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Substandard Care, Antidumping, and George Orwell-Reply

Helen R. Burstin, MD, MPH; Troyen A. Brennan, MD, JD, MPH
JAMA. 1993;269(11):1385. doi:10.1001/jama.1993.03500110052025.
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In Reply.  —We share Dr Gaddis' concerns regarding the care of the medically indigent in emergency departments. As he correctly points out, our data collection efforts preceded antidumping legislation. However, we did not find that patients were turned away from emergency departments but instead were treated in the emergency department in a substandard fashion. None of the cases we uncovered would have been actionable under COBRA. Emergency departments that rely on physicians trained in emergency medicine may provide higher quality care, but we were unable to comment on this issue for our study. Our concerns about health care in the emergency department have in part led us to undertake a multiple institution study of emergency department care.Dr Evans' description of George Orwell's experience as a poor patient in a hospital is very dramatic. Orwell's dramatization, however, suggests sinister intentions or gross callousness. Our concern is with the system of


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