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While I was working in the Emergency Department, a young man was admitted following a motor vehicle accident in which he was ejected through the sun roof at near highway speed. This was in the mid 1980s, prior to the enactment of EMTALA laws. Now, patients can not be turned away for lack of insurance, however, they can easily be bankrupted. He had no insurance.He had slid on the road and his clothes simply shredded off him. His injuries were primarily on his hips, back, arms, and shoulders. He had at least three broken vertebrae. His skin had severe “road rash,” which meant there were pieces of gravel ground underneath all the damaged skin.Every bit of the foreign particles had to be removed or they would cause the appearance of bumpy tattoos all over. In addition, everything would become infected. The road rash also consists of areas of skin abraded away so as to need to be treated similar to a severe burn. If he had had insurance, he would have gone to the operating room, and be put under general anesthesia to treat such a huge area of his body.Instead, the ED doctor told me to get about 30 mg of morphine and keep injecting him intravenously as I tediously removed the gravel and dead skin with a scapel and tweezers.This guy on the Internet has about 25% of the road rash my patient sustained. Ouch.I don’t know how long I worked on him. It was hours, though. He cried and shuddered and screamed. I sweated through my scrubs until my shoes and socks were soaked.The whole time, I was aware that when I finished, he was going to be transported to his house by ambulance and left there, even though there was no one to care for him. With his fractured vertebrae, he could not get up. Who would feed him, clean him, give him medication, keep him from dying? He couldn’t even afford to buy his medication.I carefully removed over a cupful of gravel from his skin, one piece at a time with tweezers. As gently as possible, I scrubbed the abraded skin with betadine soap using an abrasive scrubber. Every two or three minutes, I injected more morphine and stopped until he could stand for me to continue.I used much more than 30 mg of morphine with the ED doctor’s blessing. The patient kept asking me what he could do because he knew there was no way he could take care of himself. I told him, “I don’t know,” then gave him even more morphine. I was starting to consider taking him home with me. I didn’t know how else I could live with myself. If he were a dog, I would have taken him. Here’s a human, being treated worse than a dog, for lack of insurance.It was like being in hell, for both of us—although probably more so for him.When I was finally starting to get to the point where it looked like maybe I would actually be done in another hour or so, the ED doctor came back. He announced that I could stop now because one of the surgeons had agreed to treat him for free and had somehow convinced administration to admit him to the hospital.The patient and I both burst into tears. Remember, we had been through hell together, and I still feel there was no shame for me to cry for him. I was so very relieved he would finally receive appropriate care.About this time, the benevolent surgeon dropped by. He said he was taking him to the OR to do a deeper debridement and finish what I had started. Then he pushed my patient’s stretcher to the elevator, himself.Now laws ( see below) prevent what was going to happen to this guy. If it happened today, he’d be taken care of, but ruined financially. We have just got to get our healthcare system resuscitated. I only hope it happens in my lifetime.Patient dumping violates the federal Emergency Medical Treatment and Active Labor Act (EMTALA). Enacted in 1986, EMTALA seeks to prevent any refusal of care for patients who are unable to pay [2]. It imposes three requirements on any Medicare-participating hospital and enforces monetary sanctions against physicians or hospitals that do not comply [3]. Participating hospitals must: (1) conduct medical-screening examinations, (2) provide necessary stabilizing treatment to any patient seeking emergency medical care in an emergency department, and (3) hospitals that are unable to do (1) and (2) may transfer the patient to a facility that can provide those services in a manner that accords with EMTALA guidelines [4].[1][1][1][1]Edit: correction of date of accident and addition of EMTALA information.Footnotes[1] Refusal of Emergency Care and Patient Dumping[1] Refusal of Emergency Care and Patient Dumping[1] Refusal of Emergency Care and Patient Dumping[1] Refusal of Emergency Care and Patient Dumping

These aren’t all myths so much as they are misconceptions or assumptions. But still, people outside of the United States believe these things, and they are not all true.Myth:We are all obsessed with guns - The majority of Americans, 68% (according to a 2020 Gallup Poll), do not own firearms. There are unfortunately way too many shootings, and these, of course, generate lots of discussions. The truth is that not every American owns a gun or has ever fired a gun.** This is the minority. At least he didn’t write “don’t” on the sign.If you don’t have healthcare insurance, you won’t be treated - The Emergency Medical Treatment and Labor Act (EMTALA) is a federal law that requires anyone coming to an emergency department to be stabilized and treated, regardless of their insurance status or ability to pay. Non-emergency treatment can be another matter.** Hospitals don’t want to get hit with EMTALA violations. It affects their federal funding.Racism is rampant here - I’m not saying it is non-existent. Anywhere you go on the planet, there is going to be some degree of racism, some much worse than in the US. It seems that every time you turn on the TV, there is a story about a racist incident. That doesn’t mean we are all like that. Most of us aren’t.English is the only language spoken here - Not the case. While English may still be the predominant language in the US, it’s certainly not the only one. Depending on where you go, you’ll find that many Americans are bilingual. One in five Americans speaks a language other than English when they are at home.** Vote sign in the US during the latest presidential primaryWe’re all super cheerful - Spend ten minutes with me on an average day, and you’ll quickly see that this myth is false. There are many over-the-top cheerful people here, but most of them tend to be servers and salespeople who stand to make money from you. If you choose not to buy or tip, the smiles and peppy attitude fade quickly.** They really like you, for you. Really.Every nation has negative stereotypes that verge on the ridiculous. For example, the French aren’t all cheese-eating surrender monkeys; not all Russians are alcoholics, Australians don’t all run around with Bowie knives and Paul Hogan hats.You get my drift. When it comes to a culture of millions of individuals, you have to spend some time there and judge for yourself.

They don’t have a recourse — or it’s the same one we had before Obamacare — EMTALA.EMTALA is the law that says an ER is legally obligated to triage and treat people who show up — “regardless of ability to pay.”This care, however, isn’t paid for by the government, so it shows up on the accounting books as a category called “uncompensated care.” Obamacare successfully reduced this amount — and as people lose coverage (and access to healthcare services) — we should naturally expect to see this number rise again.Hospitals who run the ER’s don’t actually lose this money, though, because they simply use the amount as an offset against real income — AND — they increase the amount they charge for services to the insurance carriers (who, in turn, raise premium rates to compensate).