Dear Dr. Setnik,
.PP
Since the time of our recent discussion,
I have had the opportunity to review
Title 42, Section 1395dd of the United States Code
a copy of which I enclose.
.PP
It is my interpretation that this law authorizes a screening
physician in the Emergency Department
to summon a physician like myself whose is "on call"
if and only if the screening physician makes a determination
that the patient has an "emergency medical condition" which
has not been "stabilized".
.PP
The Code further specifies:

      (B) The term ''stabilized'' means, with respect to an emergency
    medical condition described in paragraph (1)(A), that no material
    deterioration of the condition is likely, within reasonable
    medical probability, to result from or occur during the transfer
    of the individual from a facility, or ...

.PP
Patients in the Mount Auburn Hospital Emergency room with eye disease
who require medical or surgical treatment not available at Mount Auburn
are customarily transferred to the Massachusetts Eye and Ear 
Infirmary, five miles distant, to which the patient can be 
conveyed by ambulance in less than fifteen minutes.
A patient in the Mount Auburn Emergency room whose eye diaease 
is not "stabilized", therefore, is one who, in the course of the
fifteen minute transfer will suffer a material deterioration
in his condition which deterioration would have been
preventable if an "on call" physician such as myself
had "stabilized" the patient at Mount Auburn Hospital.
Since, in my judgment, such a situation would be extraordinarily rare.
I conclude that an "on call" physician is likely to be summoned to the Mount
Auburn Emergency Room under color of 42 U.S. Code 1395dd
only as a result of the misrepresentation of the law, the facts,
or of both.
.PP
Please note that the $50,000 penalty imposed by the law
applies not only to the on-call physician
who wrongfully fails to appear, but also to
the screening physician who wrongfully summons him,
and
    "(ii) misrepresents an individual's condition or other
    information, including a hospital's obligations under this
    section,... "
.PP
Please note also that aside from the $50,000 administrative penalty,
Section 1395dd makes other remedies available to an aggrieved individual:

    (A) Personal harm
      Any individual who suffers personal harm as a direct result
    of a participating hospital's violation of a requirement of
    this section may, in a civil action against the participating
    hospital, obtain those damages available for personal injury
    under the law of the State in which the hospital is located,
    and such equitable relief as is appropriate.
    (B) Financial loss to other medical facility
      Any medical facility that suffers a financial loss as a
    direct result of a participating hospital's violation of a
    requirement of this section may, in a civil action against the
    participating hospital, obtain those damages available for
    financial loss, under the law of the State in which the
    hospital is located, and such equitable relief as is
    appropriate.
.PP
I respectfully suggest that you discuss these issues with
the hospitals' attorney,
that you review Emergency Department policies,
in the light of the objections that I have raised
and that you advise the
emergency room personnel under your direction accordingly.