NONEMERGENCY CARE

Health care providers have only a limited duty to provide nonemergency care. A patient that does not need emergency care can, in theory, seek care elsewhere without suffering ill effects from the delay. (As a practical matter, isolated facilities should be more willing to treat patients with nonemergency conditions because of the chance that their condition will worsen during the long delay in seeking care elsewhere.) The legal basis for this lack of duty is related to the lack of harm suffered by the patient when denied nonemergency care. If the patient is successfully treated elsewhere, there are no damages to base a lawsuit on. Unfortunately, in communities without a charity hospital, there may be no other health care provider from which to seek care.

In the situation where the patient's condition will not resolve itself spontaneously, there arises the legal question of when the condition triggers a duty to treat. Must the patient periodically visit the local emergency room until the patient's malady has become life-threatening and thus qualifies for emergency care? What if the delay causes the illness to be only partially treatable; is there liability for the effects of a chronic, untreated illness? These questions are unanswered in today's medical laws.

The responsibility for delivering nonemergency care is a problem that will grow in importance as the resources available for health care services shrink. Federal and State entitlement programs have raised expectations and made health care a "right" rather than a "privilege." At the same time, these programs have supplanted traditional community-based charity program that once supplied health care to indigents, especially free care by community physicians. In communities that lack the "safety valve" of a county-run charity hospital, the duty to provide nonemergency care may be legally imposed if the alternative is that the untreated illness will progress to a life-threatening emergency. It is certainly more cost-effective for the community to pay for treating illnesses before expensive emergency care is necessary. In an isolated community, it may even be cost-effective for the institution at which emergency care will ultimately be sought to finance nonemergency care on an insurance-type basis.