Hospitalist Liability at Rural Hospitals

[ahospitalistperson]

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With the current corona situation I am at a rural hospital and the main hospital affiliated with my ship as well as surrounding hospitals cannot accept transfers of sick patients or those needing sub speciality support.

I am being asked to accept these patients as “er” boarders. I.E. treat them as floor patients in the ED pending an available bed which can be days.
Is this the norm or can you point me to resources on the Medico legal side of this situation ? Additionally , if I reject these patients is it truly an emtala violation since I am on call ?

 

[end stage fibro]

ostensibly, i think this puts you at risk. hospitals being full is not an excuse for downgrade in care. i know many governors have said there is limited liability during these times but who knows what will truly happen with that. i am not a lawyer.

i would ask for a written proposal detailing exactly what they want and with clear protocols and fall backs. ideally, you would help draft this document.
red flags: if they say “trust us,” some variant of being a team player or healthcare hero, or are hesitant to write anything down.

what is your system’s protocol for surge and diversion? this should fall under that. i recognize likely every hospital is full. ED should be in same boat as you and helping triage pt’s pre hospital if at all possible.

 

[turkeyjerky]

I’m EM, so on the other side of this. It’s a ****ty situation all around. But these patients who board in the ER get truly awful care. Some of us are good about continued management but most aren’t, and we all lack the requisite experience. When we ask you for help, it’s because we want these patients to get some semblance of good care.

There’s no EMTALA issue here. EMTALA doesn’t force you to admit a patient, and moreover it applies only to institutions, not physicians.

You guys should really sit down with EM and hospital admin and figure out a policy for how to manage this issue.

 

[chessknt]

Just because the closest appropriate hospital isnt accepting doesnt mean you just board them in your hospital until they are. Is every tertiary hospital within flight distance not accepting? If someone truly needs a transfer (eg no ICU and needs an ICU) then they shouldnt be boarded in the ER unless there is truly nowhere for them to go (eg no hospital in 800 miles accepting). Then I would think you assisting with the issues as best you can and document that no transfer available. Your hospital needs to get e-consults online if this is going to be a thing.

 

[Siggy]

There’s no EMTALA issue here. EMTALA doesn’t force you to admit a patient, and moreover it applies only to institutions, not physicians.

That's not true actually. If there's a formal call list, then everyone on the call list falls under EMTALA. On call surgeon refuses to come in for an emergent consult and the patient ends up being transferred somewhere else? That's an EMTALA violation against the surgeon. The certification for transfer form at most of the hospitals I've been at (example being the last page on this link. I have not been at this hospital, but a Google Image Search found it http://www.cheyenneregional.org/wp-content/uploads/2013/11/ADMIN-AD-69-EMTALA-1.pdf) includes a place to name and shame someone who is on call not responding in a timely manner.

 

[grt398]

Just because the closest appropriate hospital isnt accepting doesnt mean you just board them in your hospital until they are. Is every tertiary hospital within flight distance not accepting? If someone truly needs a transfer (eg no ICU and needs an ICU) then they shouldnt be boarded in the ER unless there is truly nowhere for them to go (eg no hospital in 800 miles accepting). Then I would think you assisting with the issues as best you can and document that no transfer available. Your hospital needs to get e-consults online if this is going to be a thing.

As someone on the receiving side of ICU transfer requests, this is definitely becoming more of an issue where there are no ICU beds for transfers in any tertiary facility in the state, or even some surrounding states and there is a waiting list instead that gets triaged by the ICU attending. We've had tertiary facilities in neighboring states transfer to us because they had no ICU beds at any of their facilities. It can get really bad some days.