Thursday, February 01, 2007
Emergency Medical Treatment and Active Labor Act
By Dr. Anthony Policastro

Many people use emergency rooms (ED's). Some arrive by ambulance. Some are brought by others. Some go themselves. ED's see all of these patients. There was a time when some ED's would ask patients about insurance before they signed them into the ED. Those that did not have insurance were often sent to charity hospitals without being appropriately evaluated. Some of the patients were so sick that they never made it to the other hospital. Because of situations like that, Congress passed a law to try and correct the problem. The title of the law was the Emergency Medical Treatment and Active Labor Act (EMTALA). It covered two groups of patients. One group involved those with emergency medical needs. The other involved women who were in active labor. There were several requirements of the law. One was that all patients that presented at the ED would be signed in and be evaluated. The second was that insurance information would not be asked about until after the patient had officially been signed in as an ED patient. The evaluation was called a "medical screening exam." What this meant was that all patients would have an examination that was complete enough to make sure that they did not have a serious medical condition. Patients with problems like chest pain and shortness of breath would get relatively complete examinations. Patients who presented with less serious problems only needed an exam consistent with their problems. Patients do not always understand this. A good example is the patient who presents to the ED with back pain. The purpose of the medical screening exam is just to make sure that a serious acute cause of back pain is not present. If that is not the case, the patient can be sent home with pain medication. However, patients often will want to know why they do not get a CT scan or an MRI scan of their back while in the ED. Actually, those tests are for longer term causes of back pain like a slipped disk. They are not needed on an emergency basis. For that reason, the test will need to be ordered at another time. Another area of confusion is specialty care. ED's have specialists available for consultation. However, they only need to consult that specialist if the specialist is needed for an emergency. For example, a patient with simple arm fracture only needs a splint. He/she does not need to see the orthopedic specialist. Another patient may have a compound fracture of his/her arm. In that case, the ED physician will ask the specialist to come and see the patient. All that is necessary is to make sure that the emergency condition is treated enough for the patient to be in a stable condition when he/she leaves the ED. Another point of confusion is related to follow up visits in physicians' offices after a patient is sent home. The EMTALA law only covers patients while they have an emergency medical condition. Once the patient is well enough to be discharged from the ED, the law no longer applies. For that reason when a patient goes for a follow up visit, the physician can ask about medical insurance before he/she sees the patient. If the patient does not have insurance, the physician can ask for cash payment before the visit. Some patients do not think this is fair. They feel that since the ED visit was covered under the insurance rules, the follow up visit should also be covered. That is not the case. Patients will always be seen when they go to an ED. The degree of evaluation and treatment associated with that visit will be based upon their symptoms and the results of the medical screening exam. Sometimes the expectation that patients have does not meet the amount of treatment that their symptoms would require.

Give Daffodils. Give Hope.
The American Cancer Society's Western Sussex Unit is sponsoring its annual Daffodil Days through February 22. The daffodil is the flower of hope and by supporting the American Cancer Society you give hope to those touched by cancer. The money raised through Daffodil Days funds programs and research grants that make an incredible difference in many lives. Daffodils are offered for a donation of $10 a bunch of 10 cut flowers or $10 for a single pot of bulbs. For the second year, the American Cancer Society is offering a "Bear and a Bunch," which is an adorable Boyd's Bear plus one bunch (10 stems) of cut daffodils for $25 (limited number available). Daffodils will be delivered and/or available for pickup at Cedar Avenue Medical Associates, 1 Cedar Ave., Seaford, between Tuesday, March 13, and Friday, March 16. Call Mary Catherine Hopkins at 875-7308 or the American Cancer Society at 1-800-937-9696 for more information.

Nanticoke to hold annual cholesterol screening
Nanticoke Memorial Hospital will be offering cholesterol screenings on February 14, 17 and 21, from 7:30 to 10 a.m. at the Nanticoke Stein Highway building, located in the former PK complex, next to County Bank. The Lipid Profile test requires a 12-hour fasting and reads the HDL and LDL blood levels. Cost for the Lipid Profile is $15. No pre-registration is required. In addition to the cholesterol screening FREE blood pressure checks will be offered. Results from the cholesterol screening will be mailed approximately two weeks after the test is performed. For additional information, call 629-6611 extension 2404.

Delaware Healthy Living Expo planned
The Delaware Healthy Living Expo, featuring an array of speakers and workshops on issues of family, physical, spiritual, financial, emotional, and intellectual wellness, will be held at the Chase Center on the Riverfront in Wilmington on March 10 from 10 a.m. to 4 p.m. Headlining the workshop programs will be Lisa Whaley, founder and president of Life Work Synergy, LLC. Whaley, who is also an accomplished author, will present "Finding the Off Switch in an Always On World" to give insight to attendees on finding a harmonious balance between work and life. Four additional speakers will follow addressing healing, self-sabotage, positive attitudes, and exercise. The day also features several exhibitors, providing attendees with products, services and knowledge which support health, harmony and spiritual awareness and enhance overall quality of life issues. Admission to the Expo is $7. A special luncheon package is also available for $17. You may preregister online at For more information, visit or call 215-968-4593.