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Louisiana, US_EiJ Paraconference

Misria

In Louisiana, governing elites have long found it more profitable to deny the connections between health outcomes and the structural inequities of an anti-Black petrostate. Their denial is made possible by the existence of data divergence–that is, inconsistencies between data sets or between a data set and the realities it purports to represent (Encyclopedia of Social Measurement 2005). These inconsistencies range from missing or “undone” (i.e. incomplete or ignored) data (Frickel et al. 2007) to the production of different measures (and the selection of different priorities) by institutional silos. Recognition of the need for public health capacities that address the systems and structures impacting health–especially children’s health–has motivated health equity advocates in Louisiana to fill the data gaps through collaborative datawork, that is, the work of making data meaningful across social and scientific communities. In 2022, a coalition of community organizations, academic researchers, and public health workers led by the Louisiana Center for Health Equity (LCHE), a community-based organization created by a registered nurse, worked together to examine the links between adolescent mental health and disciplinary practices in schools. Ensuring their agendas were informed by community priorities led them to incorporate the contributions of adolescents advocating for better access to physical and mental healthcare resources and the abolishment of discriminatory and punitive disciplinary actions in schools. Their collaborative datawork revealed how data gaps around adolescent mental health are a structuring component of schools’ discriminatory and punitive climates–much as gaps in environmental health data benefit polluting industries. They found that existing figures around adolescent mental health are inaccurate, as many youth are unable to receive an official diagnosis owing to lack of healthcare access. LCHE advocates at a house committee meeting in January 2023 reported that students who exhibit behavioral issues rooted in trauma or mental health more often receive punitive disciplinary actions rather than rehabilitative and restorative services. This work generated the support needed to pass legislation to expand public health infrastructure and access to mental health resources. In June 2023, House Bill 353 authorized the allotment of "mental health days" as an excused absence for students; introduced procedures for schools to connect students to medical treatment and services; and required the Louisiana Department of Education to develop and administer a pilot program for implementing mental health screening, among other changes. By mobilizing advocates and scholars from across the social and institutional silos, LCHE’s collaborative datawork tentatively expanded children’s public health infrastructures. 

Fisher, Margaux. 2023. "Collaborative Datawork and Reframing Adolescent Mental Health in the Deep South." In 4S Paraconference X EiJ: Building a Global Record, curated by Misria Shaik Ali, Kim Fortun, Phillip Baum and Prerna Srigyan. Annual Meeting of the Society of Social Studies of Science. Honolulu, Hawai'i, Nov 8-11.

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Sara_Nesheiwat

The Emergency Medical Treatment and Labor Act is a law requiring that anyone coming into the emergency department will be stabilized and treated no matter what their insurance situation is. In terms of women's health, it is important to note that this means for active labors, medical treatment is necessary and required, no matter the health insurance of the patient. The purpose of this law to prevent certain patients from being turned away in an emergency situation or refused medical treatments if they are unable to pay, putting their health at risk.

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Sara_Nesheiwat

EMTALA was enacted by Congress in 1986 and was part of the Consolidated Omnibus Budget Reconciliation Acts of 1985. Congress saw different cases around America where doctors were refusing medical care to patients who could not make a deposit at the time of their admittance to the ER. An example of this is a patient Eugene Barnes, who in 1985 suffered a stab wound and ultimately ended up dying because 6+ doctors refused to help him without payment or some form of compensation. This made national news and other cases began to come to light, such as at Baptist Hospital in Miami and many other areas. News outlets began to follow these cases and this caught attention of government officials. Shortly after, EMTALA was enacted.

http://www.pitt.edu/~kconover/ftp/emtala-draft.pdf

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Sara_Nesheiwat

This was touched upon a little in a previous question. Many cases of patient dumping were popping up around America. Patients in need  of emergency medical care were being cast aside, ignored and delayed due to their inability to pay. In addition to the stab patient, Eugene Barnes that sparked this law, there were dozens of other cases where patients needed to be transferred to larger hospitals but the hospital refused to take patients without insurance, so the patients died. There were cases of people being asked right before surgery for a deposit, and being unable to pay were discharged with no surgery. There was also a very high rate of dead babies that were arising due to the fact that mothers in labor were being turned away because the patient was uninsured. It was then realized by the government that there were no legal duties for a hospital to treat people who are in emergency situations but cannot pay, only ethical and moral duties, which apparently weren't enough in some cases. This led to the birth of the EMTALA, requiring medical attention to all ED patients as well as transfers if needed to stabilize, including mothers in labor.

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Sara_Nesheiwat

This policy greatly helped sculpt emergency medicine and public health. By giving the right to the patient to have emergency medical treatment required without proof of insurance or payment, astronomically influenced the amount of patients being turned away and their possibilty of developing worse illnesses or dying. In a paper I read, a young doctor in the late 70s and early 80s remembers watching a woman in labor give birth in the doorway of the hospital and proceed to borht her child in the parking lot after being turned away for not having insurance. By requiring hospitals and doctors to see that all ED patients get care, no patient was at risk of dying or complicating their baby's health and birth due to a lack of insurance, ultimately increasing public health efforts. Not all hospitals turned away their patients, but enough did to make it a public health concern and get Congress involved. EMTALA changed emergency medicine protocols but also public health expectations and actions.

http://www.hhnmag.com/articles/5010-the-law-that-changed-everything-and…

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Sara_Nesheiwat

This policy was explicitly made for vulnerable populations who couldn't afford or for whatever reason did not have health insurance. The vulnerable parties that did not have health insurance were at risk of being turned away at hospitals during crucial times of need and emergency situations. This act completely absolved the worries and fears of this vulnerable population without health insurance by making it a law that these ED patients were to receive care and stabilization. This act was made for this specific vulnerable population, to prevent discrimination.

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Sara_Nesheiwat

This policy was received in good light by the public for the most part. Patients were only to benefit from this, especially those who lacked insurance. Even those with insurance didn't have to waste time proving it any longer, they were treated and stabilized and insurance issues and payment were brought up later. Any ethically sound doctors, such as the ones working in hospitals that were already implementing the actions set forth by EMTALA (before it was law) had no issues with EMTALA. No doctor should have any issues with it due to their duty to act as well as ethical and moral standards they should be holding themselves up to, written in their oath they took to become doctor. The only people that would stand to receive this act negatively would be the doctors who were actively turning away patients in need, who are clearly morally compromised. Yet, media, patients, a majority of doctors and staff found and received this act positively or with little reservation.

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Sara_Nesheiwat

It is said that EMTALA doesn't apply to ambulance services, technically this would be true. Yet, EMTALA does indeed effect our patients, and anything that effects our patients can effect us and should be a concern of ours as EMS providers. If EMTs are spending time in the hospital sorting out insurance issues and payment, that is more time they are out of service. Also, if the patient's treatment time is delayed, not only will the hospital be blamed, but so will EMS. If a patient is in cardiac arrest, EMTs will not be stopping and wasting time to find out insurance and payment issues from family members, that will be the last thought on their mind. They will be transporting and attempting to stabilize the patient. EMTs and EMS will not compromise the health of a patient due to insurance or payment issues, just like hospitals are now mandated to do.