Politics: Just How Sick Are You? 

Chris Buttars has a bright idea for overburdened hospital ERs.

There is some irony in the fact that illiberal Sen. Chris Buttars, R-West Jordan, is pushing a bill that’s actually an argument for universal health care. Irony, because that’s not even close to what he has in mind.

Buttars, recently revered and reviled for his anti-gay remarks, has been seeking an otherwise benign little piece of legislation in the form of an Emergency Room Task Force. The idea would be to put $35,000 into a committee “to determine the appropriate use of hospital emergency rooms,” which are now patronized at great cost by a large swath of community.

“Emergency-room care is expensive because we give away a huge amount of health care for free,” says Dr. Douglas Nelson, a pediatric-emergency-care physician at Primary Children’s Medical Center. “We already have universal health care in this country—it’s called the ER, and we cannot and would not ethically turn anyone away.”

A few years ago, Buttars was absent for much of the legislative session due to a chronic illness, thus becoming an unwitting expert on emergency care. Of his time at Jordan Valley Medical Center’s ER, Buttars told his Senate colleagues, “As usual, the place was stuffed, and I noticed a lot of people who didn’t really appear to have an emergency.” Visit after visit, Buttars had become close to the hospital director, so he asked him about the situation. After querying three hospital administrators, he discovered that in an average of 125 emergency room visits daily, as much as 60 percent are non-emergencies. And he was righteously indignant about the amount of money being written off for so-called emergency care—up to $65,000 a day.

“That’s terrible,” he says. Still, he understands that there’s a federal law guaranteeing emergency care, and “I agree with it; you have to treat everyone who comes in.”

In 1986, Congress enacted what is euphemistically called the “Patient Anti-Dumping Law,” or the Emergency Medical Treatment and Active Labor Act. There was growing concern that the poor and uninsured were being systematically turned away from ERs because they couldn’t pay.

“The avowed purpose of EMTALA was not to guarantee that all patients are properly diagnosed—or even to ensure that they receive adequate care—but instead to provide an ‘adequate first response to a medical crisis’ for all patients and ‘send a clear signal to the hospital community … that all Americans, regardless of wealth or status, should know that a hospital will provide what services it can when they are truly in physical distress’,” reads Reynolds v. MaineGeneral Health, an EMTALA legal case from 2000.

But Buttars thinks there’s a way around this troublesome law. IHC, he says, “has a little of the answer in their Instant (sic) Cares.” His plan would be to build small clinics next to emergency rooms, which would “triage them over to the other facility.”

He’s even talked to a few of his friends. “A lot of you guys know people of wealth that give to the community,” he told the Senate. He, in fact, talked to two or three who said they’d be interested in helping fund such a clinic for, say, naming rights. “I think we could get the private sector to build most if not all of these clinics next to the hospital,” said Buttars.

Despite this elicited community good will, there is still the economy to consider—and the law.

“By the time someone comes into the ER and has a screening exam to find out how sick they are, we actually are not allowed to send them out of our health-care facility unless the required level of experience is not available,” says Nelson.

Buttars has been told his bill won’t make it this session, but it may go into study. As if there isn’t already volumes of research on the subject.

“I am not faulting him wanting to improve health care by decreasing costs,” says Nelson. “That is a worthy goal. It’s not the fact that people come to the ER or that it’s expensive—it’s because we are taking care of all the patients in the country that the American health-care system is not caring for.”

A Harvard Health Letter from the late ’90s noted studies that showed ER visits decreased in areas with abundant managed care. Managed care, InstaCares, universal care. Senator Buttars may be on to something.

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