The Bush administration is relaxing federal regulations that require all Medicare-participating hospitals to provide appropriate medical screening and stabilizing treatment to any person who comes to the emergency department, regardless of ability to pay.

The revisions to the 1986 Emergency Medical Treatment Act (EMTALA) go into effect on Nov. 10 and could make it difficult for patients to get certain types of emergency care at some hospitals or hospital-owned clinics.

Under the new rule, patients seeking emergency care can only receive it at a "designated emergency department." A designated emergency department is defined as any facility licensed by the state or advertised to the public as an emergency room, or one providing "urgent care." Any office that devoted at least one-third of its outpatient visits to treating emergency cases last year will also qualify.

"Radiology clinics and other outpatient facilities will have no obligations to provide emergency medical treatment under the new regulations," said Ellen Griffith, a spokeswoman for the Center for Medicare and Medicaid Services (CMS).

The revision also clarifies that there is no federal mandate that a specialist, such as a neurologist or an orthopedic surgeon, be on call 24 hours a day.

If there's no requirement for specialists to be on call 24 hours a day, patients in need of emergency care by a specialist may not receive it in time, said Claudia Lennhoff, executive director of Champaign County Health Care Consumers.

Carle Foundation Hospital will continue to have on-call specialists 24 hours a day, said Allen Rinehart, emergency department manager at Carle Hospital.

The rulings have raised concerns that it will be easier for hospitals to turn away patients who need emergency care but cannot afford it.

"There is no relationship to ability to pay," said Dr. Gregory Smith, emergency department physician at Carle Foundation Hospital. "We have to evaluate a patient's medical condition before we even identify who they are. Everyone with an emergency condition gets care."

Patients admitted to a hospital, including those who are admitted through the emergency department, will no longer be protected under EMTALA regulations.

If they are uninsured they may no longer have access to a specialist, Lennhoff said. "Their access and protections are rolled back."

The revisions to the act come as a result of problems with litigation.

"Over time there's been a lot of questions on how (EMTALA) should be interpreted," Griffith said. "The final ruling makes it clear."

Problems arise when patients seek non-emergency care at an emergency facility, costing emergency departments time and money, Smith said.

He said he is in favor of the new rulings because they will help prevent abuse of the act. EMTALA has been invoked regularly in lawsuits.

In the last five years, the government has collected more than $4 million from 164 hospitals and doctors accused of violating the law, according to a report by the New York Times.

"Some of these cases are a detriment to patient care," Smith said.

The act will allow ambulances to take patients to a variety of hospitals or clinics. Under the old EMTALA if an ambulance was owned by a hospital it would have to return to that hospital, even if it passed four other emergency departments on the way, Griffith said.

Griffith said the goal of the EMTALA revisions is to "provide appropriate care more efficiently and reduce regulatory burden on hospitals that does not contribute to patient care."