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Medical Author:

Charles Patrick Davis, MD, PhD

Charles Patrick Davis, MD, PhD

Dr. Charles "Pat" Davis, MD, PhD, is a board certified Emergency Medicine doctor who currently practices as a consultant and staff member for hospitals. He has a PhD in Microbiology (UT at Austin), and the MD (Univ. Texas Medical Branch, Galveston). He is a Clinical Professor (retired) in the Division of Emergency Medicine, UT Health Science Center at San Antonio, and has been the Chief of Emergency Medicine at UT Medical Branch and at UTHSCSA with over 250 publications.

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Medical Editor:

William C. Shiel Jr., MD, FACP, FACR

William C. Shiel Jr., MD, FACP, FACR

Dr. Shiel received a Bachelor of Science degree with honors from the University of Notre Dame. There he was involved in research in radiation biology and received the Huisking Scholarship. After graduating from St. Louis University School of Medicine, he completed his Internal Medicine residency and Rheumatology fellowship at the University of California, Irvine. He is board-certified in Internal Medicine and Rheumatology.

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Most people agree that everyone deserves the basic right to healthcare, but how far that right goes has been the center of America's healthcare debate; even with the Supreme Court upholding the current new federal healthcare laws, the debate continues, even to the point that the new laws may undergo repeal. Within the existing social structure, inequities in access to healthcare are widespread. Because of numerous inequities in healthcare that often involve such factors as race, socioeconomic status, and gender, politicians have tried for many years to change the healthcare system and are likely to continue to intervene and change these "patient rights."

America's health care system consists of a patchwork of healthcare programs and insurance that includes private health insurance, HMOs, Medicaid, and Medicare, among others. However, more than 49 million Americans are uninsured according to 2010 census data, and the government has been forced to pass various laws in order for America's health care system to provide more equal care.

An example of such a law is the Consolidated Omnibus Budget Reconciliation Act (COBRA). The COBRA regulations are federal legislation that mandates an evaluation of patients who seek medical attention at emergency facilities. If an emergency care institution refuses to provide care, the institution and health care providers are held responsible and liable. These regulations prevent health care institutions from refusing needed care to people without money or health insurance.

• Together, the COBRA laws and the newer Emergency Medical Treatment and Active Labor Act (EMTALA) refer to federal laws related to patient screening and transfer. They require all emergency departments and Medicare-participating hospitals to do the following:
  • Perform an appropriate medical screening examination by a qualified provider to determine whether an emergency condition exists
  • Provide further examination and treatment to stabilize the patient, and if necessary and appropriate, to arrange a transfer
  • Consider patients in labor unstable for transfer, under special conditions (see below).
• EMTALA requires that all emergency departments and Medicare-participating hospitals to screen anyone who is in active labor or is seeking emergency care. If such a screening reveals the presence of an emergency medical condition - such as severe pain, serious threat to life or limb, or active labor - the hospital is required to perform stabilizing treatment to the best of its capabilities.

In order to provide continuing health insurance for the recently unemployed, COBRA provisions also permit continuation of coverage through the workplace. Recently, many federal and civil lawsuits have been filed and both won and lost against HMOs for failing to provide needed care because of the drive to reduce health care costs. The outcome of such lawsuits is sometimes unclear, but the quality of provided care is on the minds of all who obtain health care.

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