Abstract
Emergency medicine, usually centered in a hospital emergency department, presents both health care professionals and patients with unique problems. In a typical physician-patient interaction, the patient voluntarily enters the relationship, the physician gets to know the patient and has an opportunity to discuss treatment options in detail with time for reflection. In an emergency department, the patient is brought in by ambulance, the police, or others, does not choose the physician, and there is rarely opportunity for detailed discussion of treatment options. The pain or fear that drives people to seek medical advice is often more extreme in the emergency setting. In some cases, the situation may be even worse: The patient may be under the influence of drugs or alcohol, or be suffering a severe psychotic episode and actually be hostile to the nurses and physicians who are trying to help.
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Notes
Sanders, “Unique Aspects of Ethics in Emergency Medicine,” in K. V. Iverson et al., eds., Ethics in Emergency Medicine (Baltimore, Md.: Williams & Wilkins, 1986), at 9–12.
Knowles, “The Hospital,” Scientifc American, Sept. 1973, at 136; and see Brook & Stevenson, Effectiveness of Patient Care in An Emergency Room, 283 New Eng. J. Med. 904,907 (1970); Berarducci, Delbanco & Rabkin, The Teaching Hospital and Primary Care, 292 New Eng. J. Med. 615 (1975); and French, “Emergency Rooms Overwhelmed as New York’s Poor Get Sicker,” New York Times, Dec. 19, 1988, at 1, B4.
Thompson v. Sun City Community Hospital, 141 Ariz. 597, 688 P.2d 605 (1984).
Hint, Emergency Treatment and Management, 3d ed. (1965), at 88. Some of the leading textbooks on emergency medicine are P. Rosen et al., Emergency Medicine: Concepts and Clinical Practice, 2d ed., 2 vols. (St. Louis, Mo.: Mosby, 1988); Roberts & Hedges, Clinical Procedures in Emergency Medicine (Philadelphia, Pa.: W. B. Saunders, 1985); Fleisher & Ludwig, Textbook of Pediatric Emergency Medicine, 2d ed. (Baltimore, Md.: Williams & Wilkins, 1988); and Haddad & Winchester, Clinical Management of Poisoning and Drug Overdose (Philadelphia, Pa.: W. B. Saunders, 1983).
Wilmington General Hospital v. Manlove, 54 Del. 15, 174 A.2d 135 (1961).
Other courts have arrived at the same conclusion. See, e.g., Stanturf v. Sipes, 447 S. W. 2d 558 (Mo. 1969), Williams v. Hospital Authority of Han County, 119 Ga. App. 626, 168 S.E.2d 336 (1969).
E.g., Cal. Health and Safety Code sec. 1797 et seq. (West 1988); Ill. Ann. Stat. ch. Ill 1/2, para. 86 (Smith-Hurd 1977); N.Y. Public Health sec. 2805(b) (McKinney 1985); Tex. Rev. Civ. Stat. Ann. art. 4438(a) (Vernon 1976) and art. 4438(f) Vernon 1985).
Williams v. Hospital Authority, supra note 6; see also Jackson v. Power, 743 P.2d 1376 (Alaska, 1987).
Cypress v. Newport News Gen. & Nonsectarian Hospital Ass’n., 375 F.2d 648 (4th Cir. 1967).
See, e.g., Annas, Not Saints but Healers: The Legal Duties of Health Care Professionals in the AIDS Epidemic, 78 Am. J. Public Health 844 (1988); Kelen et al., Unrecognized Human Immunodeficiency Virus Infection in Emergency Department Patients, 318 New Eng. J. Med. 1645 (1988).
P.L. 99-272, codified, 42 USC sec. 1395(dd).
See, e.g., “16 Hospitals under Investigation on Charges of Patient Dumping,” American Medical News, Jan. 15, 1988, at 2, 12.
Committee on Government Operations, U. S. House of Representatives, 100th Cong., 2d Sess., Equal Access to Health Care; Patient Dumping,Union Calendar No. 326, Mar. 25, 1988; and see “Report Assails Patient Transfers,” New York Times, Mar. 30, 1988, at A20.
Tolchin, “U. S. Seeks to Require Treatment of all Hospital Emergency Cases,” New York Times, June 18, 1988, at 1, 8.
Hospital Responsibility for Emergency Care, Proposed Rules, 53 Federal Register 2513-22527 aune 167 1988).
Equal Access, supra note 13, at 19, and see Note, Preventing Patient Dumping: Sharpening the COBRA’s Fangs, 61 N.Y.U. L. Rev. 1186 (1986); and Enfield & Sklar, Patient Dumping in the Hospital Emergency Department, 13 Am. J. Law & Medicine 561(1988).
Joint Commission on Accreditation of Healthcare Organizations, 1989Accreditation Manual for Hospitals (1988).
New Biloxi Hospital v. Frazier, 245 Miss. 185, 146 So. 2d 882 (1962).
Bulletin of the American College of Surgeons (May–June 1963), at 112. But see French, “New Emergency-Room Rules Seen Going Unheeded in New York City,” New York Times, Jan. 4, 1989, at 1, B4
Joint Commission, supra note 17, at 29.
Citizen’s Hospital Assoc. v. Schoulin 48 Ala App. 101,262 So. 2d 303 (1972).
O’Neill v. Montefiore Hospital, 11 A.D.2d 132, 202 N.Y.S.2d 436 (1960).
Jones v. City of New York, 134 N.Y.S.2d 779 (Sup. Ct. 1954), modified, 286 A.D.2d 825, 143 N.Y.S.2d 628 (1955).
Methodist Hospital v. Ball, 50 Tenn. App. 460, 362 S.W.2d 475 (1961). See also Mulligan v. Wetchler, 39 A.D.2d 102, 332 N.Y.S.2d 68 (1972).
Thompson v. Sun City Community Hospital, 141 Ariz. 597, 688 P.2d 605 (1984).
Id.
St. Joseph’s Hospital v. Maricopa Co., 142 Ariz. 94, 98, 688 P.2d 986, 990 (1984).
LeJeune Road Hospital v. Watson, 171 So. 2d 202 (Fla. Dist. Ct. App. 1965); Tabor v. Doctors Memorial Hospital, 501 So. 2d 243 (La. Ct. App. 1987).
Taylor, “Cracking Down on Patient Dumping,” National Law J., June 6, 1988, at 1, 30.
Mercy Medical Center v. Winnebago Cty., 58 Wis. 2d 260, 268, 206 N.W.2d 198, 201 (1973).
Editorial, “Health and Hot Potatoes,” Washington Post, Mar. 16, 1985. And see Ansberry, “Despite Federal Law, Hospitals Still Reject Sick Who Can’t Pay,” Wall Street Journal, Nov. 29, 1988, at 1, All (approximately 250,000 people are “dumped” from hospitals annually for economic reasons).
Signor, “Shifted from Hospital to Hospital with Knife in His Back,” St. Louis Post-Dispatch, Oct. 26, 1980.
Schumer, “Hospitals Unload Poor on County,” Chicago Tribune, Jan 3, 1984. And see Relman, Economic Considerations in Emergency Care: What Are Hospitals For? 312 New Eng. J. Med. 372-73(1985); Himmelstein et al., Patient Transfers: Medical Practice as Social Triage, 74 Am. J. Public Health 494-97 (1984).
Barbanel, “Refusing Patients Becomes a Crime,” New York Times, Aug. 6, 1983. And see Barron, “Hospitals Get Orders to Reduce Crowding in Emergency Rooms,” New York Times, Jan. 24, 1989, at 1, B4.
Tokarz, “Odyssey of AIDS Victim Ends in Death,” American Medical News, Nov. 4, 1983. See also People v. Flushing Hospital, 122 Misc. 2d. 260, 471 N.Y.S.2d 745 (1983).
Wing, Medicare and President Reagan’s Second Term, 75 Am. J. Public Health 78–84 (1985).
Friedman, “The Dumping Dilemma: The Poor Are Always with Some of Us,” Hospitals, Sept. 1, 1982, at 53.
Such a card has been used for years by Legal Services of Middle Tennessee [800-342-3317], and even when it does not help procure needed services, it identifies the physician who determined that such services were not necessary.
Equal Access, supra note 13, at 20-21.
G. J. Annas, Judging Medicine (Clifton, NJ.: Humana Press, 1988), at 42–45.
Kellermann & Ackerman, Interhospital Patient Transfer: The Case for Informed Consent, 319 New Eng. J. Med. 643 (1988).
Annas, Your Money or Your Life: Dumping Uninsured Patients from Hospital Emergency Wards, 76 Am. J. Public Health 74 (1986).
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© 1992 George J. Annas and the American Civil Liberties Union
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Annas, G.J. (1992). Emergency Medicine. In: The Rights of Patients. Humana Press, Totowa, NJ. https://doi.org/10.1007/978-1-4612-0397-1_4
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