Many of the medical billing nightmares in the United States originate in the Emergency Room because of bad law, hospital abuse of the law, and patient lack of knowledge of the law.

The law  is known as the Emergency Medical Treatment and Active Labor Act (usually abbreviated EMTALA and usually pronounced “Em-Tal-A”).

EMTALA is the law that requires a hospital emergency room to treat anyone that presents them self regardless of their ability to pay. It is very well-intentioned law that is designed to prevent discrimination on the basis of economic status. Though the law only says that a hospital must treat you until you are “stable,” it has been interpreted by the Federal Government to imply they must treat everyone, regardless of the situation. So, if you go in complaining of a sore throat, they’re not going to send you to the urgent care down the street. They are going to treat you like you are having an emergency; and what should have been a $100 visit to Urgent Care may cost you thousands of dollars.

EMTALA was intended to prevent discrimination and to ensure people in dire straits receive the emergency care they need. However, it has many unintended consequences and, like many laws, has been exploited by hospitals for profit. While on the one hand, this requirement to treat anyone, whether they are suffering a real emergency or not, imposes a burden on hospitals because many people never pay their bills, hospitals have, in turn used this law to justify outrageous billing practices. They like to talk about the problem of non-payment, but never their own profit motives. Both the Federal Government and the Hospitals are complicit in creating the problems we patients suffer, so it is up to us to protect ourselves until they fix it. We, too, are entitled to use the law to our advantage.

When you present yourself at a hospital emergency room, they have to obtain your consent to be treated, which is only reasonable. However, that’s all they need, because beyond that, EMTALA takes care of the rest. They must treat you. So, when you are presented with a contract to sign—one that often includes much more than your consent, you do not have to sign it. They must treat you.

It is very unfortunate, but a number of courts have ruled that the contract you sign in the emergency room is binding, so beware. Many attorneys disagree with the courts, and while I am not an attorney, I vehemently disagree with the courts, too. People are in no position to review a contract in an emergency room.

It is most likely that the hospital’s contract was carefully crafted by a team of lawyers to favor the hospital. For a lay person who is not familiar with contract law, and who is not feeling 100% (or they wouldn’t be at the ER), it is very unfair. Fortunately, EMTALA means we do not have to sign anything the hospital gives us in order to be treated. Thus, the best way to protect yourself is to refuse to sign any paperwork provided by the hospital. The government could have fixed this problem a long time ago by providing a contract that is designed to protect patients (consumers), and not just the hospital—one that is the same in every hospital, all the time. But it has not done that. Maybe this will prompt them to.

The Broken Healthcare Emergency Room Contract  is designed to be an aide—to provide you with the confidence to explain your refusal to sign the hospital’s contract. It is not required for you to decline to sign anything, it just makes it easier. If you prefer, you can take a blank piece of paper and write, “I hereby consent to treatment,” sign and date the piece of paper, and refuse to sign anything else.