INDIVIDUAL RIGHTS AND THE HEALTHCARE SYSTEM The “global perspective” you just read was brief for two reasons. First, a full treatment of international and foreign health rights is well beyond the scope of this chapter, and second, historically speaking, international law has played a limited role in influencing this nation’s domestic legal principles. As one author commented, “Historically the United States has been uniquely averse to accepting international human rights standards and conforming national laws to meet them.”15(p1156) This fact is no less true in the area of health rights than in any other major area of law. As described earlier in this chapter, universal rights to health care are virtually nonexistent in the United States, even though this stance renders it almost solitary among industrialized nations of the world. This is not to say that this country has not contemplated health care as a universal, basic right. For instance, in 1952, a presidential commission stated that “access to the means for attainment and preservation of health is a basic human right.”16(p4) Medicaid and Medicare were the fruits of a nationwide debate about universal healthcare coverage. And during the 1960s and 1970s, the claim that health care was not a matter of privilege, but rather of right, was “so widely acknowledged as almost to be uncontroversial.”17(p389) Nor is it to say that certain populations do not enjoy healthcare rights beyond those of the general public. Prisoners and others under the control of state governments have a right to minimal health care,18 some state constitutions expressly recognize a right to health or healthcare benefits (for example, Montana includes an affirmative right to health in its constitution’s section on inalienable rights), and individuals covered by Medicaid have unique legal entitlements. Finally, it would be inaccurate in describing healthcare rights to only cover rights to obtain health care in the first instance, because many important healthcare rights attach to individuals once they manage to gain access to needed healthcare services. The remainder of this section describes more fully the various types of individual rights associated with the healthcare system. We categorize these rights as follows: · 1. Rights related to receiving services explicitly provided under healthcare, health financing, or health insurance laws; for example, the Examination and Treatment for Emergency Medical Conditions and Women in Labor Act, Medicaid, and the Affordable Care Act. · 2. Rights concerning freedom of choice and freedom from government interference when making healthcare decisions; for example, choosing to have an abortion. · 3. The right to be free from unlawful discrimination when accessing or receiving health care; for example, Title VI of the federal Civil Rights Act of 1964, which prohibits discrimination on the basis of race, color, or national origin by entities that receive federal funding.12(p12),19 Right.

1. INDIVIDUAL RIGHTS AND THE HEALTHCARE SYSTEM
The “global perspective” you just read was brief for two
reasons. First, a full treatment of international and foreign
health rights is well beyond the scope of this chapter, and
second, historically speaking, international law has played a
limited role in influencing this nation’s domestic legal
principles. As one author commented, “Historically the United
States has been uniquely averse to accepting international
human rights standards and conforming national laws to meet
them.”15(p1156) This fact is no less true in the area of health
rights than in any other major area of law. As described earlier
in this chapter, universal rights to health care are virtually
nonexistent in the United States, even though this stance
renders it almost solitary among industrialized nations of the
world.
This is not to say that this country has not contemplated health
care as a universal, basic right. For instance, in 1952, a
presidential commission stated that “access to the means for
attainment and preservation of health is a basic human
right.”16(p4) Medicaid and Medicare were the fruits of a
nationwide debate about universal healthcare coverage. And
during the 1960s and 1970s, the claim that health care was not a
matter of privilege, but rather of right, was “so widely
acknowledged as almost to be uncontroversial.”17(p389) Nor is
it to say that certain populations do not enjoy healthcare rights
beyond those of the general public. Prisoners and others under
the control of state governments have a right to minimal health
care,18 some state constitutions expressly recognize a right to
health or healthcare benefits (for example, Montana includes an
affirmative right to health in its constitution’s section on
inalienable rights), and individuals covered by Medicaid have
unique legal entitlements. Finally, it would be inaccurate in
describing healthcare rights to only cover rights to obtain health

2. care in the first instance, because many important healthcare
rights attach to individuals once they manage to gain access to
needed healthcare services.
The remainder of this section describes more fully the various
types of individual rights associated with the healthcare system.
We categorize these rights as follows:
· 1. Rights related to receiving services explicitly provided
under healthcare, health financing, or health insurance laws; for
example, the Examination and Treatment for Emergency
Medical Conditions and Women in Labor Act, Medicaid, and the
Affordable Care Act.
· 2. Rights concerning freedom of choice and freedom from
government interference when making healthcare decisions; for
example, choosing to have an abortion.
· 3. The right to be free from unlawful discrimination when
accessing or receiving health care; for example, Title VI of the
federal Civil Rights Act of 1964, which prohibits discrimination
on the basis of race, color, or national origin by entities that
receive federal funding.12(p12),19
Rights Under Healthcare and Health Financing Laws
We begin this discussion of rights-creating health laws with the
Examination and Treatment for Emergency Medical Conditions
and Women in Labor Act (also referred to as EMTALA, which
is the acronym for the law’s original name—the Emergency
Medical Treatment and Active Labor Act—or, for reasons soon
to become clear, the “patient anti-dumping statute”). We then
briefly discuss the federal Medicaid program in a rights-
creating context and wrap up this section with a brief discussion
of the ACA.
Rights Under Health Care Laws: Examination and Treatment for
Emergency Medical Conditions and Women in Labor Act
Because EMTALA represents the only truly universal legal right
to health care in this country—the right to access emergency
hospital services—it is often described as one of the building
blocks of health rights. EMTALA was enacted by Congress in

3. 1986 to prevent the practice of “patient dumping”—that is, the
turning away of poor or uninsured persons in need of hospital
care. Patient dumping was a common strategy among private
hospitals aiming to shield themselves from the potentially
uncompensated costs associated with treating poor and/or
uninsured patients. By refusing to treat these individuals and
instead “dumping” them on public hospitals, private institutions
were effectively limiting their patients to those whose treatment
costs would likely be covered out-of-pocket or by insurers. Note
that the no-duty principle made this type of strategy possible.
EMTALA was a conscious effort on the part of elected federal
officials to chip away at the no-duty principle: By creating
legally enforceable rights to emergency hospital care for all
individuals regardless of their income or health insurance
status, Congress created a corresponding legal duty of care on
the part of hospitals. At its core, EMTALA includes two related
duties, which technically attach only to hospitals that
participate in the Medicare program (but then again, nearly
every hospital in the country participates). The first duty
requires covered hospitals to provide an “appropriate” screening
examination to all individuals who present at a hospital’s
emergency department seeking care for an “emergency medical
condition.” Under the law, an appropriate medical
109
110
screening is one that is nondiscriminatory and that adheres to a
hospital’s established emergency care guidelines. EMTALA
defines an emergency medical condition as 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

4. functions, or (iii) serious dysfunction of any bodily organ or
part; or with respect to a pregnant woman who is having
contractions, that there is inadequate time to effect a safe
transfer to another hospital before delivery, or that transfer may
pose a threat to the health or safety of the woman or the unborn
child.20
The second key duty required of hospitals under EMTALA is to
either stabilize any condition that meets the above definition or,
in the case of a hospital without the capability to treat the
emergency condition, undertake to transfer the patient to
another facility in a medically appropriate fashion. A proper
transfer is effectuated when, among other things, the
transferring hospital minimizes the risks to the patient’s health
by providing as much treatment as is within its capability, when
a receiving medical facility has agreed to accept the transferred
patient, and when the transferring hospital provides the
receiving facility all relevant medical records.
The legal rights established under EMTALA are accompanied
by heavy penalties for their violation. The federal government,
individual patients, and “dumped on” hospitals can all initiate
actions against a hospital alleged to have violated EMTALA,
and the federal government can also file a claim for civil money
penalties against individual physicians who negligently violate
an EMTALA requirement.
Rights Under Healthcare Financing Laws: Medicaid
Many laws fund programs that aim to expand access to health
care, such as state laws authorizing the establishment of public
hospitals or health agencies, and the federal law establishing the
vast network of community health clinics that serve medically
underserved communities and populations. However, the legal
obligations created by these financing laws are generally
enforceable only by public agencies, not by individuals.

5. The Medicaid program is different in this respect. (Medicaid
has been covered elsewhere in greater depth, but because of its
importance in the area of individual healthcare rights, we
mention it also in this context.) Although most certainly a law
concerning healthcare financing, Medicaid is unlike most other
health financing laws in that it confers the right to individually
enforce program obligations through the courts.21(pp419–424)
This right of individual enforcement is one of the reasons why
Medicaid, nearly 50 years after its creation, remains a hotly
debated public program. This is because the legal entitlements
to benefits under Medicaid are viewed as a key contributor to
the program’s high cost. Yet whether Medicaid’s legal
entitlements are any more of a factor in the program’s overall
costs than, say, the generally high cost of health care, is not
clearly established.
Rights Under Health Insurance Laws: The Affordable Care Act
As you will learn in subsequent chapters, the ACA is far more
than a law that just concerns health insurance; in fact, it is a
sweeping set of reforms that touch on healthcare quality, public
health practice, health disparities, community health centers,
healthcare fraud and abuse, comparative effectiveness research,
the health workforce, health information technology, long-term
care, and more. However, for purposes of this chapter, we
mention it briefly it in terms of its impact on the rights of
individuals to access health insurance and to equitable treatment
by their insurer. Details concerning the ACA’s effect on the
public and private insurance markets are discussed elsewhere.
Through a series of major reforms to existing policies, the ACA
reshapes the private health insurance market, transforming
private health insurance from a commodity that regularly
classified (and rejected) individuals based on their health status,
age, disability status, and more into a social good whose
availability is essential to individual and population health.22

6. The key elements of this shift include: a ban on exclusion and
discrimination based on health status or pre-existing health
conditions; new protections that ensure that, once covered by
insurance, individuals will have access to necessary care
without regard to artificial annual or lifetime expenditure caps;
a guarantee that once insurance coverage is in place, it cannot
be rescinded except in cases of applicant fraud; a ban on
additional fees for out-of-network emergency services; the
provision (by 2019) of financial subsidies for an estimated 19
million low- and moderate-income individuals and for some 4
million small businesses; the inclusion, in the individual and
small group insurance markets, of a package of “essential health
benefits” that must be covered; and the creation of state health
insurance “exchanges” through which individuals and small
employer groups can purchase high-quality health insurance in a
virtual marketplace that is substantially regulated and that
simplifies the job of learning about, selecting, and enrolling in
insurance plans.
Research Project Guidelines
Field Research Project Format
Components of the Research Project
Cover Page
Abstract
Introduction
Literature Review
Methods
Findings
Discussion

7. Conclusion
References
Components of the Research Project and Their
Suggested Minimum Lengths
Cover Page
Abstract (5 - 7 lines)
Introduction (at least half a page)
Literature Review (at least one and a half pages)
Methods (at least half a page)
Findings (up to you to decide and organize the format for this)
Discussion (at least two pages)
Conclusion (at least half a page)
References (be sure to make in-text citations throughout your
paper
and to properly include all references in this section at the end)
*Note: Once again, these are only suggested lengths for each
section. If you feel you
have to write more to get your point across as accurately as
possible in order to
get the best possible grade, then I encourage you to do so. Also
be sure to start
each new section on a new page with a clearly marked title
(Abstract, Introduction,
Literature Review, etc.) in bold, underlined, and larger font.
Cover Page
Include basic information about your
research project (your name, the name

8. of the class, the date and the title of
your research project)
Include a title that is at the same time
accurate and compelling to your reader
Abstract
An abstract is a summary of all of the
components that will follow in your a
research project.
Much like the summaries that you read on
the inside flap on a book let you decide
whether or not to buy it, an abstract allows
your reader to decide whether or not your
research will be useful to his or her
particular area of interest.
Introduction
Presentation of your topic
Presentation of the population and sample you will study
(identify the geographic location)
Why is your topic important to society?
Present at least two hypotheses that you will set out to
examine through your research. At the end of your
introduction, you can literally write out one or two sentences
for each of the following. These are two specific points
about the topic that you will focus on and that will guide

9. your research.
– Hypothesis 1: ______
– Hypothesis 2: ______
Literature Review
Select a minimum of three sociologists from
Chapter 1 who wrote about your topic.
For each author, explain his or her theory
and why it will help you explain your own
research. So this section can be at least
three paragraphs long.
Methods
Present an overview of the methods you used to conduct
research on the
sample of your population. These include but are not limited to:
Surveys
Face to face interviews
Observation of events and the description of them in anecdotes
What calculations did you make to conduct a statistical analysis
of
your survey (average, median, percentages, mode)?
Additional research from the school library and the Internet

10. (Note:
Be sure to properly give credit to all sources and to list them in
the
bibliography.)
What sources did you consult to gain information for this
research
project:
- Academic journals?
- Database in school library?
- Websites for articles?
- Websites for maps, time lines, and population charts?
Findings
Present the findings that will help explain
your hypotheses. For each finding, write a
two or three sentences explaining it.
Findings can include:
Charts
Maps
Tables
Photos
Quotations from people you interview

11. Discussion
Use your literature review and your findings
to discuss your topic.
Whereas the Findings section was a quick
presentation of facts, this section will attempt
to explain the causes and consequences of
these facts.
Based on your literature review and findings
sections, are the two hypotheses that you
proposed in the beginning of this research
project valid?
Conclusion
Brief summary of your results
Challenges that affected your research
Commentary about how this research can
help us reflect on the problems facing our
own society today
Solution

12. s
Suggestions for potential follow up
research on a related topic
References
List the sources used in this project
in alphabetical order.
An example of the suggested
format is as follows:
Hochschild, Arlie. The Second Shift:
Working Parents and the Revolution at
Home. New York: Viking Press,1989.
*Note: Do not only paste a link if you are using an online
article. You need to
include full information to before the link
Slide 1Slide 2Slide 3Slide 4Slide 5Slide 6Slide 7Slide 8Slide
9Slide 10Slide 11Slide 12

13. Research Methods in Sociology
*
A. Sociology as a Science
Criticism of Marxists: political agenda, subjective thinking
(philosophy instead of rigorous Durkheim-style data collection),
caution is needed understand the meaning behind their work
Subjective versus Objective Knowledge: Empirical Research
means that the unit under observation must be observable,
measurable, and testable.
Example of Religion: As a science, sociology cannot prove or
disprove the existence of God, but it can analyze the opinions,
beliefs, and behaviors of people who adhere to different
religions.

14. *
B. Goals of Sociological
ResearchDescriptionExplorationExplanationPredictionControl
*
C. Challenges
Biases: When the subject resembles or fails to resemble the
observerEthical Considerations (for example the responsibility
to notify the proper authorities upon the discovery of an
impending crime)Subjects tend to respond to
observation:Hawthorne Effect: response is what the observer
wants to hearStory of Elton MAYO (1880 - 1949) and his
research at the General Electric Company that gave birth to the
Human Relations Movement: “Individual workers cannot be
treated in isolation but must be seen as members of a group.”
From The Human Problems of an Industrialized Civilization

15. (1933)
*
D. Measurement
The relationship between variables
Reliability: Is your observation a “fluke” or is it a repeatable
social phenomenon?
Validity:Are you really measuring what you want to measure?
*
E. Understanding CorrelationsNegative Correlation: Social
integration and the likelihood of committing suicide (Suicide,
DURKHEIM, 1897)
Positive Correlation:Increased usage of drugs and the risk of
homelessnessDecrease of available positions on the employment

16. market and the purchase of new homes
*
Research MethodsTheory versus
hypothesisPopulationSampleSurveysFace to face interviews
(directed versus semi-directed)Email interviewsObserving
behavior in a natural setting and explaining observations in
anecdotes
*
Statistical AnalysisInterpreting chartsInputting data from a
table to create a pie or bar chartMode (the most frequently
repeated number)MedianAverage (mean)

17. *
American Sociologists
*
*
Albion SMALL (1854 – 1926)
of Chicago
This brought the United States to a prominent position in the
world of sociological thought
Introduction to the Science of Sociology (1890)
Founded the American Journal of Sociology in 1895

18. *
*
Robert PARKS (1864 - 1944)
Chicago School of SociologyJournalist in ChicagoFounded the
American Sociological
SocietyUrbanizationDiscordDisintegrating effect (becoming less
integrated into society)Crime ratesIsolation of communities and
the need to integrate people into society in a better way
*
*
Jane Adams (1860 – 1935)
Active sociologistFounded the Hull House for the
PoorPublished hundreds of articles in the American Journal of
Research
methodologyNobel Peace Prize laureate

19. *
*
George Herbert MEAD (1863 - 1931)
Socialization: Interaction creates a concept of the selfSocial
interaction through symbols, words, gestures, and body
languageThe Symbolic Interactive PerspectiveHated writing:
After his death, his students published his book based on class
notesMind, Self, and Society, 1934, University of Chicago Press
*
*
W.E.B. Du Bois (1868 - 1963)
Founded the NAACP in 1909“Pen pal” with Albert Einstein,
who called racism “America’s Worst Disease”Political

20. activistVisited Germany in 1936: Called the treatment of Jews
an “attack on civilization”Directed the Encyclopedia Africana
in Ghana in 1961
*
*
Talcott Parsons (1902 - 1979)
Structural functionalistFamily is the most important institution
for the survival of society (Different from Jean Jacques
Rousseau)The “traditional” division of labor in the family
needsOther institutions (welfare, school, social services, etc.)
are meant to assist the family meet its needs
*
*

21. Robert Merton (1910 - 2003)
Structural functionalistBehavior:Manifest consequences
(intended)Latent consequences (unintended)In business, there
are negative and positive consequencesA dysfunctional
consequence weakens the social bonds and produces a negative
societal effectSocial Theory and Social Structure
(1968)Influenced Herbert GANS:
*
*
C. Wright MILLS (1916 - 1962)
The Sociological Imagination (1959)“Vocabularies of motive”
way they are expressed and justifiedPosition at Columbia
University in 1945 even though he was often criticized because
of unconventional viewsConflict theorist accused of being a

22. men, generals, politicians, media moguls,
and bank owners who structure the entire
country in order to suit their own desires
*
*
References
Pictures of sociologists taken from www.wikipedia.org (All
others)www.thesocietypages.org (C. Wright MILLS)
*
*
Compilation Of The Social Security Laws
EXAMINATION AND TREATMENT FOR EMERGENCY
MEDICAL CONDITIONS AND WOMEN IN LABOR[298]

23. Sec. 1867. [42 U.S.C. 1395dd] (a) Medical Screening
Requirement.—In the case of a hospital that has a hospital
emergency department, if any individual (whether or not
eligible for benefits under this title) comes to the emergency
department and a request is made on the individual’s behalf for
examination or treatment for a medical condition, the hospital
must provide for an appropriate medical screening examination
within the capability of the hospital’s emergency department,
including ancillary services routinely available to the
emergency department, to determine whether or not an
emergency medical condition (within the meaning of subsection
(e)(1)) exists.
(b) Necessary Stabilizing Treatment for Emergency Medical
Conditions and Labor.—
(1) In general.—If any individual (whether or not eligible for
benefits under this title) comes to a hospital and the hospital
determines that the individual has an emergency medical
condition, the hospital must provide either—
(A) within the staff and facilities available at the hospital, for
such further medical examination and such treatment as may be
required to stabilize the medical condition, or
(B) for transfer of the individual to another medical facility in
accordance with subsection (c).
(2) Refusal to consent to treatment.—A hospital is deemed to
meet the requirement of paragraph (1)(A) with respect to an

24. individual if the hospital offers the individual the further
medical examination and treatment described in that paragraph
and informs the individual (or a person acting on the
individual’s behalf) of the risks and benefits to the individual of
such examination and treatment, but the individual (or a person
acting on the individual’s behalf) refuses to consent to the
examination and treatment. The hospital shall take all
reasonable steps to secure the individual’s (or person’s) written
informed consent to refuse such examination and treatment.
(3) Refusal to consent to transfer.—A hospital is deemed to
meet the requirement of paragraph (1) with respect to an
individual if the hospital offers to transfer the individual to
another medical facility in accordance with subsection (c) and
informs the individual (or a person acting on the individual’s
behalf) of the risks and benefits to the individual of such
transfer, but the individual (or a person acting on the
individual’s behalf) refuses to consent to the transfer. The
hospital shall take all reasonable steps to secure the individual’s
(or person’s) written informed consent to refuse such transfer.
(c) Restricting Transfers Until Individual Stabilized.—
(1) Rule.—If an individual at a hospital has an emergency
medical condition which has not been stabilized (within the
meaning of subsection (e)(3)(B)), the hospital may not transfer
the individual unless—
(A)(i) the individual (or a legally responsible person acting on

25. the individual’s behalf) after being informed of the hospital’s
obligations under this section and of the risk of transfer, in
writing requests transfer to another medical facility,
(ii) a physician (within the meaning of section 1861(r)(1)) has
signed a certification that based upon the information available
at the time of transfer, the medical benefits reasonably expected
from the provision of appropriate medical treatment at another
medical facility outweigh the increased risks to the individual
and, in the case of labor, to the unborn child from effecting the
transfer, or
(iii) if a physician is not physically present in the emergency
department at the time an individual is transferred, a qualified
medical person (as defined by the Secretary in regulations) has
signed a certification described in clause (ii) after a physician
(as defined in section 1861(r)(1)), in consultation with the
person, has made the determination described in such clause,
and subsequently countersigns the certification; and
(B) the transfer is an appropriate transfer (within the meaning
of paragraph (2)) to that facility.
A certification described in clause (ii) or (iii) of subparagraph
(A) shall include a summary of the risks and benefits upon
which the certification is based.
(2) Appropriate transfer.—An appropriate transfer to a medical
facility is a transfer—
(A) in which the transferring hospital provides the medical

26. treatment within its capacity which minimizes the risks to the
individual’s health and, in the case of a woman in labor, the
health of the unborn child;
(B) in which the receiving facility—
(i) has available space and qualified personnel for the treatment
of the individual, and
(ii) has agreed to accept transfer of the individual and to
provide appropriate medical treatment;
(C) in which the transferring hospital sends to the receiving
facility all medical records (or copies thereof), related to the
emergency condition for which the individual has presented,
available at the time of the transfer, including records related to
the individual’s emergency medical condition, observations of
signs or symptoms, preliminary diagnosis, treatment provided,
results of any tests and the informed written consent or
certification (or copy thereof) provided under paragraph (1)(A),
and the name and address of any on-call physician (described in
subsection (d)(1)(C)) who has refused or failed to appear within
a reasonable time to provide necessary stabilizing treatment;
(D) in which the transfer is effected through qualified personnel
and transportation equipment, as required including the use of
necessary and medically appropriate life support measures
during the transfer; and
(E) which meets such other requirements as the Secretary may
find necessary in the interest of the health and safety of

27. individuals transferred.
(d) Enforcement.—
(1) Civil monetary penalties.—
(A) A participating hospital that negligently violates a
requirement of this section is subject to a civil money penalty
of not more than $50,000 (or not more than $25,000 in the case
of a hospital with less than 100 beds) for each such violation.
The provisions of section1128A (other than subsections (a) and
(b)) shall apply to a civil money penalty under this
subparagraph in the same manner as such provisions apply with
respect to a penalty or proceeding under section 1128A(a).
(B) Subject to subparagraph (C), any physician who is
responsible for the examination, treatment, or transfer of an
individual in a participating hospital, including a physician on-
call for the care of such an individual, and who negligently
violates a requirement of this section, including a physician
who—
(i) signs a certification under subsection (c)(1)(A) that the
medical benefits reasonably to be expected from a transfer to
another facility outweigh the risks associated with the transfer,
if the physician knew or should have known that the benefits
did not outweigh the risks, or
(ii) misrepresents an individual’s condition or other
information, including a hospital’s obligations under this
section,

28. is subject to a civil money penalty of not more than $50,000 for
each such violation and, if the violation is gross and flagrant or
is repeated, to exclusion from participation in this title and
State health care programs. The provisions of
section 1128A (other than the first and second sentences of
subsection (a) and subsection (b)) shall apply to a civil money
penalty and exclusion under this subparagraph in the same
manner as such provisions apply with respect to a penalty,
exclusion, or proceeding under section 1128A(a).
(C) If, after an initial examination, a physician determines that
the individual requires the services of a physician listed by the
hospital on its list of on-call physicians (required to be
maintained under section 1866(a)(1)(I)) and notifies the on-call
physician and the on-call physician fails or refuses to appear
within a reasonable period of time, and the physician orders the
transfer of the individual because the physician determines that
without the services of the on-call physician the benefits of
transfer outweigh the risks of transfer, the physician authorizing
the transfer shall not be subject to a penalty under subparagraph
(B). However, the previous sentence shall not apply to the
hospital or to the on-call physician who failed or refused to
appear.
(2) Civil enforcement.—
(A) Personal harm.—Any individual who suffers personal harm
as a direct result of a participating hospital’s violation of a

29. requirement of this section may, in a civil action against the
participating hospital, obtain those damages available for
personal injury under the law of the State in which the hospital
is located, and such equitable relief as is appropriate.
(B) Financial loss to other medical facility.—Any medical
facility that suffers a financial loss as a direct result of a
participating hospital’s violation of a requirement of this
section may, in a civil action against the participating hospital,
obtain those damages available for financial loss, under the law
of the State in which the hospital is located, and such equitable
relief as is appropriate.
(C) Limitations on actions.—No action may be brought under
this paragraph more than two years after the date of the
violation with respect to which the action is brought.
(3) Consultation with quality
improvement[299] organizations.—In considering allegations of
violations of the requirements of this section in imposing
sanctions under paragraph (1) or in terminating a hospital’s
participation under this title, the Secretary shall request the
appropriate quality improvement[300] organization (with a
contract under part B of title XI) to assess whether the
individual involved had an emergency medical condition which
had not been stabilized, and provide a report on its findings.
Except in the case in which a delay would jeopardize the health
or safety of individuals, the Secretary shall request such a

30. review before effecting a sanction under paragraph (1) and shall
provide a period of at least 60 days for such review. Except in
the case in which a delay would jeopardize the health or safety
of individuals, the Secretary shall also request such a review
before making a compliance determination as part of the process
of terminating a hospital’s participation under this title for
violations related to the appropriateness of a medical screening
examination, stabilizing treatment, or an appropriate transfer as
required by this section, and shall provide a period of 5 days for
such review. The Secretary shall provide a copy of the
organization’s report to the hospital or physician consistent
with confidentiality requirements imposed on the organization
under such part B.
(4) Notice upon closing an investigation.—The Secretary shall
establish a procedure to notify hospitals and physicians when an
investigation under this section is closed.
(e) Definitions.—In this section:
(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,

31. (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.
(2) The term “participating hospital” means a hospital that has
entered into a provider agreement under section 1866.
(3)(A) The term “to stabilize” means, with respect to an
emergency medical condition described in paragraph (1)(A), to
provide such medical treatment of the condition as may be
necessary to assure, within reasonable medical probability, that
no material deterioration of the condition is likely to result from
or occur during the transfer of the individual from a facility, or,
with respect to an emergency medical condition described in
paragraph (1)(B), to deliver (including the placenta).
(B) The term “stabilized” means, with respect to an emergency
medical condition described in paragraph (1)(A), that no
material deterioration of the condition is likely, within
reasonable medical probability, to result from or occur during
the transfer of the individual from a facility, or, with respect to
an emergency medical condition described in paragraph (1)(B),
that the woman has delivered (including the placenta).

32. (4) The term “transfer” means the movement (including the
discharge) of an individual outside a hospital’s facilities at the
direction of any person employed by (or affiliated or associated,
directly or indirectly, with) the hospital, but does not include
such a movement of an individual who (A) has been declared
dead, or (B) leaves the facility without the permission of any
such person.
(5) The term “hospital” includes a critical access hospital (as
defined in section 1861(mm)(1)).
(f) Preemption.—The provisions of this section do not preempt
any State or local law requirement, except to the extent that the
requirement directly conflicts with a requirement of this
section.
(g) Nondiscrimination.—A participating hospital that has
specialized capabilities or facilities (such as burn units, shock-
trauma units, neonatal intensive care units, or (with respect to
rural areas) regional referral centers as identified by the
Secretary in regulation) shall not refuse to accept an appropriate
transfer of an individual who requires such specialized
capabilities or facilities if the hospital has the capacity to treat
the individual.
(h) No Delay in Examination or Treatment.—A participating
hospital may not delay provision of an appropriate medical
screening examination required under subsection (a) or further
medical examination and treatment required under subsection

33. (b) in order to inquire about the individual’s method of payment
or insurance status.
(i) Whistleblower Protections.—A participating hospital may
not penalize or take adverse action against a qualified medical
person described in subsection (c)(1)(A)(iii) or a physician
because the person or physician refuses to authorize the transfer
of an individual with an emergency medical condition that has
not been stabilized or against any hospital employee because the
employee reports a violation of a requirement of this section.
[298] See Vol. II, P.L. 108-173, §945, with respect to an
emergency medical treatment and labor act technical advisory
group and §1011, with respect to the Federal reimbursement of
emergency health services furnished to undocumented aliens.
[299] P.L. 112-40, §261(a)(3)(E), struck out “Peer review” and
inserted “Quality improvement”, applicable to contracts entered
into or renewed on or after January 1, 2012.
[300] P.L. 112-40, §261(a)(3)(C), struck out “utilization and
quality control peer review” and inserted “quality
improvement”, applicable to contracts entered into or renewed
on or after January 1, 2012.
Review pages 109–110 of Essentials of Health Policy and
Lawas well as the following legislation:

34. Examination and Treatment for Emergency Medical Conditions
and Women in Labor
You are a consultant specializing in policy analysis. Based on
theExamination and Treatment for Emergency Medical
Conditions and Women in Labor legislation, as well as the
situation that follows, you will complete a policy analysis with
3–5 options for your client, Congresswoman Moody, to
consider.
Congresswoman Moody represents a state that borders Mexico.
She is up for re election next year, and she will seek another
term in office.
There are many undocumented workers that reside in her
district. Congresswoman Moody is vocal about the need to
provide health care to all that need it, but she also believes in
fiscal restraint and does not support bail-outs for private
facilities. She is well aware that her state’s Medicaid budget is
almost exhausted for this year, and the state’s unemployment
rate remains stubbornly high.
Apart from the voters, other affected constituents include three
private regional medical centers trauma units that receive
referrals from five or more small facilities that have emergency
departments with lesser trauma status. Also, the largest health
care corporation that owns two of the three medical centers in
her catchment area, and which supported her in her last bid for
election with campaign funds at the allowable limit, is

35. threatening to refuse Medicare and Medicaid patients to ensure
survival in the bad economy. An increase in unfunded mandates
for urgent care may push this corporation into private payer
only, and Congresswoman Moody is aware that there are enough
affluent families in the area to support two facilities providing
only designer medicine and concierge services.
All options must:
· Be within the power of Congresswoman Moody to do
· Be consistent with Congresswoman Moody’s values, and
· Address the issue identified in the problem statement
You will:
1. Identify 3–5 options for Congresswoman Moody’s
consideration
2. Identify criteria that will be used to evaluate the options
3. Identify pros and cons for each option
4. Use a side-by-side table (MS® Excel® would be appropriate
for this) to assist in analyzing the options.
Submitting Your Assignment
Prepare your written Assignment in a Word and/or Excel
document and save it in a location and with a name you will
remember, using the following naming convention: username-
assignment-unit#.doc.
NOTE: If you do not currently have Microsoft Office installed
on your computer, please contact your instructor immediately.
Files must be submitted in the appropriate format in order to

36. earn a grade.
When you are ready to submit it, click on the Dropbox and
complete the steps below:
1. Click the link that says Submit an Assignment.
2. In the "Submit to Basket" menu, select Unit 8: Assignment.
3. In the "Comments" field, include at least the name of the
Assignment.
4. Click the Add Attachments button.
5. Follow the steps listed to attach your Word document.
6. To view your graded work, come back to the Dropbox or go
to the Gradebook after your instructor has evaluated it.
7. Make sure that you save a copy of your submitted
Assignment.