EMTALA violations in Maine.

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love it. wish we could implement more of this
 
Dr.McNinja said:
I'm sorry, what? You want to break the law, risk getting your hospital to lose Medicare funding (ie a death knell), and harm patients?
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im saying I wish it was legal to kick our malingering patients out the door as soon as they turned up
 
LOL - funny comments.

The article writes "The licensing inspectors also found that one of the hospitals, Central Maine Medical Center, instructed area law enforcement and ambulance services not to take patients with mental health problems to the medical center because it didn’t provide the services those patients needed."

That doesn't sound like an EMTALA violation. The patient has not arrived to the ER or hospital property asking for a medical screening exam, yet.

Overall I am surprised this kind of stuff with mental health patients still happens.

Suppose that a patient is in the ER with a psychiatric complaint. Then they commit a crime in the ER in front of police, who then want to arrest the patient and lawfully can do so immediately. Does the patient stay in the ER until they no longer have a medical or psychiatric emergency? The simple answer is yes? Which law gets invoked first?

Lastly, here is a link to the past 8 years of OIG cases for EMTALA violations, nationwide.
Civil Monetary Penalties and Affirmative Exclusions | Fraud | Office of Inspector General | U.S. Department of Health and Human Services
Do a search for "EMTALA" and you should get like 56 hits. Some of these are ridiculous...surprised they would ever happen.
 
ainsky said:
im saying I wish it was legal to kick our malingering patients out the door as soon as they turned up
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Then how do you know they are malingering? Just as paranoids sometimes have enemies, malingerers eventually actually get sick.

thegenius said:
Then they commit a crime in the ER in front of police, who then want to arrest the patient and lawfully can do so immediately. Does the patient stay in the ER until they no longer have a medical or psychiatric emergency? The simple answer is yes? Which law gets invoked first?
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Key word: emergency. This is nothing unusual: I think about 75% of the people arrested in my town end up at the ED between arrest and jail. This just cuts out the trip between arrest and the ED.
 
thegenius said:
LOL - funny comments.

The article writes "The licensing inspectors also found that one of the hospitals, Central Maine Medical Center, instructed area law enforcement and ambulance services not to take patients with mental health problems to the medical center because it didn’t provide the services those patients needed."

That doesn't sound like an EMTALA violation. The patient has not arrived to the ER or hospital property asking for a medical screening exam, yet.
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Unless you are on diversion for capacity issues this is an EMTALA violation.
 
goodoldalky said:
Unless you are on diversion for capacity issues this is an EMTALA violation.
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Not if they're not on campus it isn't. Also, if there's a better equipped hospital in town, they actually should go there. It's why stroke, trauma, and cardiac centers exist. If the other shop uses the same mobile crisis system, I agree it's distasteful, but not illegal. It's only illegal if you dissuade them once on campus.
 
goodoldalky said:
Unless you are on diversion for capacity issues this is an EMTALA violation.
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Well, we are not lawyers. At least I'm not a lawyer. The patient has not yet asked for a screening medical examination because the event hasn't happen yet. If they are en route with a patient, yes in general you can't divert unless there are very specific criteria.
 
Dr.McNinja said:
Not if they're not on campus it isn't. Also, if there's a better equipped hospital in town, they actually should go there. It's why stroke, trauma, and cardiac centers exist. If the other shop uses the same mobile crisis system, I agree it's distasteful, but not illegal. It's only illegal if you dissuade them once on campus.
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Exactly right. This is why it's legal to direct EMS to transport trauma patients to trauma centers, STEMI patients to chest pain centers, and OB emergencies to an OB facility. It is actually in the best interest of the patient to go to a facility that has the ability to take care of their problem.
 
Dr.McNinja said:
Not if they're not on campus it isn't. Also, if there's a better equipped hospital in town, they actually should go there. It's why stroke, trauma, and cardiac centers exist. If the other shop uses the same mobile crisis system, I agree it's distasteful, but not illegal. It's only illegal if you dissuade them once on campus.
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Does that change if the only two shops in town are both doing this?
 
Dr.McNinja said:
Um, what?
Court doesn't work that way. Not criminal court anyway. You have to actually break the law.
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Criminally, no. But I have never heard of EMTALA even coming close to a criminal prosecution. I may have completely missed it, but I don't think that is even theoretically possible.

However, in most government health care investigations, it does not start with a complaint about a specific violation and go from there; it is rather a complaint that something "bad" is taking place and then them looking for something to nail the organization/physician with.
 
It's not criminal court, you're correct. And yes, they start with complaints. But they don't hammer people who aren't actually breaking the law. Generally you have to be pretty egregious to get even fined. They like to warn a lot.
 
See, UPMC, in one of our annual training modules, had a scenario where a person calls the hospital, and gets the ED, and telling them "we would have to transfer you, because we don't have that service here" is construed as an EMTALA violation.

I didn't write it, and that is just the dictate from the US Steel Tower in Pittsburgh.
 
Apollyon said:
See, UPMC, in one of our annual training modules, had a scenario where a person calls the hospital, and gets the ED, and telling them "we would have to transfer you, because we don't have that service here" is construed as an EMTALA violation.

I didn't write it, and that is just the dictate from the US Steel Tower in Pittsburgh.
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Agreed. We are not allowed to say such things on the phone per enterprise-wide policy. All we can say is "we don't have xyz service here, but we are happy to evaluate the patient and arrange transfer as needed." Designation as a trauma facility or chest/stroke/psych receiving center doesn't mean you can turn people or ambulances away, but such designations can assist EMS in deciding where they choose to bring patients.
 
Apollyon said:
See, UPMC, in one of our annual training modules, had a scenario where a person calls the hospital, and gets the ED, and telling them "we would have to transfer you, because we don't have that service here" is construed as an EMTALA violation.

I didn't write it, and that is just the dictate from the US Steel Tower in Pittsburgh.
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Depending on what's said that isn't a violation. I wonder how the courts would construe this.

Sometimes these training modules are appropriately conservative because even though one might win an EMTALA court proceeding, doesn't mean the hospital wants to go through with it.

You can say "Sure we don't have neurosurgical abilities to clip your bleeding aneurysm. But if you can still hear me and are not unconscious, please come to my ER and I'll transfer you to another hospital."

No EMTALA violation there!!!
 
A lot, and I mean A LOT, of that, is the hospital not wanting to lose those evals. A hospital I worked at came down hard on us for recommending on the radio to EMS that they take pediatric patients to a pediatric hospital, or chest pain patients to a chest pain center. This was after multiple STEMIs brought to us that then required ~1hr transfer processes.
There's no rule. You can refuse if you don't have capacity. If you don't have that service (ortho, trauma, psych, etc), then you can refuse until they're on campus.

When was the last time your hospital considered that TJC doesn't have a rule against drinks at the workstation? I wouldn't use their interpretation as the actual law, just the local rules. You won't win against the hospital, but you don't have to worry about a federal lawsuit.

OTOH, if you have the capability, don't refuse transfers unless theres no room at the inn. I can't rule in or out anything at the other facility (unless I can see those images on PACS or whatever). You will always lose that battle.
 
Apollyon said:
Yeah, all we are told is to tell any and all that "we are ecstatic to see you as a patient!"
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Funny....I tell them I can’t dispense medical advice over the phone. I try hard NOT to say, please come into the ER. And I work at a 100% RVU place!
 
When reading a story in the news like this, always ask yourself, “Are both sides of the story presented, here?” Often, you have an allegation, the story is written by a reporter based on allegations by someone claiming something. Often there’s a lawsuit being filed, or some formal complaint. More often than not, the person or entity accused has not had a chance to comment, or has been advised not to based on legal advise, so that the charges can be faught in court, not in the media.

This concept also applies if you’re accused of some egregious malpractice act you did not commit. Horrible charges are alleged in the media. The first thing your lawyers tell you is, “Do not comment publicly.” While that’s often sound legal advice, it gives the accuser a tactical advantage in the court of public opinion. Accusations go undefended in public and often the other side (correct or not) isn’t heard, except behind closed doors, in court.

I’m not taking a side here, and I have no knowledge of the specifics of this case, although the allegations (if true) certainly sound bad. I’m just reminding that there always are two sides. Often in the media, it’s only the accuser’s allegations being heard, initially, whether true or not.
 
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Dr.McNinja said:
Not if they're not on campus it isn't. Also, if there's a better equipped hospital in town, they actually should go there. It's why stroke, trauma, and cardiac centers exist. If the other shop uses the same mobile crisis system, I agree it's distasteful, but not illegal. It's only illegal if you dissuade them once on campus.
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It’s a grey area, and there *may* be some variability depending on what federal ciurcuit court jurisdiction you practice under. Here is a case of an EMTALA violation for a patient in non hospital owned ambulance, not on hospital campus, who was directed elsewhere.


First Circuit Holds That Diversion of Nonhospital-Owned Ambulance Can Violate EMTALA
Intelligence | Foley.com

The stroke and PCI center issues are different primarily because EMTALA is a hospital obligation not an EMS obligation. What I mean by that is, most EMS systems operate with policies and procedures to autonomously take patients to the closest appropriate facility (ie: THEY can say we are taking this clear STEMI to a the closest PCI facility provided these criteria are met - EMTALA is not even a question - but if they attempt to present at a non-PCI hospital and the hospital attempts to divert them the HOSPITAL is at EMTALA risk for diverting their transport).

The bottom line is EMTALA is a complex risk mitigation statute that is at times vague and open to interpretation. Tread carefully.
 
Second line.
Although the United States Court of Appeals for the Ninth Circuit issued a similar ruling in 2001, both decisions appear to conflict with the plain meaning of the EMTALA regulations, which states that a nonhospital-owned ambulance does not become subject to EMTALA until it arrives on hospital property.
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Later in there.
Most EMTALA experts thought at the time that the Arrington decision was wrongly decided and believe the First Circuit has now compounded the error.
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Thankfully I don't practice in either of those circuits. I find it amazing that this hasn't been appealed to the Supreme Court either.
 
goodoldalky said:
It’s a grey area, and there *may* be some variability depending on what federal ciurcuit court jurisdiction you practice under. Here is a case of an EMTALA violation for a patient in non hospital owned ambulance, not on hospital campus, who was directed elsewhere.


First Circuit Holds That Diversion of Nonhospital-Owned Ambulance Can Violate EMTALA
Intelligence | Foley.com

The stroke and PCI center issues are different primarily because EMTALA is a hospital obligation not an EMS obligation. What I mean by that is, most EMS systems operate with policies and procedures to autonomously take patients to the closest appropriate facility (ie: THEY can say we are taking this clear STEMI to a the closest PCI facility provided these criteria are met - EMTALA is not even a question - but if they attempt to present at a non-PCI hospital and the hospital attempts to divert them the HOSPITAL is at EMTALA risk for diverting their transport).

The bottom line is EMTALA is a complex risk mitigation statute that is at times vague and open to interpretation. Tread carefully.
Click to expand...
That case doesn't really address whether you can recommend the stemi patient be directed to a stemi facility or the stroke patient can be directed to a strike facility as this thread is discussing.

That case was brought because the patient was allegedly diverted from a hospital that clearly had the specialty she needed simply because she didn't have insurance coverage. It's not surprising the court sided with the patient.
 
KGflyboy said:
That case doesn't really address whether you can recommend the stemi patient be directed to a stemi facility or the stroke patient can be directed to a strike facility as this thread is discussing.

That case was brought because the patient was allegedly diverted from a hospital that clearly had the specialty she needed simply because she didn't have insurance coverage. It's not surprising the court sided with the patient.
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If the question is whether EMTALA applies to these patients, the answer is that the courts have said yes despite the law being a grey area.

The reason for refusal is sort of irrelevant - if a patient is presented to a facility under the auspices of EMTALA, they are required to provide an MSE and stabilization within the capability of the facility. (If it is a STEMI and you have no cardiologist, this means diagnosis and therapy to the extent you can provide it, transfer if necessary - same for stroke, trauma, psych, OB, etc., even if you do not have those specialists).

The combination of the above two points demonstrates why the case in the OP’s post is an EMTALA problem.
 
goodoldalky said:
If the question is whether EMTALA applies to these patients, the answer is that the courts have said yes despite the law being a grey area.

The reason for refusal is sort of irrelevant - if a patient is presented to a facility under the auspices of EMTALA, they are required to provide an MSE and stabilization within the capability of the facility. (If it is a STEMI and you have no cardiologist, this means diagnosis and therapy to the extent you can provide it, transfer if necessary - same for stroke, trauma, psych, OB, etc., even if you do not have those specialists).

The combination of the above two points demonstrates why the case in the OP’s post is an EMTALA problem.
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Our EMS has protocols built in to address this. I don't think we would have been able to operate in the open this long if it was an emtala violation. Our EMS automatically bypasses a hospital without a Cath Lab to go to a hospital with a Cath Lab if the patient has a stemi. Would it be a violation of emtala to remind EMS over the radio that patient should be transported difrectly to the Cath Lab hospital if they happen to "forget" the protocol. I don't think so.

The court case above does not address this. Turning them away upon arrival is a different story.
 
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Vandalia said:
Key word: emergency. This is nothing unusual: I think about 75% of the people arrested in my town end up at the ED between arrest and jail. This just cuts out the trip between arrest and the ED.
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CMS considers an "emergency" much different than what an ED doc considers an emergency. I view an emergency as an unstable patient at risk of imminent demise. CMS views an unstable or emergency patient as one that needs stabilizing care. Stabilizing care often is interpreted differently by CMS regulators, but the following are actual EMTALA violations:
  • RLQ abdominal pain; doesn't get CT. Has appendicitis, ruptures. Comes back next day, gets admitted, IR drains. EMTALA violation.
  • Sudden intense headache. No CT in a timely fashion. Has a ntSAH. Dies. EMTALA violation.
  • Esophageal food impaction. Admitted for GI to take to lab. Admitted at 4 am, GI lab opens at 7 am. Perforates, becomes septic. EMTALA violation.
  • Esophageal food impaction. ENT credentialed to perform endoscopy. ENT called but states he hasn't done them in years. Patient transferred to facility with GI. Aspirates on way to other hospital, becomes hypoxic, then dies. EMTALA violation. (CMS ruled that ENT should not have been recredentialed for procedure if he couldn't perform anymore.)
There are a lot of EMTALA violations that are committed daily. It's just bad luck when you're caught.
 
KGflyboy said:
Our EMS has protocols built in to address this. I don't think we would have been able to operate in the open this long if it was an emtala violation. Our EMS automatically bypasses a hospital without a Cath Lab to go to a hospital with a Cath Lab if the patient has a stemi. Would it be a violation of emtala to remind EMS over the radio that patient should be transported difrectly to the Cath Lab hospital if they happen to "forget" the protocol. I don't think so.

The court case above does not address this. Turning them away upon arrival is a different story.
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CMS has not been consistent with EMTALA violations when paramedics make radio contact with the hospital. Some CMS investigators have ruled them as violations, while others have viewed them as appropriate.
 
southerndoc said:
CMS considers an "emergency" much different than what an ED doc considers an emergency. I view an emergency as an unstable patient at risk of imminent demise. CMS views an unstable or emergency patient as one that needs stabilizing care. Stabilizing care often is interpreted differently by CMS regulators, but the following are actual EMTALA violations:
  • RLQ abdominal pain; doesn't get CT. Has appendicitis, ruptures. Comes back next day, gets admitted, IR drains. EMTALA violation.
  • Sudden intense headache. No CT in a timely fashion. Has a ntSAH. Dies. EMTALA violation.
  • Esophageal food impaction. Admitted for GI to take to lab. Admitted at 4 am, GI lab opens at 7 am. Perforates, becomes septic. EMTALA violation.
  • Esophageal food impaction. ENT credentialed to perform endoscopy. ENT called but states he hasn't done them in years. Patient transferred to facility with GI. Aspirates on way to other hospital, becomes hypoxic, then dies. EMTALA violation. (CMS ruled that ENT should not have been recredentialed for procedure if he couldn't perform anymore.)
There are a lot of EMTALA violations that are committed daily. It's just bad luck when you're caught.
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Where do you get these? I would love to read them. I found
Civil Monetary Penalties and Affirmative Exclusions | Fraud | Office of Inspector General | U.S. Department of Health and Human Services
and I search for "EMTALA" and get a bunch of hits.

The hardest one to swallow above is the first one - and I bet the violation was "not an appropriate medical screening examination." I bet some of these decisions (like #1 above) suffer from hindsight bias. The fact that the patient had ruptured appendicitis means we didn't do an appropriate screening test.
 
Several sources. I do a lot of healthcare legislative advocacy and expert witness/peer review. I've had a lot of EMTALA training... some of this comes directly from CMS representatives. You'd be surprised at how they interpret things. I also subscribe to a few legal healthcare newsletters and podcasts (ED Legal Letter, Risk Management Monthly, etc.).
 
Here's the appy case (from the link you provided) where the hospital was fined. Apparently it was the same day:
California Hospital Settles EMTALA Case Involving Patient Dumping Allegations
Olive View - UCLA Medical Center - a county hospital in Sylmar, CA - entered into a settlement agreement with the Office of Inspector General (OIG) of the U.S. Department of Health and Human Services, effective May 23, 2014. The $40,750 settlement resolves allegations that Olive View violated the Emergency Medical Treatment and Labor Act, (EMTALA), by failing to provide an individual with an appropriate medical screening examination (MSE) within the capability of the hospital's emergency department in order to determine whether he had an emergency medical condition.

Specifically, the individual presented to the Olive View emergency department with signs of appendicitis and severe abdominal pain that he rated at a 10 on a 10-point scale. Despite his severe pain and symptoms, he was forced to wait for several hours to receive an MSE. After waiting for 6.5 hours, he left to seek medical screening and treatment at another hospital, where he was diagnosed with acute appendicitis with a large peritoneal abscess and had to undergo an immediate laparoscopic appendectomy. According to EMTALA, if an individual comes to a hospital emergency department and a request is made on his/her behalf for examination or treatment for a medical condition, the hospital must provide for an appropriate MSE within the capability of the emergency department to determine whether or not an emergency medical condition exists. OIG was represented by Associate Counsel Odies Williams, IV. Olive View was represented by Brandi M. Moore of the Los Angeles County Counsel's Office.

Patient struck a security guard and was arrested instead of receiving psychiatric care:
Floyd Medical Center in Georgia Settles Case Involving a Patient Dumping Allegation
On January 6, 2016, Floyd Medical Center (FMC), in Rome, Georgia, entered into a $50,000 settlement agreement with OIG. The settlement agreement resolves allegations that FMC violated the Emergency Medical Treatment and Labor Act (EMTALA) when it failed to evaluate and treat a mentally ill patient who was transferred from another hospital to FMC for involuntary inpatient psychiatric care. OIG's investigation revealed the following. The patient was aggressive and combative upon his arrival to FMC's emergency department. Three security personnel, including an off-duty police officer working for FMC, attempted to restrain the patient while a nurse went to retrieve medication to calm him down. When the security personnel entered the room, the patient attempted to strike one of them. In response, a security officer hit the patient in the head and pushed him until he fell on the bed. The security officers then wrestled the patient to the ground and handcuffed him, causing injury to the patient. When the nurse returned, the security personnel informed her that the patient's behavior was beyond what FMC could safely control. Without psychiatric evaluation or appropriate medical treatment, the emergency department physician medically cleared the patient and he was taken to jail. Despite having an on-call psychiatrist and capabilities to treat the patient, at no point was he evaluated or treated by a mental health professional. Under EMTALA, hospitals can be fined up to $50,000 per violation. Senior Counsel Sandra Sands represented OIG.


Missed meningitis EMTALA:
Lake City Medical Center in Florida Settles Case Involving a Patient Dumping Allegation
On December 21, 2015, Lake City Medical Center (LCMC), in Lake City, Florida, entered into a $25,000 settlement agreement with OIG. The settlement agreement resolves allegations that LCMC violated the Emergency Medical Treatment and Labor Act (EMTALA) when it failed to provide an appropriate medical screening examination and stabilizing treatment for a 42-year-old female. OIG's investigation revealed the following. The patient arrived at LCMC's emergency department complaining of headaches, right arm pain and diarrhea the previous day. She was seen by a physician's assistant and then asked to wait in the waiting room. While there, she vomited and continued to complain of right arm pain. The physician's assistant concluded that she did not need immediate medical attention and asked the patient to leave the emergency department. When the patient resisted and her family complained, the emergency department personnel called the police to escort her out of the emergency department. After unsuccessful attempts by police and paramedics to get the patient into a car, her family requested the emergency department call an ambulance so she could be taken to another hospital. When the ambulance arrived, the patient was unresponsive and taken to another hospital where she was placed on a ventilator in the Intensive Care Unit and later diagnosed with bacterial meningitis. Under EMTALA, a small hospital can be fined up to $25,000 per violation. Senior Counsel Sandra Sands represented OIG.


Didn't x-ray a hip. Clearly a missed hip fracture isn't an emergency in most ER docs' view, but it's an EMTALA violation to miss a hip fracture:
12-29-2015
Moses H. Cone Memorial Hospital in North Carolina Settles Case Involving a Patient Dumping Allegation
On December 29, 2015, Moses H. Cone Memorial Hospital (MCMH), in Greensboro, North Carolina, entered into a $35,000 settlement agreement with OIG. The settlement agreement resolves allegations that MCMH violated the Emergency Medical Treatment and Labor Act (EMTALA) when it failed to provide an adequate medical screening examination and stabilizing treatment for an 86-year-old female who presented to MCMH's emergency department after falling at home. OIG's investigation revealed that although an emergency room doctor evaluated her knee pain and performed other imaging tests, he did not fully evaluate her reported severe pain and inability to ambulate. OIG alleged she was discharged with a displaced fracture of her hip. Senior Counsel Sandra Sands represented OIG.
 
southerndoc said:
Here's the appy case (from the link you provided) where the hospital was fined. Apparently it was the same day:.
California Hospital Settles EMTALA Case Involving Patient Dumping Allegations
Olive View - UCLA Medical Center - a county hospital in Sylmar, CA - entered into a settlement agreement with the Office of Inspector General (OIG) of the U.S. Department of Health and Human Services, effective May 23, 2014. The $40,750 settlement resolves allegations that Olive View violated the Emergency Medical Treatment and Labor Act, (EMTALA), by failing to provide an individual with an appropriate medical screening examination (MSE) within the capability of the hospital's emergency department in order to determine whether he had an emergency medical condition.

Specifically, the individual presented to the Olive View emergency department with signs of appendicitis and severe abdominal pain that he rated at a 10 on a 10-point scale. Despite his severe pain and symptoms, he was forced to wait for several hours to receive an MSE. After waiting for 6.5 hours, he left to seek medical screening and treatment at another hospital, where he was diagnosed with acute appendicitis with a large peritoneal abscess and had to undergo an immediate laparoscopic appendectomy. According to EMTALA, if an individual comes to a hospital emergency department and a request is made on his/her behalf for examination or treatment for a medical condition, the hospital must provide for an appropriate MSE within the capability of the emergency department to determine whether or not an emergency medical condition exists. OIG was represented by Associate Counsel Odies Williams, IV. Olive View was represented by Brandi M. Moore of the Los Angeles County Counsel's Office.
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OK...I feel a little better. This patient waited way too long and sounds like was never evaluated by a doctor or medical provider. I was under the impression that a physician evaluated the patient, did whatever, and then discharged - and was told by the federal legal system that an appropriate medical screening examination was not performed.
 
southerndoc said:
Several sources. I do a lot of healthcare legislative advocacy and expert witness/peer review. I've had a lot of EMTALA training... some of this comes directly from CMS representatives. You'd be surprised at how they interpret things. I also subscribe to a few legal healthcare newsletters and podcasts (ED Legal Letter, Risk Management Monthly, etc.).
Click to expand...

I looked into ED Legal Letter - it is expensive! Risk Management Monthly also appears to be pretty expensive.
Any EM legal healthcare blogs you are aware of?
 
thegenius said:

OK...I feel a little better. This patient waited way too long and sounds like was never evaluated by a doctor or medical provider. I was under the impression that a physician evaluated the patient, did whatever, and then discharged - and was told by the federal legal system that an appropriate medical screening examination was not performed.
.
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As in the hip fracture? Patient got x-rays of their knee, discharged home, then found to have a hip fracture? EMTALA violation? Doesn't sound like a life-threatening emergency to most ER docs, but to CMS it required stabilization.

How many patients wait 4+ hours in busy ER's during flu seasons or surge volumes? A lot. If you work in a very busy ER, this happens frequently during peak volumes.

EMTALA violations are luck of the draw. If a patient files a complaint with CMS, then you're likely toast.
 
southerndoc said:
As in the hip fracture? Patient got x-rays of their knee, discharged home, then found to have a hip fracture? EMTALA violation? Doesn't sound like a life-threatening emergency to most ER docs, but to CMS it required stabilization.

How many patients wait 4+ hours in busy ER's during flu seasons or surge volumes? A lot. If you work in a very busy ER, this happens frequently during peak volumes.

EMTALA violations are luck of the draw. If a patient files a complaint with CMS, then you're likely toast..
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No the appendicitis case. The patient was never even given an MSE.
 
I don't understand the EMTALA issue with the appendicitis case- wasn't he just waiting to be seen in a busy ER? Six hour waits are not uncommon in many places.
 
miacomet said:
I don't understand the EMTALA issue with the appendicitis case- wasn't he just waiting to be seen in a busy ER? Six hour waits are not uncommon in many places.
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I think that is what @southerndoc was alluding to. CMS can say that the patient waited too long to get an MSE. Under that logic, there would be hundreds of thousands of violations a year at ER's across the nation. CMS can do whatever they want though.

I think this case, like others, also suffers from hindsight bias. If the patient had a stupid symptom like stuffy nose, waited 6 hours, went to another hospital and diagnosed with a common cold, an filed an EMTALA complaint, there is higher chance it will not end up as a violation.

It's like the guy who cheats on his taxes. If one guy cheats to give himself a $500 tax return, and the other guy cheats to give himself a $10,000 return, both are cheaters. But the IRS will first go after the $10,000 guy.
 
thegenius said:
No the appendicitis case. The patient was never even given an MSE..
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You say he was never given an MSE. Keep in mind that doesn't translate to never being seen. A PA or physician up front screening people could have examined him. Also, nurses can perform MSE's if hospital bylaws allow it. The hospital determines who can perform an MSE -- not CMS.

As I said earlier, CMS has in past defined MSE to include labs and CT scan. A severe headache that ends up being a ntSAH that didn't get a CT can be defined as not having an MSE.
 
A lot of these cases posted above seem so inconsistent and illogical as to be considered random. My feeling is, don't transfer or treat patients differently for insurance reasons and if you mess up and miss something they'll try to add on an EMTALA violation. It's not the end of the world
 
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