EMTALA, Private Equity, & Equal Rights
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A Good Day To Advocate for Better Healthcare
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Hospitals to Patients - No Room Here
The Emergency Treatment and Labor Act was passed in 1986. This federal law requires facilities that accept Medicare funding to provide a medical screening exam to anyone who shows up at or near their door and offer stabilizing treatment, if needed.
It was to have been a warning to private hospitals that had been dumping pregnant patients and gunshot victims on the doorsteps of public hospitals.
Emergency rooms without the resources or staff to properly treat that patient are required to arrange a medical transfer to another hospital, after they've confirmed the facility can accept the patient.
The author of the bill said on its passage "That all Americans, regardless of wealth or status, should know that a hospital will provide what services it can when they are truly in distress."
We will see that this is not the case.
The problem of dumping patients is not new. A report published by the U.S. Commission on Civil Rights, 30 years after the law’s passage concluded there was "insufficient regulatory oversight of the law,"
Now 100 emergency rooms have mistreated or turned away pregnant women since 2022. One woman in Louisiana at Our Lady of the Lake hospital was having contractions every 2 minutes. They refused to stabilize her, put her in an ambulance to be taken elsewhere. The baby was born in the cab of the ambulance.
Inspectors determined that hospital’s emergency room's staff members violated the federal mandate seven times since 2017, when they refused a needed surgery to a Medicaid patient with a broken spine, left a suicidal teenager unattended in the lobby, and failed to examine another pregnant woman before sending her to another hospital, federal records show. (AP)
Other emergency rooms denied care to pregnant women, sometimes leaving them to miscarry in bathrooms, deliver babies in cars, or develop risky infections. Some repeatedly flouted the mandate without consequence, including one Tennessee emergency room with such long wait times that a pregnant woman had to be hospitalized for a week after an 8-hour wait and a man with chest pain collapsed in the lobby, then died.
HHS has sent letters to hospitals repeatedly reminding them of that law and the penalties -- up to $129,232 per violation or loss of Medicare funding -- for flouting it.
Last year HHS announced that two facilities -- Freeman Health System in Joplin, Missouri, and University of Kansas Health System in Kansas City, Kansas -- ran afoul of the federal law after refusing an emergency abortion to Mylissa Farmer.
Doctors at both hospitals told the 41-year old Missouri woman that her baby had no chance of surviving after her water broke at 17 weeks but because of the states' abortion bans, her condition needed to worsen before they'd terminate her pregnancy.
A Tennessee hospital agreed to pay a $100,000 fine for a 2018 case involving a pregnant patient who was discharged and gave birth in a car at 42 weeks pregnant. A Kentucky hospital was fined $90,000 for refusing to help a patient with an ectopic pregnancy in 2021.
After a complaint against a hospital is filed, a state surveyor investigates the hospital. A physician and the federal government review the findings to determine whether or not a patient received inadequate treatment. If an emergency room violated the federal law, CMS may refer the case to the HHS inspector general to consider penalties.
The bottom line is that patients in critical need are being mistreated. Sometimes it is because they are pregnant, need an abortion and doctors are scared to do it. Sometimes it is because they have no insurance or they are the wrong color or race.
Justice, as usual is slow and complaints take time to investigate and when a life is on the line that seems too little too late. Universal Healthcare, would help with the insurance part of this issue. The Women’s Health Protection Act helps with the abortion part. Racism requires diversity and the Extreme (supreme) court shot that down for medical schools.
VOTE ACCORDINGLY
Anyway the HHS info for filing a complaint is below.
Have you been denied treatment to stabilize your emergency medical condition in a hospital emergency department?
Because of EMTALA, you can't be denied a medical screening exam or treatment for an emergency medical condition based on:
If you have health insurance or not
If you can pay for treatment
Your race, color, national origin, sex, religion, disability, or age
If you aren't a U.S. citizen
Learn how to file an EMTALA complaint here. (HHS)
Private Equity Revisited
When private equity firms take over a hospital or healthcare facility, prices increase, quality declines, and workers are forced to do more with less.
In November 2010, the global private equity firm Cerberus Capital Management bought six Massachusetts hospitals in an $895 million deal through the newly formed Steward Health Care. By 2017, it had taken over 37 hospitals in 10 states, according to the Private Equity Stakeholder Project, a nonprofit watchdog organization.
CEO of Steward Healthcare, de la Torre loaded the hospitals with billions of dollars in debt; sold the land underneath them to Medical Properties Trust, a real estate investment group; and charged them "unsustainably high rents."
Steward has also closed six hospitals since 2018, laid off at least 2,650 workers, and has cut vital services across hospitals, including obstetrics, behavioral health, and oncology.
In May, Steward Health Care filed for bankruptcy and announced plans to sell its more than 30 hospitals.
Meanwhile, de la Torre had spent $160 million on a yacht, two private jets, a luxury fishing boat, and a donation to an elite preparatory school.
An estimated 15 patients in Steward's hospitals have died due to lack of medical equipment or staff, and thousands more were put in danger,
At one hospital in Brockton, Massachusetts, an 81-year-old man with pancreatic cancer died waiting for care in an emergency department that was understaffed. At another, a 28-year-old patient in an acute mental health crisis "went into distress" and died. A 39-year-old woman who had a normal childbirth then bled to death; her life might have been saved by an embolism coil used to stop serious bleeds, only the coils had been repossessed by the vendor weeks earlier.
Audra Sprague, RN, a former nurse at Nashoba Valley Medical Center in Lunenburg, Massachusetts, brought her 18-year-old son who was in diabetic ketoacidosis to her hospital. He had been newly diagnosed with type 1 diabetes and was admitted to the intensive care unit. Due to staffing shortages, he stayed in the emergency department overnight where there were 18 patients and two nurses.
No matter how hard or fast they worked, there is no way for two nurses to care for 18 patients, Sprague said. The hospital's local leadership asked for a third nurse for night shifts, but corporate negotiators repeatedly rejected the request. So, "I had to be his nurse that night and not his mother," Sprague said.
The Senate Health Education Labor and Pensions Committee will meet to discuss a contempt resolution for de la Torre on September 19.
There is a way to fix this. Senator Markey and Representative Jayapal have submitted that Health over Wealth Act (S. 4804/ HR 9156) in Congress that will fix the behaviors that for profit firms use to squeeze out profits from health care systems and then leave them to die in bankruptcy and threatening the health of their communities.
This bill will
Require that private equity-owned health care facilities publicly report on their debt and executive pay, lobbying and political spending, health care costs for patients and insurance plans, and any reductions in services, wages, or benefits
Require that private equity-owned firms set up escrow accounts to cover five years of expenses to ensure continuation of care in the event of a hospital closure or service reduction
Authorize the Department of Health and Human Services to revoke investment licenses from private equity firms that price gauge, understaff, or create access barriers to care
Establish a task force to review the role of private equity and consolidation in health care, including how market trends create or exacerbate health care disparities
Prohibit private equity firms from stripping assets from health care entities or undermining the quality, safety, or access to health care
Close tax loopholes for real estate investors in order to disincentivize health care entities from selling their property and then paying exorbitant rents to these investors
Tell your member of Congress and Senators it is time to pass the Health Over Wealth Act and protect the ability of their constituents to get healthcare when they need it.
ACTION
Call or email your Congressional Representative and Senators and let them know it is time to pass the Health Over Wealth Act. Here is a link to their contact info, https://www.usa.gov/elected-officials.
Or use RESISTBOT via [Apple Messages / WHATSAPP / MESSENGER] or by texting SIGN PBDMMH to 50409 on your cell phone to send this message.
“I am your constituent and I want you to know that Private Equity investment firms are squeezing the life out of medical communities. Steward Health’s bankruptcy is just the latest debacle. They load facilities with debt to fund super sized dividends to investors and then force the facility to pay extra high rents. Critical functions like maternal care and cancer treatment are often removed because they are insufficiently profitable. Then after the money is squeezed out of the system they declare bankruptcy and leave communities devastated.
Steward health is the latest, but this goes on all the time - ask any constituent in a rural area.
YOU CAN FIX THIS AND HELP YOUR CONSTITUENTS.
Get the Health Over Wealth Bill to a vote and passed. Here is what it does.
Provides for HHS review before the sale can occur
Establishes an escrow account with funding for 5 years of operations so communities aren’t left helpless
Requires transparency about financial and management operations such as debt and executive pay, lobbying and political spending, health care costs for patients and insurance plans, and any reductions in services, wages, or benefits
Authorize the Department of Health and Human Services to revoke investment licenses from private equity firms that price gauge, understaff, or create access barriers to care
Prohibits private equity firms from stripping assets from health care entities or undermining the quality, safety, or access to health care
Closes tax loopholes for real estate investors in order to disincentivize health care entities from selling their property and then paying exorbitant rents to these investors
Here is a link to the bill so you and your staff can examine it, https://www.congress.gov/bill/118th-congress/senate-bill/4804.
Thank you in advance for protecting patients.”
Actions - Justice & Equal Rights
These are all easy mostly one click after entering your name and address. Make sure to uncheck the boxes when you click edit subscription preferences if you don’t want to be contacted further.
RESOURCES
Find My Elected Officials
Contact State and Federal Representatives - phone and email
Healthcare Advocacy (Us) Website
Our Newsletter resources including reproductive healthcare - Healthcare Advocacy Reading List
Important Healthcare Resources
League of Women Voters Healthcare Reform Toolkit
Organizations to Contact
National Nurses United Medicare4All
Physicians for a National Health Program
One Payer States
Healthcare Now
Reproductive Health
NARAL - Pro Choice America
Charley. chatbot abortion resource - make sure to use a secure incognito browser if you live in a state that has banned abortion
Planned Parenthood
Miscarriage and Abortion Hotline has references about where to procure abortion medications. They also assist women in the process of self managed abortion or miscarriage by phone or text and will respond in an hour. Details and hours of operation at their website.
United State of Women Reproductive health page (bottom of the page) has important resources such as medical support, access to Telehealth, prescriptions by mail, and legal support references.
Practice careful communications - The Digital Defense Fund has a number of tips to keep texts, calls, and internet use private. Here is their site.
If you need financial help with an abortion try abortionfunds.org
Claims Denials and Appeals & What to Do
Appeal a Healthcare Decision
Appeal/Negotiate a Hospital Bill
Disinformation Management
Cybersecurity Infrastructure Security Agency
Save Democracy
Chop Wood, Carry Water by Jessica Cravens
RESISTBOT
Link to the RESISTBOT site to learn more
Link to Chop Wood, Carry Water RESISTBOT write up
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