Has anyone ever filed an EMTALA complaint?

[thegenius]

As the title says...

I feel like almost every day someone (a consult, or a consult at an accepting hospital), or something (the hospital itself) violates the law. Sometimes I so desperately want to file a complaint but I don't know how to do it.

I've looked online, there doesn't appear to be a form. I think there are regional CMS offices where you send the complaints.

So...does anyone have any experience filing a complaints? How do you do it? What information? Is there a form?

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[deleted109597]

You contact the regional office. There's usually a contact person who can direct you to the form or emails it to you.
You fill out the form.
If you are anonymously sending it, make sure there's enough information there for them to act because they can't contact you afterwards. If you don't send it anonymously, be prepared to file a separate whistleblower suit if anything comes down on you.
Basically, they want proof that a violation occurred. Make sure you know what EMTALA actually means, I've learned over the years that residency does a terrible job of teaching what it actually is, but instead talks about idealistic views.

 

[southerndoc]

Most ER docs that file EMTALA complaints suddenly find themselves relocating for a job.

Do not, I repeat do NOT, file an EMTALA complaint. Escalate it up to your management and let them deal with it. Unless it's really bad, most hospitals would rather just suck it up rather than filing an EMTALA complaint.

 

[thegenius]

Most ER docs that file EMTALA complaints suddenly find themselves relocating for a job.

Do not, I repeat do NOT, file an EMTALA complaint. Escalate it up to your management and let them deal with it. Unless it's really bad, most hospitals would rather just suck it up rather than filing an EMTALA complaint.

That's really sad. So...depending on the complaint, it puts the hospital itself at risk too even if the complaint is against a different hospital.

The times I get most pissed off is when consults at other hospitals (other than the one I'm at) essentially refuse to hear my story or accept the patient in transfer.

 

[goodoldalky]

Hospitals are at much more risk for this than individual physicians. There is about one penalized violation a month for hospitals and more like one a year for physicians nationwide.

If you do this, CMS is mandated to come visit the site that you have filed on. This is an administrative pain in the neck for the hospital system and you are unlikely to tag that consultant you are upset with.

If there is any sort of goodwill between your hospital system and the other one, you may find yourself as the odd man out.

These sorts of decisions have repercussions above your pay grade, so I would recommend the decision be made by someone above your pay grade. There’s almost nothing good that can come of filing an EMTALA complaint for you.

 

[deleted245139]

I agree w bumping it up the chain. There is alot of administrative soft-touch that occurs to assess if one, a violation occured, and two, culpability. But.... Absolutely engage your leadership if you are concerned. The wrong answer is to ignore something that you felt may have negatively impact driver patient care, violation or not

 

[EM Junkie]

Most ER docs that file EMTALA complaints suddenly find themselves relocating for a job.

Do not, I repeat do NOT, file an EMTALA complaint. Escalate it up to your management and let them deal with it. Unless it's really bad, most hospitals would rather just suck it up rather than filing an EMTALA complaint.

Agree with this 1000 times over. This will not have the effect you’re looking for, and guaranteed you will be out of a job.

 

[Mad Jack]

As the title says...

I feel like almost every day someone (a consult, or a consult at an accepting hospital), or something (the hospital itself) violates the law. Sometimes I so desperately want to file a complaint but I don't know how to do it.

I've looked online, there doesn't appear to be a form. I think there are regional CMS offices where you send the complaints.

So...does anyone have any experience filing a complaints? How do you do it? What information? Is there a form?

My hospital filed one against the local for-profit recently because they were engaging in some extremely bad behavior that was well documented and blatant

 

[Angry Birds]

Snitches get stitches.

 

[MechEDoc]

That's really sad. So...depending on the complaint, it puts the hospital itself at risk too even if the complaint is against a different hospital.

The times I get most pissed off is when consults at other hospitals (other than the one I'm at) essentially refuse to hear my story or accept the patient in transfer.

My understanding is that the receiving hospital is required to report EMTALA violations, not the sending hospital (you). I have been in your situation. I avoid chart bashing, but note that I spoke with XXX at YYY time and ZZZ occurred. What the final accepting hospital does with that information is up to them.

 

[Redrox]

Snitches get stitches.

With emtala complaints, snitches end up in ditches

 

[NITRAS]

This is a dumb question, as I am a hospitalist who doesn't transfers hardly anyone.

What qualifies as an EMTALA violation from a consultant? Not accepting transfer?

 

[MechEDoc]

This is a dumb question, as I am a hospitalist who doesn't transfers hardly anyone.

What qualifies as an EMTALA violation from a consultant? Not accepting transfer?

My lay understanding (based upon conversations with colleagues as well as general medical training, not the view of a lawyer) is as follows:

1. The sending facility determines medical emergency which requires further care. E.g. I am at a hospital with an orthopedic surgeon, the patient has a serious hand injury, I consult the surgeon, this surgeon informs me that the patient will require the care of a hand surgeon and that these capabilities do not exist at our facility.

2. I contact the closest facility that has both capacity (beds, nursing, operating room space) and capability (a hand surgeon). If the facility declines to accept the patient they have committed an EMTALA violation. This would be an EMTALA violation. However, I do not believe that I am mandated to report it.

3. I then transfer the patient to another facility, somehow or another (e.g. in the patient's documentation written by a diligent scribe with timestamps, quoted conversations, etc.) they note that the previous facility had failed to accept the patient and the patient did have an emergency. This facility is required to report the alleged EMTALA violation.

Having worked at outlying hospitals with undesirable patients, EMTALA appears to be breached frequently. The violations are usually not wildly egregious, and are frequently resolved with a polite conversation that frequently and indirectly references EMTALA, the concern for the patient's well-being, the concern that we believe we have identified an emergent medical process, and a concern that the patient will decompensate due to delays in care before arriving at the facility with capacity and capability. As these conversations are on a recorded line, the receiving facility usually caves and accept the patient.

I have had one or two overt EMTALA violations. In one of the violations nothing was done. In the other violation the hospital I worked at sent a polite note to the other hospital suggesting that they had a "concern that things may not have been handled appropriately, but otherwise they were thankful for their ongoing and long-standing productive working relationship". I don't think either facility ultimately had an appetite for an EMTALA fight.

 

[CajunMedic]

Only know of 1 (and it was in med school) Hospital an hour up the interstate calls to transfer a chest pain to us. My attending accepts since the patient's cardiologist is at our facility and they has an extensive history there. They load up in the hospital's ambulance and head our way....Nurse calls report and apparently the sending doc neglected to tell ours about the Lower GI bleed and Hemoglobin of 4. So, they get to our facility, 2 units PRBC's, onto the waiting helicopter and goes 2 hours the opposite way to the Level 1 that has GI capabilities. Patient's spouse was pissed they sent them to us, even they knew we didn't have GI. I knew it was filed, but never heard the outcome.

 

[EM Junkie]

This is a dumb question, as I am a hospitalist who doesn't transfers hardly anyone.

What qualifies as an EMTALA violation from a consultant? Not accepting transfer?

Here’s an example - 50ish year old uninsured guy with risk factors shows up at for-profit facility with NSTEMI. For-profit facility caths patient, sees triple vessel disease, admits to ICU with plan for CABG. Patient stays in hospital 5 days, troponins rising, CABG keeps getting pushed back. Registration staff and case management visit patient daily, informing him of his rising bill, asking how he planned to pay for it, and becoming threatening and aggressive. They may or may not have suggested patient leave and come to our not for profit institution down the road.

After 5 days of this, patient has enough, leaves AMA (their cover), comes straight to our ED and has a free CABG the next day.

Reported to risk management, and have no idea what became of it.

 

[MechEDoc]

Here’s an example - 50ish year old uninsured guy with risk factors shows up at for-profit facility with NSTEMI. For-profit facility caths patient, sees triple vessel disease, admits to ICU with plan for CABG. Patient stays in hospital 5 days, troponins rising, CABG keeps getting pushed back. Registration staff and case management visit patient daily, informing him of his rising bill, asking how he planned to pay for it, and becoming threatening and aggressive. They may or may not have suggested patient leave and come to our not for profit institution down the road.

After 5 days of this, patient has enough, leaves AMA (their cover), comes straight to our ED and has a free CABG the next day.

Reported to risk management, and have no idea what became of it.

Sounds like someone went to evil medical school.

 

[WilcoWorld]

It's almost like we live and work in a culture that makes it hard for people to speak up against injustice...almost.

 

[deleted109597]

You won't get fired. You can report it anonymously, I promise. I worked for 2 hospitals in my town, and I reported one of them while I was working at the other.
And you know what it did? It forced them to change the culture of the asshat orthopod refusing to take transfers. It resulted in better patient care. If you honestly think bad things are happening, then report it.

 

[MechEDoc]

You won't get fired. You can report it anonymously, I promise. I worked for 2 hospitals in my town, and I reported one of them while I was working at the other.
And you know what it did? It forced them to change the culture of the asshat orthopod refusing to take transfers. It resulted in better patient care. If you honestly think bad things are happening, then report it.

Sure, you won't get fired. But most of us can't get "fired", we aren't employed by the hospital/CMG/SDG. We are independent contractors and work for ourselves. But you might find yourself off the schedule or you might not.

 

[thegenius]

Yea man violations happen every day. I guess there are "mild" ones and "severe" ones, but they happen every day.

If you call Ophtho at 10:00 AM for some eye problem and they say "I can't come until clinic is over at 5:00 PM"...that is a violation. The consultant is not coming to stabilize the medical emergency in a timely fashion.

What a lot of people don't understand is the original doctor, the one who SEES the patient, is the only one who can certify that there is a medical emergency. A consultant over the phone cannot. A consultant at another hospital cannot. Only you. And if you think your hangnail is a medical emergency, then the consultant has to come in.

There is a sticky wicket when the ER doc thinks there is a medical emergency and the consultant comes to the ED, examines the patient, and says there is not. I never know what to do in these cases. Thankfully this only happens like once a year.

 

[deleted109597]

Sure, you won't get fired. But most of us can't get "fired", we aren't employed by the hospital/CMG/SDG. We are independent contractors and work for ourselves. But you might find yourself off the schedule or you might not.

Again, nobody will ever know unless you make a big stink of it.
Try using admin the first time. If they fix the problem, then good. But after getting nowhere with admin on multiple occasions, you simply take it in your own hands. Don't tell anyone you're reporting it. Don't raise a stink. Just document and report anonymously. It's not like your hospital will ever hear of it anyway. Do you think he's reporting his own hospital, or a different one?

 

[thegenius]

So contact the regional what office? The CMS office?

 

[MechEDoc]

Again, nobody will ever know unless you make a big stink of it.
Try using admin the first time. If they fix the problem, then good. But after getting nowhere with admin on multiple occasions, you simply take it in your own hands. Don't tell anyone you're reporting it. Don't raise a stink. Just document and report anonymously. It's not like your hospital will ever hear of it anyway. Do you think he's reporting his own hospital, or a different one?

Maybe I'm just more paranoid than the next guy...

 

[deleted109597]

Where to Report EMTALA Vioaltions | Public Citizen

 

[GeneralVeers]

I'd rather report non-anonymously, document it, get fired then sue them for a large 6-figure settlement under the Whistleblower statutes.

 

[Hamhock]

k

 

[hundreddaysoff]

I'd rather report non-anonymously, document it, get fired then sue them for a large 6-figure settlement under the Whistleblower statutes.

Intriguing... could allow one to FIRE, screw over hospital admin, and look like an idealist all at the same time! Might be hard to get another ER job after that though. Maybe I'll try this in a few years when I have a bit more in savings.

 

[Redrox]

All joking aside, I agree with Dr McNinja (which is a strange sentence to be typing)

And yeah, violations happened more often than you'd expect from med school ethics classes.

Had a guy on coumadin get kicked out of the local for profit ER for being drunk and aggressive. Fell down in their parking lot on the way out and got a huge scalp lac. They refused to see him again and he called 911 who picked them up from their lobby to take him to us.

Almost couldn't believe it, called over to their place and got told yep, totally happened.

No head bleed but took a substantial number of staples to close the lac and yep he totally threatened to bomb our hospital and follow all the nurses to their cars and do bad things.

Not a nice guy, but def an emtala violation. Passed it up the chain of command, didn't report it myself but maybe shoulda, I dunno. Not sure if anything came of it.

 

[deleted109597]

Passed it up the chain of command, didn't report it myself but maybe shoulda, I dunno. Not sure if anything came of it.

Nothing came up from it. Hospital admins are afraid that the other hospital will report them the next time. It's like filling out hospital based surveys. Has any good ever come from them? No. Next question.

 

[southerndoc]

@Redrox, that is a clear cut EMTALA violation of the worst kind. Had the guy died, the hospital would've been fast tracked and likely would've lost their ability to receive CMS funds.

 

[Psai]

Here’s an example - 50ish year old uninsured guy with risk factors shows up at for-profit facility with NSTEMI. For-profit facility caths patient, sees triple vessel disease, admits to ICU with plan for CABG. Patient stays in hospital 5 days, troponins rising, CABG keeps getting pushed back. Registration staff and case management visit patient daily, informing him of his rising bill, asking how he planned to pay for it, and becoming threatening and aggressive. They may or may not have suggested patient leave and come to our not for profit institution down the road.

After 5 days of this, patient has enough, leaves AMA (their cover), comes straight to our ED and has a free CABG the next day.

Reported to risk management, and have no idea what became of it.

wtf...

 

[WilcoWorld]

All joking aside, I agree with Dr McNinja (which is a strange sentence to be typing)

And yeah, violations happened more often than you'd expect from med school ethics classes.

Had a guy on coumdin get kicked out of the local for profit ER for being drunk and aggressive. Fell down in their waiting room lobby on the way out and huge scalp lac. They refused to see him again and he called 911 who picked them up from their lobby to take him to us.

Almost couldn't believe it, called over to their place and got told yep, totally happened.

No head bleed but took a bazillion staples to close the lac and yep he totally threatened to bomb our hospital and follow all the nurses to their cars and do bad things.

Not a nice guy, but def an emtala violation. Passed it up the chain of command, didn't report it myself but maybe shoulda, I dunno. Not sure if anything came of it.

@Redrox, that is a clear cut EMTALA violation of the worst kind. Had the guy died, the hospital would've been fast tracked and likely would've lost their ability to receive CMS funds.

wtf...

On the one hand, this sounds egregious.

On the other hand... the first ED turned out to be correct (and very, very lucky) - in the end he didn't have a brain injury.

You aren't obligated to do a lac repair on someone who's threatening your safety. I would've discharged that a$$hat once his CT was negative.

 

[southerndoc]

On the one hand, this sounds egregious.

On the other hand... the first ED turned out to be correct (and very, very lucky) - in the end he didn't have a brain injury.

You aren't obligated to do a lac repair on someone who's threatening your safety. I would've discharged that a$$hat once his CT was negative.

Remember, CMS views things as unstable emergencies that we may view can be handled in urgent care (i.e., a laceration on warfarin). Appendicitis is considered unstable medical emergency until appropriately treated. (The new research suggesting antibiotics only might make this murky.)

 

[goodoldalky]

On the one hand, this sounds egregious.

On the other hand... the first ED turned out to be correct (and very, very lucky) - in the end he didn't have a brain injury.

You aren't obligated to do a lac repair on someone who's threatening your safety. I would've discharged that a$$hat once his CT was negative.

With respect to EMTALA, presence or absence of an EMC is sort of irrelevant. Once the referenced patient fell leaving the facility and then they refused to see him again, he was not provided an appropriate medical screening exam, and so it is an EMTALA violation whether he had an EMC or not. Also, for the purposes of EMTALA, a scalp laceration "requiring a bazillion staples" probably qualifies as an emergency medical condition requiring stabilization.

 

[WilcoWorld]

Remember, CMS views things as unstable emergencies that we may view can be handled in urgent care (i.e., a laceration on warfarin). Appendicitis is considered unstable medical emergency until appropriately treated. (The new research suggesting antibiotics only might make this murky.)

With respect to EMTALA, presence or absence of an EMC is sort of irrelevant. Once the referenced patient fell leaving the facility and then they refused to see him again, he was not provided an appropriate medical screening exam, and so it is an EMTALA violation whether he had an EMC or not. Also, for the purposes of EMTALA, a scalp laceration "requiring a bazillion staples" probably qualifies as an emergency medical condition requiring stabilization.

I agree with you both. Perhaps I should've been more clear.

My point is not about EMTALA. Rather, I'm discussing my willingness to perform cosmetic procedures on people who are threatening to stalk me.

 

[BoardingDoc]

With respect to EMTALA, presence or absence of an EMC is sort of irrelevant. Once the referenced patient fell leaving the facility and then they refused to see him again, he was not provided an appropriate medical screening exam, and so it is an EMTALA violation whether he had an EMC or not. Also, for the purposes of EMTALA, a scalp laceration "requiring a bazillion staples" probably qualifies as an emergency medical condition requiring stabilization.

As Wilco alluded to above, I think the issue is treating an aggressive patient. I agree that I would have CTed the guy and then done the repair if he were cooperative. If he threatened me or my staff after the CT but before the repair, I would simply document that he's stable and his threats and discharge him.