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The laws that require treatment are EMTALA - emergency medical treatment and active labor act. Patients are not to be transferred until they are stabilized, and not during active labor. Most states have county hospitals that treat those on Medicaid or without coverage. That woould be Cook County Hosp. in Chicago.

As for busing sick patients - many ER patients are not that sick and can stand the travel. They might have bronchitis. They might have a UTI. They sprained a wrist, or have a laceration needing a few stitches.

Some people don’t need professional treatment - buy your feverish kid some Tylenol; buy your own pregnancy test. It’s not an emergency.

Some people don’t have a doctor; some people can’t get an early appointment; some people don’t know any better.

I’m a volunteer EMT. I’d guess roughly, a third of our patients don’t need the ER - they could call their doctor in the morning or even self-treat. Maybe a third need the ER but don’t need an ambulance ride there. Most of the rest decide to decline transport or assistance. And a few, maybe 10%, really need to go in the ambulance.

The local ER has a Fast Track for minor ailments.
The U of C hospital is setting up local “Fast Tracks” and trying to train people to use them. Nothing wrong with that.

I’m sure they don’t want to get rid of all poor patients. One reason major teaching hospitals are located in inner cities is because of all the tremendous learning opportunities presented by the pathologies and traumas of the urban poor. They just want to send the sniffle cases to the neighborhood clinics.

Proper triage will free up resources for the people who really need them. I've tried to help refugee mothers tell the difference between run of the mill stomach upset/fever and something serious. But coming from zero education and the bush, they take their kids into the emergency room for everyday bouts of illness that can be handled at home. At least this particular group doesn't practice folk medicine like burning coins to chase out the demons of fever. However, after an 18 month old boy was scalded on his chest and stomach with boiling water, raising blisters the size of a half dollar, the older woman told the boy's mom to put salt on it. I had instructed them by phone to put nothing but cold water on it. She said that he cried a lot when they put the salt on it. No kidding. I guess it really hurt on the skin where the blisters had popped. The doctor at the emergency room told me that he had seen someone smear toothpaste all over a child burn victim.

Gotcha ... I’ve heard the stories as my son is an ER doc. But my question is, as spelled out below, if a teaching hospital has a reputation for specialty diseases/procedures, can they arbitrarily turn away critically ill patients who don’t fall under their specific specialities?

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“In the past, we opened our doors and saw whoever came,” Whitaker said Friday. “We would see a patient who had general pneumonia, and if we needed to see a patient who needed a liver transplant, that liver transplant patient couldn’t get in the door.”

And rather than dump patients on other health care facilities, Whitaker said the initiative actually is improving their bottom lines.

“We were taking general patients away from Mercy Hospital, Michael Reese, and they were financially at risk,” Whitaker said. “We harmed other hospitals without knowing we harmed other hospitals.”

At the same time, the Urban Health Initiative is improving the university’s finances. Fewer poor patients are showing up at the U. of C. emergency room for basic medical treatment and are no longer admitted to the hospital. That frees beds for transplants, cancer care and other more-profitable medical procedures that the university prides itself on.”

http://www.suntimes.com/news/politics/obama/1122691,CST-NWS-hosp23.article

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So, I’m taking it that the above seems to be a sensible arrangement? Having been in ER’s several times myself, they obviously take the sickest first, so the docs explanation above doesn’t really sound logical. It does seem that the receiving hospitals could be thrust into financial and staff crisis as a result of this arrangement.