I know a little bit about ERs in general,and Boston ERs in particular,because I worked in the ER of one of Boston's largest hospitals for over 20 years.
To be certified as a general hospital under Medicare and Medicaid regulations, hospitals must have Emergency Departments. There are specialty licenses categories that don't require E.D.'s, but few general hospitals meet those requirements.
Romney opposes the the requirement to dispense the pills, but has been advised he has no authority to over ride this.