EMTALA

Discussion in 'Emergency Medicine' started by docB, Dec 2, 2002.

  1. docB

    docB Chronically painful
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    Before I started residency I had never heard of EMTALA which stands for the Emergency Medical Treatment And Labor Act. This is a HUGE deal in EM. For those who don?t know an unbiased summary goes something like this: any patient, regardless of ability to pay, must be given a medical screening exam and if an emergency medical condition or labor exists they must be stabilized to the ability of the facility. If they require additional treatment they can be transferred. The biased summary is everyone now has a right to free medical care in the ER and woe be it to the physician and hospital that doesn?t toe the line on a poorly defined and Byzantine group of bureaucratic red tape. If you (or your triage nurse or whoever) lets someone leave the ER without a medical screening exam or proper stabilization you face fines that start at $50k. This is not covered by malpractice insurance. Horror stories abound. Is anyone getting any info on this in med school? Are future docs tuned in at all to how much of a problem this is?
     
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  3. southerndoc

    southerndoc life is good
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    Not every patient is guaranteed free medical treatment. If they are stable, then you are not obligated to treat them. It is also my understanding that EMTALA only applies to hospitals that accept federal funding (Medicare, Medicaid, etc.), but that's nearly every single hospital in the nation.

    EMTALA can really hurt EM physicians and hospitals, even if it's not their fault. Consider this true story... An ambulance responds to an accident and picks up 2 patients. One patient wants to go to hospital A, while the other wants to go to hospital B. Hospital A is less than 1/4 mile away from hospital B.

    First patient is taken to hospital A. The patient is taken into the ED to be seen. A paramedic remains with patient #2 in the ambulance.

    Patient 2 is then taken to hospital B. Hospital B's staff finds out that the patient was in the parking lot of hospital A, and thus they set in motion something that dramatically affected hospital A (by the way, hospital A and B are feuding royally and there was actually a lawsuit going on at the time).

    So anyhow, end result is that hospital A **and** hospital A's emergency physician were fined substantially. Nearly $100,000 for the hospital and $25,000 for the EM physician if I recall correctly. The sad thing? Neither the hospital nor the EM physician ever knew that patient B was ever on their property.

    Now that's screwed up!
     
  4. docB

    docB Chronically painful
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    I just worked a moonlighting shift last night and the medical director wandered through. It sounds like the enforcement folks came down and opened up a can of EMTALA whup ass all over the hospital over a bunch of nit-picky things. I sure am glad we have bureaucrats to slap our wrists and reduce our operating budgets.
    docB
     
  5. womansurg

    womansurg it's a hard life...
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    Our hospital had a big to-do over EMTALA because we are a Level I trauma center and we only had one plastic surgeon - who adamantly refused to be on call 24/7 (can you blame him?)

    So, they took every plastic surgeon in town who had admitting privileges at our hospital and put them into a rotating call schedule, so that we wouldn't be in violation. Well, those guys already worked out of their own hospitals and took their own call there, and so were naturally furious that they were being drafted to cover a hospital that they virtually never set foot in. BIG political battle, and ultimately everyone (except the one guy) withdrew their privileges anyway.

    The guy got himself a partner, so it's all good now, but what a mess.
     

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