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A different EMTALA ruling in Idaho

Aug 26th, 2022
by Charles Kuffner.
Comments are off for this post

As expected. You know where this goes from here.

A federal judge on Wednesday blocked Idaho from enforcing a ban on abortions when pregnant women require emergency care, a day after a judge in Texas ruled against President Joe Biden’s administration on the same issue.

The conflicting rulings came in two of the first lawsuits over Biden’s attempts to keep abortion legal after the conservative majority U.S. Supreme Court in June overturned the 1973 Roe v. Wade decision that legalized the procedure nationwide.

Legal experts said the dueling rulings in Idaho and Texas could, if upheld on appeal, force the Supreme Court to wade back into the debate.

[…]

In Idaho, U.S. District Judge B. Lynn Winmill agreed with the U.S. Department of Justice that the abortion ban taking effect Thursday conflicts with a federal law that ensures patients can receive emergency “stabilizing care.”

Winmill, who was appointed to the court by former Democratic President Bill Clinton, issued a preliminary injunction blocking Idaho from enforcing its ban to the extent it conflicts with federal law, citing the threat to patients.

“One cannot imagine the anxiety and fear (a pregnant woman) will experience if her doctors feel hobbled by an Idaho law that does not allow them to provide the medical care necessary to preserve her health and life,” Winmill wrote.

The Justice Department has said the federal Emergency Medical Treatment and Labor Act requires abortion care in emergency situations.

“Today’s decision by the District Court for the District of Idaho ensures that women in the State of Idaho can obtain the emergency medical treatment to which they are entitled under federal law,” U.S. Attorney General Merrick Garland said in a written statement.

“The Department of Justice will continue to use every tool at its disposal to defend the reproductive rights protected by federal law,” Garland said. The DOJ has said that it disagrees with the Texas ruling and is considering next legal steps.

See here for the background. TPM goes deeper into the two rulings and also provides copies of them, but the bottom line is that the Texas judge said that the federal guidance went too far, didn’t go through the formal rule-change process (even though it was guidance on an existing rule and not a change), didn’t take the rights of the fetus into account, and could only apply when the mother’s life was in danger, not just when her health was threatened. The Idaho judge didn’t do any of that.

Both rulings will be appealed, and as Idaho is in the more liberal Ninth Circuit, there’s a very good chance that this ruling will be upheld. The same is true for Texas, where the radical and lawless Fifth Circuit will get its paws on it. While it is usually the case that a split in the appellate courts means that SCOTUS will weigh in, it seems possible to me that they will duck the issue, perhaps on the grounds that this is really a dispute over state laws, and since the Texas case applies only to Texas, there’s no need for them to step in. I’m just guessing, I could easily be wrong. We’ll know soon enough. DAily Kos has more.

Restraining order granted in Paxton’s EMTALA lawsuit

Aug 25th, 2022
by Charles Kuffner.
1 comment

Ugh.

Texas hospitals will not be required to provide emergency abortions after a federal judge ruled the Biden administration was unauthorized to enforce such a rule.

U.S. District Judge James Wesley Hendrix in Lubbock ruled that the guidance by the U.S. Department of Health and Human Services went beyond the text of a related federal law, Reuters reported. The judge’s ruling agreed with Republican Texas Attorney General Ken Paxton.

Hendrix, who was appointed by former President Donald Trump, only barred federal regulators from enforcing the guidance and its interpretation of the Emergency Medical Treatment and Active Labor Act in Texas, and against two anti-abortion groups of doctors. The judge declined to enjoin the guidance nationwide.

[…]

The ruling is the latest in an ongoing battle for abortion rights in Texas and other conservative-led states. When the U.S. Supreme Court overturned abortion rights in the country, Texas had a clear path for its “trigger law” that bans almost all abortions, which goes into effect Thursday.

The Biden administration’s guidance was an attempted response to concerns about the health of pregnant patients being turned away or delayed care by hospitals worried about abortion bans. The Texas Medical Association wrote a letter asking state regulators to “prevent any wrongful intrusion into the practice of medicine.”

See here for the background. At least this time it’s just limited to the state and not nationwide, though of course it’s our effed-up state that needed this to be decided differently. As TPM notes, there’s a similar case in Idaho that may have a ruling by the time you read this, so we’re going to be fighting this out in the appeals courts and then very likely SCOTUS. Joy.

I often say that I Am Not A Lawyer in posts about legal things. I say that in part to make it clear that my analysis is that of a layperson, and one should be wary of accepting my acumen of the finer points of legal theory. But that also frees me to an extent of the concern about the technicalities and lets me just focus on the things that should matter, whether they actually will in a real courtroom or not. As a prime example of this, let’s look at a bit of the judge’s ruling. I’m quoting from that TPM story now:

“That Guidance goes well beyond EMTALA’s text, which protects both mothers and unborn children, is silent as to abortion, and preempts state law only when the two directly conflict,” Hendrix writes.

Siding with the two groups of anti-abortion physicians as well as the state of Texas, Hendrix writes that the HHS guidance requiring physicians to act when the woman’s health is at risk is too generous.

“The Guidance states that EMTALA may require an abortion when the health of the pregnant woman is in serious jeopardy,” he says. “Texas law, on the other hand, limits abortions to when the medical condition is life-threatening, and HLPA goes further to expressly limit the condition to a physical condition,” he adds, referring to Texas’ trigger law that outlaws abortions in most cases.

He argues that the guidance also does away with consideration for the embryo or fetus. The government contends that, when the wellbeing of the woman and embryo or fetus are in conflict, it should be the pregnant patient who decides whether or not to go forth with an abortion. Hendrix says that the decision should be taken out of the woman’s hands and put into the doctor’s — who has to then comply with state law.

He also dips into agency power arguments to hack back the guidance, claiming that Congress has not resolved the specific question at play.

“Specifically, the question at issue here is whether Congress has directly addressed whether physicians must perform abortions when they believe that it would resolve a pregnant woman’s emergency medical condition, irrespective of the unborn child’s health and state law,” he writes. “Congress has not.”

In other words, unless you the doctor who may get prosecuted for murder are sure the pregnant person is going to die, you have to let them suffer. I don’t care about the legal technicalities, I’m here to say that if you’re capable of committing these words to a document, you’re a goddamned sociopath and you have no business having power of any kind. That of course also applies to Ken Paxton and Greg Abbott and every single member of the Legislature who voted for these barbaric laws. It’s what this election is about. And I should note that Slate’s Mark Joseph Stern, who is an actual lawyer, sees this the same way I do. So there. Daily Kos and CNN have more.

Paxton sues over emergency guidance to doctors

Jul 15th, 2022
by Charles Kuffner.
1 comment

This is what “leaving it to the states” looks like.

Best mugshot ever

Texas is suing the Biden administration over guidance released Monday telling the nation’s doctors they’re protected by federal law to terminate a pregnancy as part of emergency treatment — and threatening to defund hospitals that don’t perform these procedures.

The Biden administration’s guidance states that federal law requires doctors to perform abortions for pregnant people in emergency rooms when it is “the stabilizing treatment necessary” to resolve a medical emergency, including treatments for ectopic pregnancy, hypertension and preeclampsia.

On Wednesday, the Biden administration also warned retail pharmacies that they must fill prescriptions for pills that can induce abortion or risk violating federal civil rights law.

These two recent actions pit the federal executive branch against state governments after the U.S. Supreme Court undid a nearly half-century-old precedent that had affirmed access to abortion as a constitutional right.

Texas Attorney General Ken Paxton’s office filed the suit challenging the guidance in federal court on Thursday, saying the Biden administration’s guidance violates the state’s “sovereign interest in the power to create and enforce a legal code.”

[…]

The Biden administration reassured the nation’s doctors that they don’t need to wait until a patient’s health deteriorates before acting and that they can act in cases where nontreatment would result in serious impairment, guidance that comes as medical professionals in Texas and other states where abortion is banned are trying to figure out what kind of women’s health care is allowed under new restrictions. The guidance isn’t seeking to update existing law but is said to clarify a hospital’s duties under the Emergency Medical Treatment and Active Labor Act.

I thought it was federal law that was sovereign, but what do I know? I know that if Paxton gets his way women are going to die because doctors won’t be able to treat them properly and in a timely fashion. That’s what’s really at stake here. And I expect Paxton to get his way, at least at first. The Chron points out the obvious:

The case underscores the dominant position that conservative Republicans hold in the federal judicial system: Paxton filed the case in Lubbock, in the U.S. Northern District of Texas, where there are 12 judges, 10 of whom were appointed by Republican presidents and six of whom were named by former President Donald J. Trump.

If Paxton were to lose, the case would go to the Fifth Circuit Court in New Orleans, widely recognized as one of the most conservative federal appellate courts in the country, and the final step would be the Supreme Court, which ruled last month to overturn Roe v Wade in the first place.

I guarantee you, whatever the district court judge does, the Fifth Circuit will give Ken Paxton what he wants because that’s what they do. And then SCOTUS gets to make another abortion ruling. Great system we have here, isn’t it?

I had drafted a post about the imminent threat to EMTALA that the Biden administration’s guidance had queued up, and then made the mistake of not publishing it in time to keep up with the news cycle. My bad. The original post is beneath the fold. I stand by what I said in this post. Now let’s bring the fight that this requires. Daily Kos and Mother Jones have more.

(more…)

Study claims Uber has reduced drunk driving in Houston

Jun 14th, 2021
by Charles Kuffner.
3 comments

Of interest.

Paid rides have saved lives and lessened drunk driving convictions in Houston, according to a new study released Wednesday by local researchers that claimed a direct link between more folks hailing an Uber and fewer wheeled into emergency rooms.

“The data shows that ridesharing companies can decrease these incidents because they give young people an alternative to driving drunk,” said Dr. Christopher Conner, a neurosurgery resident at McGovern Medical School at UTHealth in Houston and lead author of the report, published in the Journal of the American Medical Association’s surgery periodical.

Conner and the other researchers compared trip information from Uber — which supplied the data — in Houston between 2014 and 2018 to emergency room visits to Houston’s two Level I trauma centers during the same period and four years prior to Uber’s debut.

Vehicle-crash visits to the ERs at Ben Taub and Memorial Hermann-Texas Medical Center dropped 23.8 percent after Uber arrived in February 2014 during the peak Friday and Saturday night periods, researchers found. The decline was even more pronounced among people below age 30, where researchers reported a 38.9 percent drop in hospital visits as a result of wrecks.

The authors also found a decrease in drinking and driving convictions in Harris County during the same period.

Back in the early days of Uber and Lyft, when they were trying to get licensed to operate in all the cities (and seeking to pass a bill in the Lege to mandate their approval), there were studies conducted that showed similar results in other locations, and at least one study that disputed such effects. What we have now that we didn’t have then is a lot more data. I thought at the time that the connection between ridesharing services and a reduction in DWI made intuitive sense, and I still think that now even as I find the overall case for Uber and Lyft to be less compelling. I do think it’s easier, and more the societal norm, to get a drunken friend or colleague or whoever into an Uber or Lyft than it was in the older days to persuade them to call a cab. More work should be done to better quantify that, but that such a trend is visible is no surprise to me.

Houston’s hospitals are still busy

May 7th, 2021
by Charles Kuffner.
1 comment

Interesting.

While local hospital leaders aren’t sounding the alarm about capacity concerns, we heard a similar story from leaders at St. Luke’s and Houston Methodist: hospital beds and emergency rooms are regularly filling up as both health systems continue to manage coronavirus patients on top of all the folks finally heading to the hospital for care they may have delayed due to the pandemic, all while the number of patients coming into local emergency rooms is already hitting pre-COVID levels.

Roberta Schwartz, Executive VP of Houston Methodist Hospital in the Texas Medical Center, told the Press that it wasn’t surprising to hear that the Houston Methodist ER in Sugar Land was recently so busy it had to turn away ambulances temporarily.

“The emergency rooms and the hospitals are very full,” Schwartz said.

When we asked Dr. Brad Lembcke — Chief Medical Officer at St. Luke’s — about the current status of his hospital system’s bed count and ER capacity, he said “We’re full, I guess is probably the two-second version.”

[…]

Lots of Schwartz’s colleagues around the country have told her their hospitals are seeing lower numbers of emergency room visits than they did before COVID. “That is not the case at Houston Methodist,” Schwartz said, “and seems not to be the case in Houston.”

St. Luke’s is also seeing a similar trend of ERs packed with more patients than in other parts of the United States, Lembcke said. While “a lot of places report only recovering to about 80 percent of what their prior volumes were,” he said, St. Luke’s main downtown hospital is now seeing ER numbers that have “just about reached the pre-COVID states.”

Even though coronavirus hospitalizations have fallen after the winter surge, local hospitals continue to deal with steady numbers of COVID-19 patients. At Houston Methodist, the number of coronavirus hospitalizations has plateaued in recent weeks, and at a level higher than where that patient count leveled-off at after the first two surges in the spring and summer of 2020.

Schwartz said that after the first surge last spring, coronavirus hospitalizations at Houston Methodist fell to around 50. Following the summer surge, they averaged “about 100 COVID patients on a daily basis.”

“When we came down from this latest surge in December and January, we’re settling in at about 180 to 200,” Schwartz said.

“If you had a normal load of patients, and you add on 200, that would put some stressors to the system, and I think that you’re seeing that across Houston. And this comment on saturation is not just us, it’s lots of hospitals,” she said.

Lembcke said that St. Luke’s average number of coronavirus hospitalizations these days is “maybe a little higher” than what they saw right after the summer surge. “But it’s more consistent. It’s been pretty stable over the last month or so.”

When asked about why Houston’s hospitals are still so full, Schwartz said she and her colleagues have a few educated guesses.

“We do know for sure — 100 percent, this is documented in many papers — that people have delayed their care in many cases, and are coming in with later stage illnesses,” many of whom whose conditions got bad enough that they needed emergency care, Schwartz said. Some of those patients “were people who said ‘I don’t want to get COVID from going to the hospital or to the doctor.’ We know that.”

They note also that a lot of nurses have retired or left the industry due to burnout from the previous high volume of COVID cases, and that they are seeing a lot more younger patients with serious COVID issues, as is “needing a lung transplant”-level of seriousness. I certainly hope we’ll get back on a downward trajectory as more people get vaccinated, but this is a reminder both that we really need to get as many people vaxxed as we can, and that even as the overall numbers have dropped we’re still not out of the red yet.

How it’s going at the hospitals

Jul 2nd, 2020
by Charles Kuffner.
7 comments

In a word, it’s bad.

At Lyndon B. Johnson Hospital on Sunday, the medical staff ran out of both space for new coronavirus patients and a key drug needed to treat them. With no open beds at the public hospital, a dozen COVID-19 patients who were in need of intensive care were stuck in the emergency room, awaiting transfers to other Houston area hospitals, according to a note sent to the staff and shared with reporters.

A day later, the top physician executive at the Houston Methodist hospital system wrote to staff members warning that its coronavirus caseload was surging: “It has become necessary to consider delaying more surgical services to create further capacity for COVID-19 patients,” Dr. Robert Phillips said in the note, an abrupt turn from three days earlier, when the hospital system sent a note to thousands of patients, inviting them to keep their surgical appointments.

And at The University of Texas MD Anderson Cancer Center, staff members were alerted recently that the hospital would soon begin taking in cancer patients with COVID-19 from the city’s overburdened public hospital system, a highly unusual move for the specialty hospital.

These internal messages highlight the growing strain that the coronavirus crisis is putting on hospital systems in the Houston region, where the number of patients hospitalized with COVID-19 has nearly quadrupled since Memorial Day. As of Tuesday, more than 3,000 people were hospitalized for the coronavirus in the region, including nearly 800 in intensive care.

“To tell you the truth, what worries me is not this week, where we’re still kind of handling it,” said Roberta Schwartz, Houston Methodist’s chief innovation officer, who’s been helping lead the system’s efforts to expand beds for COVID-19 patents. “I’m really worried about next week.”

What’s happening in Houston draws eerie parallels to New York City in late March, when every day brought steep increases in the number of patients seeking care at overburdened hospitals — though, so far, with far fewer deaths. But as coronavirus cases surge in Texas, state officials here have not reimplemented the same lockdown measures that experts say helped bring New York’s outbreak under control, raising concern among public health officials that Houston won’t be able to flatten the curve.

“The time to act and time to be alarmed is not when you’ve hit capacity, but it’s much earlier when you start to see hospitalizations increase at a very fast rate,” said Lauren Ancel Meyers, a professor of integrative biology who leads the University of Texas at Austin COVID-19 Modeling Consortium. “It is definitely time to take some kind of action. It is time to be alarmed.”

[…]

Although hospital executives in Houston stress that they have the ability to add additional intensive care beds in the region to meet the growing demand — for a few more weeks, at least — the strain on hospitals is already being felt in other ways.

Houston Fire Chief Samuel Peña said his paramedics sometimes have to wait for more than an hour while emergency room workers scramble to find beds and staffers to care for patients brought in by ambulance — a bottleneck that’s tying up emergency medical service resources and slowing emergency response times across the region.

Part of the problem, Peña said, is that when his crews arrive at a hospital with a patient suspected of having COVID-19, the hospital may have a physical bed open for them, but not enough nurses or doctors to staff it. That’s a problem that’s likely to deepen as a growing number of medical workers have been testing positive for the virus, according to internal hospital reports. Just as New York hospitals did four months ago, some Houston hospitals have posted on traveling nurse websites seeking nurses for “crisis response jobs.”

“If they don’t have the nursing staff, then you can’t place the patient,” Peña said. “Then our crews have to sit with the patient in the ER until something comes open. It has a huge domino effect.”

There’s more, so read the rest. If you’re thinking that the death rate is low and that that’s a small blessing, that is true, but it’s also a bit illusory. For one thing, the sheer number of deaths will increase as the infection rate rises, not all deaths for which COVID-19 is a factor are recorded as COVID-19 deaths, and it is already the case that people are avoiding going to the hospital now for other reasons because of COVID-19, and that some of them will also die as a result. The official death count numbers have always been underestimated, and there’s no good way to spin it. Even if we were to go into total lockdown right now, we won’t begin to see the positive effects of that for another two weeks. We really need masking and better social distancing to have an effect or it’s going to get much worse. Oh, and the Texas Medical Center is above 100% ICU capacity. So we’ve got that going for us.

And as you ponder all that, ponder also this.

Despite Texas’ surge of new COVID-19 cases and hospitalizations, Lt. Gov. Dan Patrick said Tuesday evening that he doesn’t need the advice of the nation’s top infectious disease doctor, Anthony Fauci.

“Fauci said today he’s concerned about states like Texas that ‘skipped over’ certain things. He doesn’t know what he’s talking about,” Patrick told Fox News host Laura Ingraham in an interview. “We haven’t skipped over anything. The only thing I’m skipping over is listening to him.”

Patrick also said Fauci has “been wrong every time on every issue,” but did not elaborate on specifics.

Dan Patrick does not care if you live or die. You and everyone you know mean nothing to him.

Another scooter injury study

Feb 1st, 2020
by Charles Kuffner.
Comments are off for this post

Keep ’em coming.

Photo: Josie Norris /San Antonio Express-News

Electric scooter injuries have surged along with their popularity in the United States, nearly tripling over four years, researchers said in a study published Wednesday.

Nearly 40,000 broken bones, head injuries, cuts and bruises resulting from scooter accidents were treated in U.S. emergency rooms from 2014 through 2018, the research showed. The scooter injury rate among the general U.S. population climbed from 6 per 100,000 to 19 per 100,000. Most occurred in riders aged 18 to 34, and most injured riders weren’t hospitalized.

For the study published in JAMA Surgery, researchers at the University of California, San Francisco, analyzed U.S. government data on nonfatal injuries treated in emergency rooms.

“Improved rider safety measures and regulation” are clearly needed, the researchers said.

See here, here, and here for previous studies, and here to see this one. Clearly, helmets are going to have to be mandated, and from there it’s going to be up to cities to figure out how to safely incorporate these things into their transportation infrastructure. Bikes have been around for a long time and we’ve mostly figured them out, but scooters are new and sexy and are being pushed by Silicon Valley startups, so there are a lot of bumps in the road still to come. Hopefully we can begin to bend the curve on this. And no, I have no idea what the status of scooters coming to Houston is. Maybe that will be on an upcoming Council agenda. Assuming that scooter expansion is still the plan for these companies, which may not necessarily be the case any more. Maybe that’s why we haven’t had any news lately. CNet has more.

The down side of scooters

Feb 2nd, 2019
by Charles Kuffner.
Comments are off for this post

Watch out for that tree. And that pedestrian, and that street light, and that strange bump in the sidewalk, and that abandoned scooter someone just left lying there…

Photo: Richard A. Marini, San Antonio Express-News

In September 2017, Tarak Trivedi, an emergency room doctor, and Catherine Lerer, a personal injury attorney, started seeing electric scooters everywhere. Santa Monica, California, where they live, was the first city where the scooter company Bird rolled out its rechargeable two-wheelers, which could be rented with a smartphone app and dropped off anywhere. Lime and other scooter companies soon followed. As riders zipped down the street, reaching speeds of 15 miles per hour without helmets, both Trivedi and Lerer thought of the inevitable injuries.

Soon enough, victims of e-scooter accidents, both riders and pedestrians, began to show up in the ER. “I started seeing patients who had significant injuries,” Trivedi recalls. Calls about scooter-related injures poured into Lerer’s office. She says she now gets at least one new call a day. “We recognized that this is a very important technological innovation that has a significant public health impact,” Trivedi says.

More than a year after the Birds landed, Trivedi and researchers at the University of California-Los Angeles have authored the first study to quantify the public health impact of e-scooters. Their peer-reviewed study, published in JAMA Network Open, details 365 days of scooter crashes, collisions, and wipeouts. Digging through records from two Los Angeles-area emergency rooms, the researchers found 249 patients with injuries serious enough to warrant a trip to the ER. In comparison, they found 195 bicyclists with injuries and 181 pedestrians with similar injuries during the same period.

The goal of the study was to characterize how people were getting hurt, as well as who was getting hurt. Of the 249 cases the study looked at, 228 were riders, most of whom were brought to the ER after falling, colliding with an object, or being hit by a moving vehicle. The other patients were injured after being hit by a rider, tripping over a scooter in the street, or getting hurt while attempting to move a parked scooter. About 31 percent of patients had fractures, and around 40 percent suffered from head injuries. Most were between the ages of 18 and 40; the youngest was eight and the oldest was 89. While many of the injuries were minor, severe and costly injuries like bleeding in the skull and spinal fractures were also documented. Fifteen people were admitted to the hospital.

Trivedi thinks that the actual number of scooter injuries was likely higher, since the study took a conservative approach to tallying up patients, focusing only on standing electric scooters and dropping many ambiguous cases. (It also eliminated instances where riding a scooter was not the cause of a scooter-related injury—such as assaults where a scooter was used as a weapon, or injuries during attempts to steal a scooter.)

That’s from California, and it’s a partial picture of what has been observed in Los Angeles, based on two emergency rooms. The authors didn’t extrapolate from there, but it’s clear there would be a lot more than just what they focused on. That’s the first study of its kind of scooter injuries, but we do have some anecdotal evidence from Texas cities where the scooters have invaded, including San Antonio, Austin, and Dallas, where there has also been one reported fatality, though it is not clear if that person (the victim of a hit-and-run) had been using the scooter at the time of his death.

Let’s be clear, cars cause vastly more havoc every day than scooters do. The magnitude of injury and death resulting from our automobile-centric culture just dwarfs anything even an onslaught of electric scooters can do. In the long run, more scooters may lead to less vehicular damage, if it means more people rely on them in conjunction with transit to take fewer trips by car. That doesn’t mean we should ignore or minimize the potential for injury that scooters represent. It’s up to cities and states to figure out how to regulate these things in a way that maximizes their benefit and minimizes their risk. That means we need good data about the real-world effect of scooter usage, and we need to avoid being unduly influenced by the scooter companies and the venture capital behind them. Let’s pay attention to this stuff and be responsible about what we learn.

Now how much would you pay for that emergency room visit?

Dec 31st, 2018
by Charles Kuffner.
1 comment

Guess higher, and it is a guess because who knows what you’ll wind up getting charged for it.

Fifteen months after Texas enacted a law to bring transparency to the state’s for-profit free-standing emergency rooms, many of the facilities continue to send mixed messages about insurance coverage that could expose unsuspecting patients to surprise medical bills.

A Houston Chronicle review of websites representing the 52 free-standing emergency rooms in the Houston area shows a pattern in which many of the facilities prominently advertise that they “accept” all major private insurance. Some even list the insurers’ names and logos.

But often tucked under pull-down tabs or at the bottom of the page is a notice that the facilities are outside the networks of those insurers, followed by a reassurance that under the Texas insurance code, network status does not matter in emergency treatment, implying patients needn’t worry about coverage.

What the websites fail to disclose is that out-of-network status can result in insurance reimbursements far below the charges, leaving patients on the hook for the remainder of the bill — sometimes thousands of dollars.

“The word ‘accept’ means something very different to them than to the consumer, and they know that when they write their websites,” said Stacey Pogue, senior health policy analyst at the Austin-based Center for Public Policy Priorities. “They do not tell the rest of the story.”

For example, many of the Houston-area facilities advertise that they accept Blue Cross and Blue Shield of Texas, the state’s largest insurer. But the Chronicle’s review found that only five — about 10 percent — are in that insurer’s network.

Those findings are consistent with a statewide report by AARP Texas, to be released Monday at a state Senate committee hearing, that found 77 percent of the state’s 215 free-standing emergency rooms said they “take” or “accept” Blue Cross and Blue Shield insurance, but were out-of-network.

Free-standing emergency rooms defend their websites, describing concerns raised by advocacy groups and Texas lawmakers as manufactured outrage.

“I don’t see a problem with saying they ‘accept,’” said Dr. Carrie de Moor, CEO of Code 3 Emergency Partners, a Frisco-based network of free-standing emergency rooms, urgent care clinics and a telemedicine program. She insisted that patients understand that accepting someone’s insurance is different from being in that company’s network.

It may seem like a hair-splitting distinction, but it can carry high costs, health policy experts said.

Obvious point #1: It’s ridiculous that we live in a society where basic medical needs, including emergency care, are not met. It’s utterly scandalous that prior to the Affordable Care Act, there were thousands upon thousands of bankruptcies caused every year by medical issues. Plenty of other countries have figured this out. Our standard of medical care is no better than theirs. It’s just more expensive.

Obvious point #2: For those who believe in the power of the free market, why is it that medical services, especially those tied to emergency and hospital care, are so utterly opaque when it comes to their pricing? Think of all the other goods and services you buy. In nearly all of them, you know up front how much it’s going to cost. That is universally untrue for the vast majority of medical services, from basics like painkillers and bandages to anaesthesia and specialist fees to higher-end products like EKGs and colonoscopies. There’s no such thing as a free market with unknowable prices. You want to move towards something like a free market in health care, fix that.