We were once fortunate to have in place a reliable option to the imaging weight limit dilemma discussed by Dr. Baehren in August’s “In the Arena” (ACEP News, August 2009, p. 2). A regional veterinary college allowed transfer of our patients there for use of their equine CT scanner. They could readily transfer such patients back to us with our thanks and without concern for EMTALA, because such facilities are NOT subject to this law—a glaring oversight of EMTALA’s original and subsequent draftsmen. (After Congress resolves slightly more pressing matters, an appropriate amendment should be considered: IMPALA—the Interfacility Megapatient Prohibition and Limitation Act.)

It turned out, however, that a problem surfaced not with the law, but with the free market. Third-party payers began to balk at reimbursing the “animal docs” at the “animal facility” for services rendered to their covered humans. The vets were left holding the bag to seek payment from the humans directly and, evidently, didn’t do so well in that endeavor. (I guess owners of thoroughbreds are better payers than those who eat bread too thoroughly.)

End result: Human ED patients are now verboten at the vet school.

Dr. Peter J. Mariani

Syracuse, N.Y.