To ER or Not to ER

When I was in high school, my mom made one of many trips to the emergency room (ER) with a blocked intestine due to Crohn’s Disease. This visit was particularly memorable because her doctor was out of town and the ER staff was inexperienced in what was then a fairly new treatment – total parenteral nutrition. They inserted the line into her vein in the wrong direction. Let’s just say it was painful and unpleasant.

When her doctor returned, he told her that if she ever had to go to the ER while he was away again, she could tell them how to treat her and they would be legally obligated to do that. I have often wondered how that would work since it is only lately that providers have started really including patients in treatment discussions. (Let’s face it, ER doctors in the mid-1990s would have not taken patient instructions well. Even now it would be . . . unwelcome.) I’ve researched the doctor’s advice from time to time, but could never find a legal authority a process like that would fall under. It took a combination of laws and a discussion with a friend to figure out how it would work.



The first part of this process is a bit of history, unless you are one of the 15% of chronic and autoimmune patients that still don’t have health insurance. For that 15% and the insecurity of the future of healthcare at this moment, I’d like to introduce you to the Emergency Medical Treatment and Labor Act (EMTALA), which bars hospitals from turning patients away if they can’t pay. (Keep in mind that this story takes place in the 1990s, when uninsured rates were much higher.)

Back then, and even now without insurance, ERs are not obligated to treat us unless we are about to die. It’s a common misconception that EMTALA says that all you have to do is get to an emergency room and they will fix you up. First, EMTALA only applies to hospitals that participate in Medicare. Second, the emergency room is only obligated to screen you for an immediately life-threatening condition and stabilize you.

That being said, EMTALA still has some juice if you are experiencing an emergency. Pair it with the next law, and you should be able to get what you need.

The Doctrine of Informed Consent

If you do decide that the ER is the best way to go, arm yourself with knowledge of the doctrine of informed consent. Basically, it means that, as long as you are mentally competent, you can refuse any treatment the emergency room proposes.

In my mom’s case, that means that if the ER doctor was not inclined to treat her the way she wanted (I believe a blocked intestine qualifies as a immediately life-threatening condition), she could keep refusing until they arrived at the right treatment for her. Or at least they were prohibited from subjecting her to a treatment she didn’t want.

There are definitely times when the ER is your only option for a chronic or autoimmune condition in crisis (i.e. the “cardiac incident” I had once because I messed up on my own medication and almost stopped breathing at work, but that’s a story for another day.) But in my experience, rushing, overworked staffs that have to literally work miracles with what they have, are an option of last resort, to be avoided unless a call to your provider (or whoever’s on call) results in an inadequate or unsuccessful course of treatment.

If you have to go, keep in mind that you are not entirely at the mercy of providers you don’t know. It’s hard to speak up for yourself in a situation so bad that it requires an ER visit, but you know what’s best for you and you have a right to receive the care you know you need.

P.S. Informed consent applies to all care – surgery, therapy, treatments prescribed by your provider in his or her office. If you don’t like the direction in which your care is going, you can always say no and discuss an alternative.

*(no, you didn’t miss a character in the Lion King.)