Originally Posted by kugel
So here are answers about who gets to decide what is "medically stable" for transport, from the CMS regs and guidelines, from US Circuit Court, and from a large professional organization.
The obligations of receiving hospitals are found at 42 USC 1395dd(g), 42 CFR 489.24(f) and in the Interpretive Guidelines at tag no. A-2411/C-2411.
In the case St. Anthony Hospital v. U.S Department of Health and Human Services, 309 F.3d 680 (a 2002 case for the 10th Circuit), an Oklahoma hospital got in trouble for refusing a trauma patient because the on-call thoracic and vascular surgeon refused to accept the case. The appellate court said:
We note that a practical matter, however, any hospital with specialized capabilities or facilities that refuses a request to transfer an unstabilized patient risks violating (EMTALA) to the extent that it chooses to second-guess the medical judgement of the transferring hospital.
The issue of conditioning the acceptance of a transfer on additional tests, etc. is discussed in a 2007 CMS memorandum (S&C 07-20) subsequently incorporated in tag. no A-2411/C-2411 of the Interpretive Guidelines..., CMS declared that placing conditions on the acceptance of transfers is disfavored by CMS, and will likely subject the receiving hospital to an EMTALA violation. In addition, CMS has cautioned hospitals against patient delays or disparate treatment of patients based on financial or insurance status...
The California Hospital Association manual on EMTALA goes on to add a Compliance Tip:
It is strongly recommended that conditions for accepting a transfer not be made on an ad hoc basis at the time of a requested transfer, because the discussions could delay an appropriate transfer of an emergency patient. Instead, arrangements should be handled in advance through transfer agreements between hospitals.
And, most importantly, at page 7.11, describing tips for managing the transfer acceptance process:
Do not place conditions on the transfer, including requests for the sending hospital to perform more tests, use a specific mode of transport, or take the patient back after the stabilizing services are performed.
Where I work, I have NO lab/test capability, no IV's, etc., so I'm completely dependent on the ED workup in that regard. But I cannot demand any additional tests without risking an EMTALA violation on the hospital AND on myself.
Therefore, when I'm faced with a transfer request that is missing some data I'd really like (Trazodone OD with only 1 EKG done 30min post OD, or 79 yo suddenly incoherent w/o any imaging) I can suggest the tests I'd like and the reasons why they would be very helpful. When I explain myself and make polite requests, I usually get the results I'm after.
Hope this helps