EMTALA and Ophtho

[4ophtho]

I am on call in a metropolitan level 1 trauma center. My hospital has a group of comprehensive ophthalmologists that rotate taking call. We do not have a residency program or subspecialty coverage. In the same area there is a university hospital with a large ophthalmology residency department.
I have had a few experiences of repairing an open globe while on call. Of course, the OR staff does not know anything about eye cases. While they have 8-0 and 9-0 nylon / silk sutures, they are on tapered needles that bend going through sclera making for a frustrating surgery. Their ocular surgery kits are for oculoplastics, and lack some of the finer instruments for doing open globe repairs. This is not the biggest issue though: for postoperative care, these mostly uninsured patients that need a Retina specialist don't have any other option than to go to the same university hospital's resident clinic. This clinic does not accept urgent referrals, and the only way for a patient to get in their clinic quickly is to go through the ER or urgent care clinic. While I don't feel comfortable sending my postop open globe to the university hospital ER for postoperative care where they can see a Retina specialist, I don't have another option for these uninsured patient.

My questions are:
Can I get in trouble with EMTALA for denying a request to transfer an open globe for the above reasons? Of course, if they come to my ER first, I am stuck with them.

For those of you who are in private practice that may have had similar experiences, how have you been able to get subspecialty postoperative care for eye trauma cases that do not have insurance?

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[Dusn]

I don't take call at the hospital unless they get the resources I need. It sounds like this place should not have Ophtho coverage.

 

[4ophtho]

I don't take call at the hospital unless they get the resources I need. It sounds like this place should not have Ophtho coverage.

Its a level 1 trauma center. My understanding is that all level 1 trauma centers have to have ophthalmology coverage in order to qualify / maintain their certification.

I have a call in to OMIC about my responsibility and liability. I'll let you know what they say.

 

[MstaKing10]

sounds like you need to raise a stink about not having the appropriate equipment to perform the surgery. Getting sutures is easy enough, and instruments shouldn't be too difficult either. I think the standard of care is close the globe then refer to retina, so you're not doing anything wrong here. Most university programs would be delighted that you are not punting off an open globe but rather doing the right thing in closing it, then referring to retina urgently. Perhaps building a relationship with your retina colleagues at the university would make this process less painful? I'm sure if you reach out to them and explain the situation they can work with you to open up some room for your post ops. I'm also sure this is not a common issue, I mean, how many uninsured patients with open globes are you closing in a month and how many of those actually need to see a retina specialist? I'm sure the numbers are low. As a retina fellow I absolutely loved these cases because they were great learning experiences.

 

[Dusn]

"Its a level 1 trauma center. My understanding is that all level 1 trauma centers have to have ophthalmology coverage in order to qualify / maintain their certification."

Exactly. This should give you and the other ophthalmologists there all the more leverage to ask the hospital for what you need to properly treat your patients or you stop taking call there and they lose their level 1 trauma center designation. They don't care as long as you're willing to take responsibility. If they have no ophthalmologist, eye patients would have to go to the university hospital where it sounds like they would have better resources at this point in time.