COBRA: implications for emergency medicine.

The potential impact of COBRA is staggering and must be confronted. The ultimate scope and effects will take shape quickly. Federal regulations will provide some of the rules, but the most important definitions under the law will develop in court. Because of a lack of understanding hospitals may not have been in compliance with COBRA's strict terms since August 1986 and may only become educated on COBRA through the legal process. Currently, one COBRA lawsuit has been filed in the Chicago court system, and at least one physician group in California has paid a $25,000 fine for COBRA violations. Litigation in the initial phase of COBRA is likely as most hospitals continue to be unaware of the implications of COBRA legislation. EDs, emergency medical services programs, and interhospital transport programs must begin an immediate effort to examine and develop policies to comply with COBRA. Without an effective educational, compliance, and risk management effort, any emergency medical services program or hospital may become a defendant under COBRA legislation. Delays in understanding and implementing the requirements of COBRA may adversely affect the health care system rather than improve it.