A recent article in Emergency Physicians Monthly, "The Joy and Wonders of Prescription Drug Abuse", found here; http://www.epmonthly.com/features/current-features/the-joy-and-wonder-of-prescription-drug-abuse-/ is an interesting look into the world we as emergency Physicians interact with daily. Fascinating descriptions of the lengths narcotic seeking patients can go to. I really enjoyed the article until the last few paragraphs which read
"One day later, Hannah A’s leg has been surgically repaired and she is receiving excellent, high quality American health care services at a Top 100 hospital. The doctors and hospital, of course, will never receive any compensation for their efforts and costs. This excellent care is guaranteed to all Americans at no cost to them (but enormous cost to doctors, hospitals, and other paying patients) compliments of EMTALA.
At least four people – Ann L. and her husband, Hannah A., and Ashley M. – will be charged and arrested. If one more person is found to be involved then this becomes a Federal case with even more severe consequences to the criminals and even more cost to society.
This is a sad but true story of prescription drug abuse unintentionally enabled by the U.S. Medicaid program. This broken system fosters extreme fragmentation in health care delivery and sticks doctors and hospitals with the costs and liabilities of providing care without hope of remuneration.
We can and should do better. "
In this conclusion to the article, the author's tone turns decidedly more bitter. He is no longer just telling a fun, entertaining, and educational story. He is railing against what he sees as the problems in our society. While the things he said may well be true, they are not helpful here, and they represent a foul attitude of a few that does not need to be fomented and spread amongst the medical community. Does not need to be encouraged as acceptable thought, particularly not for an emergency physician. We (theoretically) do what we do as emergency physicians because we (largely) believe in access to care for all in their time of need, no questions asked. We already practice universal health care, and this is how it should be. EMTALA is the best thing that ever happened to emergency medicine. Even if you dont agree with the social and economic implications of the law, it has been responsible for the exponential growth of our field, and the high demand and high salaries we all enjoy. Should Hannah A with her tib fib fracture have received sub par care because she is a drug addict and a criminal? The author seems to suggest so. She didn't deserve excellent care at his "top 100" hospital. While I grow tired of dealing with the drug seekers, the crime in my city, and the drug related deaths the community has to contend with, I would caution against this kind of thought. It is dangerous, and there is no room for it in the emergency department