Transfer question ?emtala

[Lex81]

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Scenerio:

Pt comes to ER w/ abd pain. Workup neg, labs/CT completely reassuring. Still in sig pain. Plan was to obs pt overnight in our hospital. Pt had subsequently then wanted to be transferred to a different hospital at that time due to not "trusting" us (pt has some psych if you couldn't tell). Ended up basically saying we're not going to do that (because in reality I can't imagine anyone would accept an obs xfer when workup all completed), and I had no problem dc'ing pt for him to drive to another hospital though this wasn't explicitly stated in the record. Ended up being admitted under obs status at our institution where stayed 2 days w/o cause found, dc'd in improved condition. Now threats w/ lawsuit that pt kept against will when wanted to be xferred.

Thoughts?

 

[gamerEMdoc]

This isn't an EMTALA issue. But he could argue he was held against his will if he never consented to stay at the hospital. If he signed an admission consent, I don't think there is any legal argument, and the patient is likely just trying to throw out threats to get their bill waived. Had you transferred him elsewhere it wouldn't be an EMTALA violation even if you transfered him to a hospital with less resources. Because #1 he was stable and had a screening exam and #2 he requested. Any EMTALA transfer consent form will have reason for transfer. Higher level of acquity/service not provided is one. Another is patient request. If a patient requests to go to another hospital, you absolutely can transfer them to the hospital they choose and that isn't an EMTALA violation assuming stabilization measures have already taken place.

Once the patient was deemed stable and didn't meet any need to send by ambulance to another hospital, once they were refusing to be observed, the right way to approach that would be to have them sign out AMA at your institution and go to the hospital of their choice by POV, or providing the patient with that as an option vs staying as an observation. If they demanded you try and transfer them to another place, you could have called and when the other hospital refused you could tell the patient that the other hospital has declined a direct admission. Because I agree, trying to get that accepted elsewhere as a stable transfer would be tough since their was no diagnosis and a completely negative workup.

 

[goodoldalky]

You can always transfer a patient based on "patient preference", provided the other hospital accepts the transfer. In this case, it sounds like there was no emergent medical condition and therefore EMTALA would not bind any other hospital into accepting the transfer. Your other option would be to offer him a plan of care, i.e.: Be admitted to our hospital without evidence for EMC, and he would be permitted to decline that and leave AMA to proceed to the hospital of his/her choice, go home, etc. It sounds as though there was no "holding" of this patient against his/her will, so the "lawsuit" is nonsense.

 

[RustedFox]

Around my neck of the woods, we do elective transfers... But the patient has to pay the transfer costs. Once they learn that, they generally shut up.

 

[gman33]

Around my neck of the woods, we do elective transfers... But the patient has to pay the transfer costs. Once they learn that, they generally shut up.

Same here.

Unless there is a really good reason for a transfer, I inform the patient that a transfer will likely not be covered by insurance and they may even have to pay the ambulance bill in advance. They are welcome to leave ama and go anywhere they want.

 

[BJJVP]

I do not think that a transfer would have qualified as an EMTALA violation because
A) the patient requested the transfer and
B) it sounds like the emergent medical condition (if one existed) had been stabilized.

While I doubt that the patient has a legitimate case, I would have handled the situation differently. If the patient looked well, was young and otherwise healthy, I probably would've just discharged the patient home. However, it sounds like you felt the patient required observation. And since that was the case, I would have called the other hospital, let them tell me to f#@* off, and then told the patient that the transfer request had been denied. If, for some miraculous reason, the other hospital accepted the transfer, then I would have gladly transferred the patient.

 

[RustedFox]

Same here.

Unless there is a really good reason for a transfer, I inform the patient that a transfer will likely not be covered by insurance and they may even have to pay the ambulance bill in advance. They are welcome to leave ama and go anywhere they want.

I understand the way the patients feel sometimes, though. I can say with honesty that there's a shop or two in my neck of the woods where I myself would say "Don't take me to HospitalX."