Searcy Hospital Responds to Patient Complaint of ER Deposit Policy

SEARCY, AR - A Central Arkansas hospital criticized by a patient for requiring a deposit to be treated in the Emergency Room explains its policy and says the situation isn't how it might seem. 

The patient

Richard Seese has experienced chronic back pain since he was 17, when an accident on a trampoline left him seriously injured. Now, about 14 years later a walk across the lawn can be a painful excursion. 

"Monday was my first ER visit to them," he said of visiting Unity Health's hospital in Searcy, otherwise known as White County Medical Center. "He [the ER physician} gave me a shot of Demerol for my pain and pain medicine. He said it seemed like it was a slipped disc and told me to follow up with my doctor," Seese said. 

According to Seese, he did follow up with his doctor, but was unable to schedule an appointment until the following week. But Seese said by Thursday his condition worsened, and he called his physician. 

"I told them I was having loss of control of my bowels, the sharp shooting pains and my legs, I couldn't feel them," he said. "They told me if the symptoms didn't subside after applying ice packs and over the counter treatment to go to the ER." 

Four hours later at around 10 p.m., Seese said the pain was only growing worse, and he went back to the Emergency Room.

"They took my vitals and asked me what was going on," he said. "I explained and told them my doctor told me to come back to the ER."

According to Seese, he was told he would need to provide a $200 deposit to receive care at the ER, because a physician had determined his condition was non-emergent. 

"Not everybody just has $200 to pull out of their pocket," he said. "So, we drove around trying to find an Urgent Care clinic that was open. All I could think was that I might end up really hurt or paralyzed if I didn't get care soon." 

But according to Seese, no urgent care facilities were open, and he returned to the ER to ask for documentation of the policy. The hospital staff, he said, provided a letter explaining the deposit requirement that also included a list of clinics available in the area. 

"But none of those are open that late. If it's 10 o'clock at night and I don't have $200, what am I supposed to do?" Seese asked. 

Seese posted an online article about his perspectives on the experience, which generated comments both for and against the hospital in question.

The hospital

We reached out to Unity Health, and while staff were not available for an on-camera interview on Monday, they did provide a written statement. The hospital is barred from speaking on specifics of any patient's case by law, but alluded that there might be more to the story. 

"Unfortunately, the statements made by this patient concerning his treatment are entirely false.  However, due to the Federal HIPPA privacy regulations, we are prohibited from discussing any patient’s treatment or condition," the statement says.

The statement went on to say: 

Unity Health provides a Medical Screening Examination to every patient that presents to our Emergency Department, and appropriate treatment is provided based upon the patient’s condition.  We also attempt to educate our patients concerning the importance of follow-up visits with their primary care physician.  We are very fortunate in Searcy to have at least four Urgent Care facilities that are available to handle non-emergent medical conditions if it is not possible to obtain an appointment with a primary care physician.  

Unity Health, as well as other providers, are also attempting to educate our patients and the public about when they should seek care from an Emergency Department, such as in the case of chest pain, broken bones, gun or knife wounds, bad burns, etc.  These life-threatening conditions are more appropriately treated in the Emergency Room setting.
In this case, we followed our standard procedure and treated this patient just as we do all patients that present to our Emergency Department. 

In a follow-up conversation with LaDonna Johnston, Vice President of Patient Care Services, she explained that the policy had been created after Medicaid requested hospitals encourage patients to only seek care in emergency rooms when an actual emergency was occurring. The hospital then expanded that to all patients because insurance providers were also asking for patients to be encouraged to start with primary care. 

Johnston said the policy was based on research, policies that have been used by other local hospitals and those in place across the country. According to Johnston, the policy is not about denying treatment to patients, but providing appropriate treatment and education to patients about what is in their financial and health interests.

According to Johnston, the deposit is paid and if the insurance company or Medicaid covers the treatment, then it is refunded to the patient or applied to any unmet deductibles. 

The state's perspective

Emergency rooms are one of the largest sources of uncompensated care for hospitals, and Kate Luck with the Arkansas Department of Human Services confirmed that Centers for Medicaid and Medicare Services has encouraged patients to be educated on when to use the emergency room and when to seek out primary care treatment. 

However, Luck noted that did not require or encourage hospitals to implement a fee if a non-emergent patient sought care at an emergency room. The Department of Human Services would describe the deposit as a hospital fee, and once a medical screening had determine the condition was not emergent, then Medicaid would not cover that $200. 

"I can understand from a  hospital's perspective not wanting to create more debt and wanting people who have emergencies to be taken care of," Seese said. "But I've read so many comments from people since I published this blog that seem like real emergencies. It just seems like there's a flaw here where people are falling through the cracks."

According to Johnston, the medical screening is conducted by a nurse and follows standard criteria for determining a patient's condition. That information is shared with the ER physician and a decision is made based on the patient's known care history and current condition. 

According to Johnston, a non-emergent determination doesn't indicate that a medical condition may not exist, but that the Emergency staff may not be able to provide treatment that could immediately eliminate a person's condition.

The Arkansas Department of Health pointed to the Emergency Medical Treatment and Active Labor Act as one of the key components of emergency treatment regulation. The federal law requires that all patients presenting to the emergency room be provided a medical screening and treated if an emergency exists, without regard to if a patient can pay or not. 

The law , which you can read here,  defines a medical emergency condition as: 

(1) The term “emergency medical condition” means-
(A) a medical condition manifesting itself by acute symptoms of sufficient severity (including severe pain) such that the absence of immediate medical attention could reasonably be expected to result in-
(i) placing the health of the individual (or, with respect to a pregnant woman, the health of the woman or her unborn child) in serious jeopardy,
(ii) serious impairment to bodily functions, or
(iii) serious dysfunction of any bodily organ or part; or
(B) with respect to a pregnant woman who is having contractions-
(i) that there is inadequate time to effect a safe transfer to another hospital before delivery, or
(ii) that transfer may pose a threat to the health or safety of the woman or the unborn child.

The Department of Health could not speculate on  whether the policy follows EMTALA without a formal complaint and investigation. 

To follow this story and all of Marci Manley's coverage, click here for Facebook or here for Twitter.

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