July 20, 2021: The Legal Action Center (LAC) today released a new report examining the legal obligations of hospitals to provide evidence-based and lifesaving care to emergency department patients with substance use disorders. This comes after overdose death rates in the US reached record highs during the pandemic, with nearly 30 percent more overdose deaths in the year leading up to December 2020 than during the previous 12-month period.

As the primary point of access to the healthcare system for many individuals, hospital emergency departments have a critical role to play in delivering medical care that helps patients with substance use disorder survive and access further treatment. Specifically, evidence-based practices include substance use disorder screening and diagnosis, administration of opioid agonist medications, and treatment referral facilitation along with naloxone distribution or prescription, as appropriate. The report, EMERGENCY: Hospitals Can Violate Federal Law by Denying Necessary Care for Substance Use Disorders in Emergency Departments, concludes that hospitals that fail to provide this care could face legal liability under four separate federal laws: the Emergency Medical Treatment and Labor Act (EMTALA); the Americans with Disabilities Act (ADA); the Rehabilitation Act (RA); and Title VI of the Civil Rights Act (Title VI). Specifically:

• Hospitals may violate EMTALA when they do not conduct a medical screening examination for people who come to the emergency department with a substance use-related condition and provide stabilization services for patients diagnosed with substance use disorder.
• Hospitals violate the ADA and RA when their emergency departments deny evidence-based practices for substance use disorder based on unfounded stereotypes, rather than legitimate medical considerations.
• Hospitals violate Title VI when they deny evidence-based practices in the emergency department because of a patient’s race or ethnicity, or when their denial and/or adoption of these practices has a racially disparate impact.

Further, emergency departments’ failure to implement evidence-based practices exacts a particularly harsh toll on Black, Latinx, and Indigenous communities, who, in addition to being more likely to seek care in emergency departments because of more limited access to primary care, are experiencing the highest increases in overdose death rates in some geographic areas for some substances.

“With more than 19 million U.S. adults currently living with a substance use disorder, and amidst an escalating overdose crisis, emergency departments not only have the role and resources to address life-threatening emergencies, but, as our report shows, the legal obligation to do so,” says Sika Yeboah-Sampong, staff attorney and one of the report authors from the Legal Action Center.

“This should be a wakeup call for emergency departments across the country.” “This report adds to the professional consensus that providing effective addiction care in the emergency department is an obligation, not an option,” says Joshua Sharfstein, MD, director of the Bloomberg American Health Initiative at the Johns Hopkins Bloomberg School of Public Health, which provided funding for this report. “Emergency departments offering critical addiction services are saving lives in their communities.”

To read the full report:  https://americanhealth.jhu.edu/addiction-emergency

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