Physicians and Hospitals Join Lawsuit Against ER Visit Limit

Oct 17, 2011, 14:30 ET from Washington State Medical Association

Policy Threatens Health and Safety of Vulnerable Patients

SEATTLE, Oct. 17, 2011 /PRNewswire-USNewswire/ -- The Washington State Medical Association and the Washington State Hospital Association are joining the Washington Chapter of the American College of Emergency Physicians' lawsuit against a state plan to limit emergency room access for some of the state's most vulnerable residents. The two organizations will be named as co-plaintiffs in the lawsuit filed on September 30, 2011, and will provide financial resources for the litigation.

The new state plan limits payment for Medicaid patients to three "non-emergency" visits to emergency departments each year. More than 700 diagnoses are classified as "non-emergent," including many truly emergent conditions such as chest pain, abdominal pain, miscarriage and breathing problems. Medicaid provides insurance coverage to many of our most vulnerable residents – pregnant women, infants, children, people with disabilities, and people living with mental illnesses.

"Limiting access to care during an emergency or expecting patients to self diagnosis is a dangerous precedent," said Douglas R. Myers, M.D., President of the Washington State Medical Association. "Patients who may be seriously ill or facing a life threatening situation may forego necessary medical care with disastrous consequences. We simply cannot sacrifice patient safety for the state's erroneously-classified 'non-emergency' list."

The basis for the suit includes:

  • The list of so-called "non-emergencies" contains many emergent conditions, in direct contradiction to the legislative direction that it be a list of non-emergent diagnoses.
  • The state is violating the federal "prudent layperson" standard, a nationally-recognized guideline for determining the need to visit an emergency room using the average knowledge of health and medicine of a prudent layperson.
  • The state has misinformed patients and providers about the ability to bill patients for services. Federal Emergency Medical Treatment and Active Labor Act (EMTALA) and state charity care laws prohibit patient billing.
  • The rulemaking process is inadequate.

"We must reduce unnecessary emergency room visits, but this proposal goes too far. The need to balance the state budget is creating bad policy and bad medicine. Washington's hospitals are joining our physician colleagues in standing up for our state's most vulnerable patients," said Scott Bond, president of the Washington State Hospital Association.

The Washington State Medical Association represents over 9,800 physicians, surgeons and physician assistants throughout Washington state. The vision of the association is to make Washington the best place to practice medicine and to receive care. Patient- focused and physician driven, the WSMA works to help physicians deliver complete care patients can trust.

The Washington State Hospital Association represents all of Washington's 98 community hospitals. The association takes a major leadership role in issues that affect delivery, quality, accessibility, affordability, and continuity of health care. It works to serve its members, increase access to health care, and improve health care quality.

SOURCE Washington State Medical Association