Analyze

The Sampson County landfill can be smelled before seen. This olfactory indicator points toward the sensory scale of these pungent emissions but also toward the geographic scope: this landfill receives waste from as far away as Orange County (the state's most expensive property/tax base), among dozens of other distant counties, making this "hazardous site" a lesson in realizing impact beyond the immediate locale. So when we answer the question, "What is this hazard?" we must think not only about the landfill as a thing in itself but as a set of economic and political relations of capital and the transit of other peoples' trash, into this lower-income, rural, predominantly African-American neighborhood. In this way, 'thinking with a landfill' (like this one in Sampson County) enables us to analyze wider sets of relationships, NIMBY-ist policymaking, consumerism, waste management, and the racialized spatial politics that enable Sampson County to be the recipient of trash from all over the state. At the same time we think spatially and in transit, we can think historically to (a) inquire about the DEQ policies that enable this kind of waste management system; and (b) the emergent "solutions" in the green energy sector that propose to capture the landfill's methane in order to render the stench productive for the future -- that is, to enable more consumption, by turning garbage into gas. As such, the idea of "hazard" can expand beyond the site itself - impactful and affective as that site might be - to examine the uneven relations of exchange and capitalist-driven values of productivity that further entrench infrastructures such as these. [This offers a conceptual corrollary to thinking, as well, about the entrenchment of CAFOs for "green" biogas development, as we address elsewhere in the platform].

Danielle Koonce in an Opinion piece in the Fayetteville Observer, states...

"And it’s not just household garbage coming in — chemical waste and coal ash has also been disposed of in the Sampson County landfill."

"We listened to community members share how they can no longer garden or enjoy the outdoors due to the thick odor and fumes from the landfill."

"We learned that the landfill receives trash from around the state, from as far away as New York City, and even trash that comes in on ship-barges through Wilmington."

While Bryan Wuester, manager for the Sampson County Landfill states in the Sampson Independent...

"The Sampson landfill accepts waste from North Carolina only, about 5,450 tons from 16 different counties a day."

"The landfill accepts three kinds of waste: construction and demolition materials, solid waste and special waste, which are byproducts of industry. No coal ash comes into the Sampson facility..."

These are two different stories of the landfill coming from two different stakeholders, one in which needs the landfill to be in operation for a job and the other a concerned citizen worried about the disproportional impacts her community faces. While Danielle Koonce listens to the realities of the community members located around the landfill who express concern and worry, the landfill manager denies these realities and insists they are not true. This is not only invaliding to the community members who are fighting to get their voices heard but further embeds environmental injustice into the community.  

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.

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

This policy applies to American law and patients who are in need of emergency medical treatment and is to be followed by all emergency departments and personnel alike. 

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.

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…

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.

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.

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.