusive and demanding patients are the people that utilize the ED as their free health clinic. And it is always a massive pain when taking care of a critical patient to have someone present for a chronic or minor illness that has not been properly addressed demanding services when your critical patient actually needs you at bedside. I only wish more places would utilize the MSE process for the minor ailments, requiring payment in advance for inappropriate use of the ED so we could focus on people that are ill and requiring medical intervention.

MN-Nurse, ASN, RN · Feb 7, 2012

They are just listening to GWB:

The Pennsylvania Progressive: Bush on Healthcare: Just Go To An Emergency Room

Marshall1 · Feb 7, 2012

MN-Nurse - people were abusing the ER long before GWB was in office and will continue to do so - as you can see - long after he is gone. Washington and most of those who inhabit it live in a fantasy world regardless fo their political party.

Anyway..with the economic times we are in, many people have lost their jobs and insurance so going to an urgent clinic or an MD's office is out of the question. Also, MD offices, at least where I live, are not usually available for someone after hours or on weekends or even the same day

Some people do what they can to hold onto their jobs so if that means hitting the ER at 0600 for the flu so they can hopefully be well enough to make it to their afternoon shift at the factory they are going to do that. Many also know they do not have to pay upfront - though on of the hosptials here now DOES ask for SOME payment before you leave. Some will try to pay, others will not, some will abuse the ER as long as they can and others will hit it from time to time because they feel they have no other options.

This is not new and is not going to change. After decades in healthcare one thing I have learned is if you have a lot of prejudices or a judgemental type attitude you will be stressed out everyday you are at work. We are not there to solve all of someone's problems in an hour visit, we are there to provide care and as far as payment etc, let those who are paid the BIG bucks in the hospital organization worry about that. It is fair? No. But that's life.

33762FL · Feb 7, 2012

They bill you regardless of if you have insurance and regardless of ability to pay, assuming you gave your real name, ID and billing address at admitting (I've had patients who used fake names & addresses likely for this reason). However, there's a limit on how aggressively they may want to chase down people who haven't paid - it would look pretty bad for a hospital's PR to have a new story that says something like, "Miss X lost her job and was uninsured and struggling, she came to the ER because she was pregnant and started bleeding. The ER treated her but now creditors are hounding her day & night to pay a $10K hospital bill and the collections company is garnishing her unemployment checks. She can't even afford to buy diapers and a crib for her impending arrival."

Urgent care clinics are a rip off too, don't go there if you can possibly avoid it. Basically the ER and Urgent Care clinics will charge more for the same services you can get at a doctor's office. If you have insurance or even if you just have enough in your bank account to pay a bill of a few hundred dollars, go to a regular doctor's office. If you're uninsured and on a strict budget, go to Planned Parenthood for anything GU/OB related. If it burns when you pee, you have pus coming from your member, or you want prenatal care, Planned Parenthood charges on a sliding scale, it will be very cheap out of pocket especially in a blue state that funds their PP's well.

Esme12, ASN, BSN, RN · Feb 7, 2012

It's a complex problem. EMTALA is a part of it. Hospital/medical show up on credit reports but do not (or aren't supposed to) have a negative effect on your score. MD's can refuse to give appointments if you aren't insured by saying they aren't accepting new patients. The ED technically can't. There is a new trend to give the MSE (medical screning exam) and charging for non-emergent ED visits like "I need a pregnancy test" crap....but it's a fine line and one misdiagnosis and delay is big bucks. Personally, if I wasn't so:o embarassed, I'd go to the ED to get the testing in one evening that I have been trying to get for 6 months and more waiting for the specialist appointment. :sleep:

Fiona59 · Feb 7, 2012

It happens here in Canada where we have universal health care. We have walk-in clinics. But people without family doctors (GPs) continue to show up in our ERs.

You forgot to renew your prescription? Go to ER!

You haven't had a bowel movement in five days? Go to ER?

Then because you really aren't an emergency, sit and wait 8 hours and complain about the lack of service.

My favourites are the ones that call an ambulance for their ride to the ER. In my province an ambulance ride isn't part of universal healthcare, so it works out to a $350+ taxi ride, that they just don't pay when they get the bill.

ER abusers have no shame, they are the most important people in the world.

LynnLRN · Feb 7, 2012

Until we are allowed to refuse to treat people who are OBVIOUSLY abusing the system and not have to worry about law suits, the abuse of the ER is not going to change. I'm sorry, if someone wants to "cry wolf" 5 times a week at multiple ER's then when they are truly sick and nobody takes them seriously it should be on their shoulders not ours. But this will never happen because our leaders apparently do not think people need to be responsible for themselves and the decisions they make.

Oh and the most laughable thing I saw in the ER was a male in his early 20's (a frequent flyer) call an ambulance for a syncopal episode (it was winter). Just to leave AMA as soon as he arrived because his friend lived near the hospital. He used the ambulance as a TAXI to get to his friends house.

uRNmyway, ASN, RN · Feb 8, 2012

I found out that some states, maybe all (not sure about which ones) have emergency treatment funds. Basically, hospitals cannot refuse to care for someone in an emergency situation, whether its a GSW or active labor, because of lack of insurance or inability to pay. There are certain eligibility conditions, you have to have below a certain income, etc.. But people who cannot pay for emergency care will not necessarily go home to a huge bill.

I also have to tell you guys it is REALLY not all that bad. It is ONLY going to get worst with President Obama's health care bill. Here in Quebec, where we have public healthcare that we pay VERY dearly for, people use the ED for everything from a daycare center for their elderly parents to getting a doctor's note when they are hungover and don't want to go to work. So good luck to all of you ED employees, I really hope it doesn't get as bad there as it is here!

ckh23, BSN, RN · Feb 8, 2012

What you do is show up and give a fake SS# and a fake address and you'll get free treatment and never get a bill.