In 1986 congress enacted the Emergency Medical Treatment and Active Labor Act (EMTALA) as a result of clients being transferred from private hospitals to public hospitals without appropriate screening and stabilization (Potter & Perry, 2009). This act states that most hospitals must provide an examination and needed stabilizing treatment, without consideration of insurance coverage or ability to pay, when a patient presents to an emergency room for attention to an emergency medical condition (www. emtala. com).
This act can be applied to nursing in that most patients who enter an emergency department are often triaged by a nurse first. It is that nurse’s obligation to provide a basic assessment and notify a physician if the patient needs to be treated immediately or not. Another example of this is perinatal nursing. The perinatal nurse plays a key role in obstetrical triage and discharge; in some hospitals nurses conduct medical screening examinations in the absence of direct evaluation by a physician, consistent with federal regulations as per the Emergency Medical Treatment and Labor Act (EMTALA).
Mother and baby should be stable for discharge as per EMTALA criteria. A thorough evaluation to rule out labor and potential complications as well as to confirm maternal-fetal well-being is critical prior to discharge (The American Journal of Maternal/Child Nursing). Here is an example of EMTALA. A client comes to the emergency department of a private hospital after falling from a tree picking apples in the fields. He is transported via ambulance and arrives with an obviously broken leg.
The patient was transferred to this hospital because it was only ten minutes away from the accident scene. The triage nurse does a quick assessment on the patient on and determines that he needs to see orthopedics to have surgery on his leg. Upon getting the patients information, she realizes that this patient is an illegal immigrant and has no health insurance. She notifies the physician of this and they determine that a fractured leg is not serious enough to justify treatment immediately and decide to transfer the patient to the county hospital for treatment.
While the patient is on the thirty minute ambulance ride to the county hospital, he begins to complain of shortness of breath and has a pulse oximetry of 89%. His pulse was elevated at 120 beats per minute and respirations were at 28. The paramedic transporting the patient noticed the patient had decreased breath sounds on the right side. It became clear that the patient was suffering from rib fractures that may have punctured his lung. The patient arrived at the hospital in critical condition and required immediate surgery to repair the damage.
The triage nurse at the private hospital violated EMTALA by not doing a thorough examination of the patient to determine if he was stable enough to be transferred to the other facility. If she had done her basic physical assessment, she would have noticed the decreased breath sounds and could have treated the patient accordingly. I feel that this patient was treated unjustly. He arrived at a hospital and it was their obligation to treat him with respect and meet his needs despite his status and lack of insurance.
If I had been the triage nurse, I would have treated this patient no different than if he were the President of the United States. I would have been objective in making decisions regarding his care and would not have rushed him out of the hospital just because I knew he would not be able to afford care. I feel that all patients who live in the United States, whether legally or illegally should be treated ethically without regards to their cultural or financial background. According to the U. S.
Census Bureau, the rate of uninsured Americans had risen from nearly 32 million to 50. 7 million since 1987 (www. census. gov). I think that with the recession our country is currently in, these statistics are not going to turn around any time soon. So for this reason, I think that congress implementing this act has probably saved and will continue to save the lives of millions of patients. After all, in the end, I am now an uninsured nursing student and would hope that if I were to need emergency care, I would get the treatment I deserved despite my ability to pay.
REFERENCES Potter, P. A. , & Perry, A. G. (2009). Fundamentals of Nursing 7th Edition. St. Louis, Missouri, United State of America: MOSBY Elsevier MCN, The American Journal of Maternal/Child Nursing, Obstetrical Triage: Stable for Discharge, Issue: Volume 34(4), July/August 2009, p 268 DOI: 10. 1097/01. NMC. 0000357931. 30798. 74 www. emtala. com Number Uninsured and Uninsured Rate: 1987 to 2009. Retrieved from: http://www. census. gov/hhes/www/hlthins/data/incpovhlth/2009/fig07. pdf.