Nope, private hospitals are not the answer. In most states, a licensed health care facility (accepting MA/MC or not), must go through a “certificate of need” procedure in order to get a permit for the purchase of large new equipment (e.g., CT, MRI) / construction of facilities. The states have effectively used CONs to force facilities into accepting MA/MC in order to gain approval.

I agree, pain alone is not the problem. But my screening has to be the same for every patient with a similar complaint. Now chest pain and abdominal pain together provide a majority of my patients. Each requires extensive work up to derive the etiology. I can not transfer that patient until stabilized (thus, pain-free). Solely pain? No. Pain as the symptom of a problem? Must be “stabilized”.

You are also right about this “severe pain” debate. Pain is not an emergency medical condition. It may be a symptom of an EMC, that would require stabilization before transfer or discharge, but I have never seen a case that revolved around a patient’s self-established pain threshold. And I have looked at a lot of EMTALA cases.

First, “pain” alone is not an emergency condition requiring stabilization under EMTALA, because it is not a condition “such that the absence of immediate medical attention could reasonably be expected to result in … placing the health of the individual … in serious jeopardy, serious impairment to bodily functions, or serious dysfunction of any bodily organ or part …” Again, I know of no cases in which somebody’s “pain goal” was considered an emergency medical condition requiring stabilization, and you haven’t referenced any.

Second, you didn’t read your own quote. The very last case cited held “that providing a screening examination, even if it is negligent under state-created malpractice law, is sufficient to provide full compliance with EMTALA, and that only disparate treatment in the screening process would support a claim,” which is an even harsher rule than the one I stated. Under that rule, absolutely no one can recover under EMTALA unless they can show deliberate disparate treatment due to their ability to pay.

Moreover, those cases are all over 10 years old. I can’t speak for every district and circuit, but, in the ones I know of, EMTALA case law has become even more anti-patient over time.

http://www.npr.org/templates/story/story.php?storyId=112818960

According to the above story, a poll of physicians found “nearly three-quarters of physicians supported some form of a public option, either alone or in combination with private insurance options,”