RN GOP Lawmaker Says Emergency Rooms Should Be Able To Turn People Away

[Accolay]

GOP Lawmaker Says Emergency Rooms Should Be Able To Turn People Away

GOP Lawmaker Says Emergency Rooms Should Be Able To Turn People Away | HuffPost

Rep. Diane Black (R-Tenn.) proposed on Friday that hospital emergency rooms should be able to turn patients away to help keep health care costs down.

"I'm an emergency room nurse," Black told MSNBC host Chuck Todd on Friday. "There are people that came into my emergency room that I, the nurse, was the first one to see them. I could have sent them to a walk-in clinic or their doctor the next day, but because of a law that Congress put into place to say, no, I have to treat everybody that walks into that emergency room."

"You took away our ability to say, ‘No, an emergency room is not the proper place.' And then, you put a burden on top of that to say, ‘You must do that,'" added the congresswoman, who is also running for governor of Tennessee.

On one hand, I absolutely understand her frustration with some types of emergency room visits: the frequent fliers, people who could wait until morning for their primary or urgent care and those patients who will not participate in their care.

On the other hand I think it's a really slippery slope as to who would get turned away and who would make that decision. There was a reason Reagan signed this into law. Besides...those who come in with a sore throat will be triaged to the absolute end of the line and have to wait for hours anyway.

[amoLucia]

Off on a tangent, but I had an even more disturbing thought. What if Trump bought out some hosp (or NH) and became its CEO? Man, I wonder what kind of projects he'd try to implement.

Back to the topic - perhaps if hosps' ERs did have more say in their ability to selectively implement treatment our current system wouldn't be at such a broken level.

And all the attendant problems that seemed to trickle down.

[JKL33]

I'm not sure how her statements amount to an accurate portrayal of EMTALA. As it stands right now, patients must receive an MSE (medical screening exam) and emergency conditions must be treated/stabilized or transferred appropriately, active labor must be completed/delivered. Low-level ESIs already could be redirected to alternative services (urgent care/walk-in, primary care) but no one does it for various legit reasons.

[JKL33]

Low-level ESIs already could be redirected to alternative services (urgent care/walk-in, primary care)...

I should clarify the above statement. Patients who are determined by the triage nurse to have non-urgent/emergent concerns (primarily ESI 4 & 5) absolutely still require a medical screening exam, which is separate from triage and is performed by a medical provider.

I can see from commentary elsewhere that the general public does not understand this issue (triage is NOT the MSE), so didn't want to add to the confusion.

[Orca, ADN, ASN, RN]

On the other hand I think it's a really slippery slope as to who would get turned away and who would make that decision.

It is tricky. However, I'm sure that most everyone has a story of something ridiculous that tied up ER personnel for something insignificant (like the single mother who brought her nine children into my sister's ER and wanted them all seen for colds).

With the abundance of urgent care facilities, I don't understand why so many people continue to use the nation's ERs as physician offices. There has to be a way for ERs to turn away the players. Some people have no concept of what a real emergency is, or of the appropriate level of care.

Along those lines, I'm headed to an urgent care facility this afternoon. What I have going on needs attention, but it isn't life threatening and no need for me to bother ER personnel with this.

[DaveICURN]

Our hospital was blessed by a designer who decided we needed a 25 bed ER. When we moved to the new facility, the ER administrator decided to use the back 13 rooms as same day/ urgent care rooms for triage 4 and 5; med refills, splinters, coughs etc. and the other 10 rooms and 2 triage rooms for the standard emergency Pt.

But I believe its about the cultural change in thinking. We are now seeing an increase in Pt. who want results right now. Ergo they choose to come to the quick trip ER for their daily needs. No one want to be in pain, but a 4mg push of morphine for a stubbed tow is not worth the thousand dollar price tag.

Now, all experiences are different and every has their own needs and what not. Until we quell the right now way of thinking, we are doomed to accept every skinned knee and ear ache until the Rapture.

-Dave

[aflahe00]

I think that's necessary in this world we live in these days. We should be able to turn some away I mean come on. This is the result of taking away our ability to say NO. More than half the people seen in the ER are for non emergencies this is not what an emergency room is for.

[MunoRN, RN]

I was watching MTP when she came on and said this, there was a lot of yelling at the TV.

Her argument was that EMTALA requires ERs to treat patients with a simple sore throat, which is embarrassingly ignorant of her to state as a supposed former ER nurse.

EMTALA does not require ERs to treat any and all complaints that come in, they are only required to treat conditions that pose a threat of imminent death or harm. ERs are free to turn away patients with a sore throat so long as that is all it is.

[bgxyrnf, MSN, RN]

"There are people that came into my emergency room that I, the nurse, was the first one to see them. I could have sent them to a walk-in clinic or their doctor the next day, but because of a law that Congress put into place to say, no, I have to treat everybody that walks into that emergency room."

First off, the law does *not* say that an ED must treat everybody... it must stabilize those patients who need such treatment. If the patient was stable walking in, there's no mandate that the physician must do anything at all beyond a medical screening exam.

Secondly, it is absolutely NOT the role of the triage nurse to send people away and frankly, any nurse who would welcome that role is a complete fool. It is the role of the provider, be they physician, PA, or NP, to do the medical screening exam and decide from there what diagnostics or treatment are appropriate.

The reason that providers don't turn people away isn't because they can't, it's because they are exposed to liability in the event that the low-probability but high-morbidity condition gets missed.

It's also worth noting that EMTALA does not apply across the board, but only to those facilities who want the Medicare dollars.

Reagan was hardly a bleeding heart liberal; neither were the Republicans who controlled the senate. Reagan wouldn't recognize the GOP of today.

[Daisy4RN]

What we need is for our Government to stop playing politics, work together for the people (like they are paid to do) and solve the problems that are existing (and ongoing) within healthcare delivery. Two that would help solve the problem of people using the ER for routine office visits would be increasing the cost to the individual (higher copays for those with insurance, and at least some copay for those on Medicaid etc., maybe waived for all if true emergency) People don't care about the cost when it is not coming out of their pocket (directly). Also tort reform would help, even if cases do not go through to lawsuit payout there are still costs for hearing, etc., and also too many costs for regulations (but that is a whole different topic).

[Not_A_Hat_Person, RN]

With the abundance of urgent care facilities, I don't understand why so many people continue to use the nation's ERs as physician offices. There has to be a way for ERs to turn away the players. Some people have no concept of what a real emergency is, or of the appropriate level of care.

Along those lines, I'm headed to an urgent care facility this afternoon. What I have going on needs attention, but it isn't life threatening and no need for me to bother ER personnel with this.

I live in an area with no 24- hour urgent care. The 4 local urgent cares are open 7am to 7pm. Only the hospital's urgent care accepts Medicare and Medicaid, and if you come in after 5 or on weekends, they send you to the ER.