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Emergency Medical Care in Puerto Rico a Disaster But Federal Law Provides Relief

There has been a lot of talk in Puerto Rico lately about Federal Law and how it should be applied in Puerto Rico. Overlooked in the controversy are many Federal Laws that have undisputed beneficial effect on the Puerto Rican citizenry. One such law is EMTALA–the Emergency Medical Treatment and Active Labor Act. EMTALA was originally enacted in 1986 as part of Congress’ comprehensive Consolidated Omnibus Budget Reconciliation Act, or COBRA. Congress enacted EMTALA in response to mounting reports that federally funded hospitals were turning away patients who were potentially unable to pay for necessary medical services. But EMTALA’s sweeping breadth has led it to become much more than a guarantee of necessary medical services for the impoverished. EMTALA serves as a standard, ensuring that all patients, regardless of monetary standing, receive certain basic medical attentions when they present themselves to a federally funded hospital’s emergency room.

Sadly, although there is no question of EMTALA’s application in Puerto Rico, many of Puerto Rico’s hospitals fail to comply with the statute’s basic strictures. EMTALA applies to any hospital that receives federal funding (and most do) and operates an emergency room or emergency ward. EMTALA requires that the hospital must provide a meaningful medical screening to anyone who presents him or herself to the hospital and on whose behalf a request for a medical examination is made. In other words, a hospital that receives federal funding cannot deny an individual a medical screening!

If the screening reveals that the individual is suffering from an emergency medical condition, the hospital must provide necessary stabilizing treatment. The hospital must utilize all the services available to it, including ancillary services, in an effort to both screen and stabilize patients–regardless if the patient can pay for the services or not. A hospital may not transfer a patient to another hospital unless the patient requests a transfer or unless the transfer meets certain minimum requirements: 1. the transferring hospital must provide all available services to minimize the risks to the patient’s health; 2. the receiving hospital must have space and qualified individuals to the treat the patient, and must agree to accept the patient; 3. the transferring hospital must forward all of the patient’s records to the receiving hospital, and 4. the transfer must be made by qualified medical personnel.

Although EMTALA’s requirements could not be clearer, many hospitals in Puerto Rico, and indeed throughout the states, continue to violate the statute. Since EMTALA’s enaction, Auxilio Mutuo Hospital, San Francisco Hospital, Mennonite General Hospital and Hospital Hermanos Melendez, among others in Puerto Rico, have all been defendants in EMTALA litigations. Hospital San Francisco lost a jury verdict for $700,000 in a case in which the hospital failed to treat a patient complaining of chest pains and the patient died. Finding that the hospital had violated the federal statute, The First Circuit Court of Appeals upheld the jury’s verdict and award of damages.

And everyday the interpretations of EMTALA are growing broader. Many of the important EMTALA cases originate right here in Puerto Rico. In a landmark decision, the First Circuit Court of Appeals held that the transfer provisions of EMTALA do not apply only to patients who entered the hospital through the emergency room. In Lopez-Soto v. Hawayek, the Circuit Court determined that a family in Puerto Rico could sue under EMTALA when a hospital transferred the couple’s baby from the hospital in which the baby was born to another hospital–even though the baby was not born in the emergency room. The First Circuit determined that the right to sue arises whenever a hospital patient is found to have an emergency medical condition, regardless of how the patient entered the hospital.

The bottom line is that hospitals in Puerto Rico have the services and staff to provide excellent medical treatment, but the sad fact remains that due to poor administration and inadequate coordination of emergency medical services, many patients in Puerto Rico are denied necessary emergency medical attention. EMTALA is a Federal Law designed to protect against emergency medical deprivations. Simple compliance with EMTALA would save uncounted lives in Puerto Rico each year. It is not that the services do not exist in Puerto Rico. It is simply that the services are not administered effectively. And EMTALA should set the minimum standard for emergency medical care.

Whether we like it or not, today Federal Laws apply equally in Puerto Rico. We should take advantage of the good ones.