“911Doc” at DocsOntheWeb describes the harms of EMTALA:
If you are unfamiliar with EMTALA or our take on it you can read about it here, but to be brief, EMTALA is an unfunded federal mandate passed in 1986, which, de facto, has made it a crime to tell anyone ‘no’ in the ER. Because of this, the specialists on call have learned to hate the ER. The ER is no longer a place from which one can build a practice, it is, rather, a place that compels you lose sleep, and money. It compels consultants to expose themselves to full malpractice liability EVERY SINGLE TIME they accept a patient from us whether they ever get paid or not.
… the specialists are fed up, and they have figured out how to fight city hall. For years their battle has been against the system or even the ER doc downstairs. But now (oh the genius!) they have turned the bureaucrats game against them. EMTALA and the bylaws, policies, and rules that it has generated are being followed to the letter.
For instance, almost all hospitals have an on-call policy for specialists that require them, if the ER doc requests it, to come in to the ER and evaluate the patient. Well, they can be forced to do this, but in many cases they CAN NOT be forced to treat the patient. Unheard of twenty years ago and before EMTALA, but specialists are now routinely coming in, evaluating the patient, and finding reasons why this particular case is out of their area of expertise, or not appropriate for their care, or not in need of surgery immediately, and the specialists are going home.
But how can a surgeon refuse to operate? Well, well… by way of example, consider the lowly gall bladder. When I was in training the gall bladder came out with pain and an abnormal ultrasound. Now it doesn’t. It used to be that surgeons would operate at the drop of a hat because they loved surgery. Not anymore. You see, if a patient with acute cholecystitis can be ‘cooled down’ with fluids and antibiotics, VOILA!, no need to remove it right now. Have the patient follow up with the surgeon as an outpatient. You can’t be sued for an operation you didn’t do.
Then the patient goes to the surgeon’s office a few days later and is no longer under the rubric of EMTALA, therefore, they must pay for their surgery (payment plans are accepted), or have insurance. Still sounds fair right? I mean, who gets surgery for free, right? Well, these folks do NOT follow through with the surgeon because it’s not free, they end up right back in the ER, and on the 28th time they are sick enough to go to the ICU. Some of them die, and they ALL chose to walk the streets with the ticking time bomb in their belly because they wouldn’t pay a single dime for surgery (but they happily pay ATT for their I-phones).
EMTALA compliant? Absolutely. Fair? Yes. Optimal? No. How to force the surgeons to operate? I don’t know… at the point of a gun? Otherwise, there’s no one that can do what they do, not even an attorney