You have a hacking cough and a pounding headache that’s getting worse by the minute. You checked your temperature and you are certain you have a fever. You make the decision to go the ER, only to be told to go back home and rest. Unfortunately, this scenario has been the topic of discussion in many headlines amid the coronavirus pandemic. Getting turned away from the hospital happens far too frequently and in worse cases, some are sent home to take their final breath. How can this be prevented? How can you be sure to get the care that you need when you go to the hospital?
Since 1986, you’ve had the right to receive treatment at a hospital, even if you don’t have insurance or can’t afford to pay. The Emergency Medical Treatment and Labor Act (EMTALA) was created to prevent hospitals from patient dumping, which is refusing to treat patients who do not have insurance or are unable to pay.
EMTALA applies to any hospital that has an emergency room and accepts payments from Medicare. Even if you are lying in the grass near the hospital entrance, the law requires that emergency treatment be provided to patients up to 250 yards from the hospital’s entrance.
A triage nurse will check your vital signs to access the severity of your condition and determine if you will be seen first or last by the doctor. Your vital signs include blood pressure, heart rate, temperature and blood oxygen levels. All vital signs are associated with a number or measurement. Knowing the numbers that constitute an emergency can make the difference in you being admitted or sent home.
When the triage nurse wraps your arm with the cuff, she is checking your blood pressure. An urgent crisis is a blood pressure reading of 180/110 and an emergency is a blood pressure 180/120 with other symptoms of like headache, back pain, visual changes, shortness of breath, and nausea. If your blood pressure reading is low (a reading of less than 90/60) and you have symptoms like confusion, dizziness, nausea, or fatigue, this can be cause for further evaluation and a hospital admission.
Heart rate will usually be screened at the same time your blood pressure is. This will detect if you have an arrythmia (abnormal heartbeat). An abnormal heart rate is above 100 beats per min (bpm) or less 60 bpm. This coupled with pre-existing conditions or other symptoms is an emergency.
A temperature of over 103 degrees Fahrenheit in an adult, along with other symptoms like a rash or vomiting, is an emergency. For children, a temperature of 102.2 is considered an emergency. If body temperatures fall below 95 degrees Fahrenheit, this is abnormally low and could warrant a medical emergency.
The nurse will clamp a pulse oximeter, usually on the tip of your finger, to measure your blood oxygen levels (SpO2). A reading of 95 percent is considered low and can be life-threatening if below 88 percent.
EMTALA states that you have the right to have a medical screening examination (MSE) when you present to the hospital with a complaint. I’m not talking about when the triage nurse, calls you into a small room and takes your vitals. The purpose of triage is to determine how severe your complaints are so that the nurse can decide if you will be the first or last person to be examined.
The MSE is specific to your complaints, signs, or symptoms. For example, if you went to the ER complaining of chest pains, an EKG would be a proper screening tool for a heart attack. If your complaint was excruciating back pain, an x-ray, MRI, or CT scan would be appropriate screening tools. Therefore, if you have complaints that require more than someone examining you with the naked eye, you have the right to request the proper screening if it is not offered to you.
After you’ve been screened and it’s been determined that you have an emergency medical condition (EMC), you will be treated in the emergency room. However, that does not mean you will be admitted into the hospital. The doctor may decide to discharge you or transfer you to a different hospital if they are not equipped to treat you.
I always say, “You are the only person that is with you 24/7.” With that being said, if you feel that something is “just not right” with your body then, it probably isn’t! Regardless of what the MSE does or does not reveal, you and your loved ones have a front row seat to what you are experiencing.
Giving a thorough history, written and verbal (doctors and nurses are busy and may not read every detail) is a powerful tool to help doctors decide if they should admit you. Be sure to paint a complete picture of what you are experiencing. If you have several pre-existing conditions, it is a good idea to keep a password protected copy of your health records or at least a copy of your medications.
Never be afraid to speak up about your concerns. If you are too ill to speak for yourself have someone come along with you or have the hospital to contact your doctor. Your doctor (primary or specialist) knows your health history and therefore, can make the call to have the hospital admit you upon arrival (direct admission). If you feel that a different hospital would be better at treating you, after you are stabilized, you can request to be transferred.
Knowing the law, your rights, your body, and how to advocate for yourself can be the difference between your life and death. If you are faced with a medical emergency, the law protects your right to be properly screened, regardless of your ability to pay. If you are treated and feel that have been discharged prematurely, you have the right to appeal. Always be prepared to stand up for your health – it’s the most important thing in your life!
Dr. Candace McMillon-Dantley is on a mission to inspire and educate women to health. She is the author of Woman, Take Off Your Cape!, a collection of stories that reflect the lives of real-women who put everything first, except themselves. She is the creator of The Doc Knows, a health and wellness site for women. Connect with Dr. Candace on Instagram @drcandace.
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