EMTALA needs amending immediately, and we are not discussing this in congress at all. Its the reason our hospital system is on the brink of collapsing. I need Destiny's help!

EMTALA is the bane of my existence and is the sole reason our Hospital system is on the brink of collapse. Right now as I speak, I’m currently receiving pages that indicate our volume in the ED. We have 90+ just waiting to be triaged. The VAST majority of these people checking into the ED, do not need to be at the ED, however our Emergency departments have to abide by EMTALA and cannot under any circumstances send a pt away, or that’s what we call an EMTALA violation. Also, a Doctor or Nurse in the ED cannot hint in any way that you're issues are not emergent, this is harder to prove, but technically speaking this is also an EMTALA violation, basically they cannot use words to discourage you from being in the ED. So if you want to show up to the ED for a paper cut, you have every right, if you want to show up the ED for a paper cut 20x in one day, you will be seen. It’s almost impossible to ban someone from ED, you can ban them from hospital property, but can’t refuse Emergency Department services not matter how violent or awful they are. EMTALA was created for a good reason in the 80s, but it’s now backfired.

Here is why EMTALA is bad.

Urgent Cares/Primary Care Offices/surgical offices and the worst (Private EDs) don’t have to abide by EMTALA, they can refuse service to the pt, and send them to ED for any reason they want. Countless times since Covid, Urgent Cares have become overwhelmed and the providers break down at these zoomcares, alt care, etc and just send all the pts to the closest ED. Which then swamps our workload to the 10th degree. We are BROKEN, our EDS are BROKEN!

Why has EMTALA backfired?

PCP office for the most part close at 1700, most urgent cares close at 2200 if you’re lucky you’ll find a 24 hour zoomcare etc, but that’s rare. The Emergency Department is flooded with pts that just need education how to read the back of their insurance card and ask for a primary care appointment, or an E-visit. You would be shocked at the amount of pts when we ask do you have a primary we see you have insurance, “oh, I don’t know how to get a primary” its honestly pathetic. We need an entire class in High school on how to use your insurance benefits. How to navigate long appointment dates. For example “ my primary can’t see me for 2 months” This doesn’t mean you can’t get treatment. You can email your doctor, and they can treat almost everything by email until your appointment. They can ordering imaging, labs, and half the time they can find a reason for your issues without even seeing a doctor. Almost every major hospital system in this country has telemedicine which has SKY rocketed in popularity since covid, and is here to stay and should be utilized.

BUT… Even if you do all you can as a pt, a lot of these primary care doctors are so overwhelmed themselves and scared of being sued that they wash there hands of responsibility and send the pt to the nearest ED and make it our ED docs responsibility to be your PCP for tingling fingers that's been there for 10 years and is a chronic issue.

When you go to the ED this what you can expect,

Airway management, trauma related injuries stabilized enough for surgery, Insulin, stroke, ANAPHYLAXIS (not allergic reaction), STEMI detection (Not treatment, you need a cath lab for that, if your PCP sends you to the little ED for a heart attack, they are a moron) stabilizing septic shock to get you upstairs in the ICU for your future treatment of ECMO because you didn't get a flu/covid shot.

I could honestly keep going, but basically the reason I’m writing this is I really need to vent to Destiny about all this, and really start discussing how to combat these issues.

I have extensive knowledge in Emergency Medicine pre-hospital and post care. Destiny seems like the one person I could talk to, and completely explain what’s going on, and prepare him for future issues our country is about to face.

PS: I have a SHIT ton to talk about mental health in our EDs waiting weeks for a placement bed just to have the pt d/c from psych facility in 12 hours to end back up in our EDs... BOUCNE BACKS NEED TO STOP!