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I’m sure that whether it was an EMTALA violation is a small concern here (although it almost certainly was an infraction). The Emergency Medical Treatment and Labor Act requires that emergency rooms provide stabilizing treatment regardless of ability to pay to anybody that shows up for care, or face a $10,000 fine for each infraction. If a hospital made a general practice of violating EMTALA, it could easily bankrupt that hospital in fines. Most hospitals have EMTALA monitors to ensure that that line isn’t crossed and most ER Docs and staff have tons of EMTALA training.

On the one hand, what’s a 10K fine when you consider the economic losses at Presby?

There is the possible PR harm of turning the patient away, as evidenced by this article. Again, whatever PR economic hit involved, an EMTALA fine is the least of concerns.

My guess is they purposely weighed the economic harm of admitting the patient verses turning them away and decided that it was in their best interest to turn the patient away. EMTALA probably factored little into the equation because the other competing interests carry such a larger financial hit.

EMTALA is designed to curtail general practices with a fine for each potential violation. When any ONE patient can cause such a huge disruption to operations, that fine is paltry by comparison.

Even if you look at the ethics of it, it’s not so cut and dried as you would think on first glance. It’s not like the patient isn’t going to be treated somewhere, and EBOLA isn’t like a heart attack where minutes make a difference (time is muscle, as we say).

No. Obviously somebody is going to treat that patient, even if they ended up at Bethesda a few hours later. This hospital did have the advantage of having a major “Ebola hospital” within decent reach.

So, the hospital is considering a few hour delay in the treatment of an illness that takes place over days versus huge potential economic losses of admitting that patient. Remember that Duncan will likely cost Presby more than $1 Billion dollars in economic harm before it’s done.

It may sound tacky or morally wrong for the hospital to risk a small PR hit (the current article) to avoid a much larger hit (A potential Presby-level event), but there you go.

1. It’s not black and white, and more and more institutions will be forced to come to terms with the same decisions if Ebola continues to be a problem.

2. EMTALA is the least concern here.

3. A hospital is a business. Yes, the business is saving lives, but it’s not a suicide pact. Considering that Ebola has shown itself to be a hospital killer as well as a human killer, it’s not unreasonable for the hospital to engage in self-preservation.

4. I’m not saying this is right, there are large moral issues here. I’m just saying that it’s not so cut and dried. More important, I’m saying that if the disease takes any kind of hold here, expect more and more hospitals to make similar decisions. EMTALA is a minor player here.