EMTALA Q&A
[Editor’s Note: This column is part of an ongoing series that will address reader questions about the Emergency Medical Treatment and Labor Act (EMTALA). If you have a question you’d like answered, contact Staci Kusterbeck, Editor, ED Management, 280 Nassau Road, Huntington, NY 11743. Telephone: (631) 425-9760. Fax: (631) 271-1603. E-mail: [email protected].]
Question: There are clinics and private offices in the same building as our freestanding ED. If an ED patient requires an orthopedist or ophthalmologist, and there is a specialist available upstairs, can the patient be sent to that office for treatment, or do we have to follow the on-call schedule?
Answer: There is no EMTALA requirement to follow a particular call schedule, according to Jonathan D. Lawrence, MD, JD, FACEP, an ED physician and medical staff risk management liaison at St. Mary Medical Center in Long Beach, CA. "It is perfectly appropriate to discharge/transfer a stable patient to any physician’s office to continue or complete the care started in the ED," he says. He adds that once the screening exam is performed and stabilizing treatment provided, transfer or discharge is the next step.
The specialist’s office may the most appropriate place for the completion of care, Lawrence notes. "Some government field offices looking into EMTALA violations have not understood this and have charged violations, though I think this is a diminishing problem as they begin to understand how the system works in real life," he says. Lawrence says that, as always, careful documentation of the screening exam and a description of the patient’s stability (no reasonable likelihood of deterioration as a result of transfer or discharge) will protect the practitioner.
Question: If a sick child is examined in a pediatrician’s office and sent to the ED with written orders for lab work, X-rays, and an intramuscular injection of an antibiotic, is a medical screening examination (MSE) required? Our ED physicians believe that because of the physical absence of the pediatrician in the ED at the time of service, they are obligated to perform an MSE. The pediatricians disagree, because they have just examined that child in the office and have written orders accompanying them.
Answer: The ED physicians are correct, Lawrence says. He explains that the pediatricians have the capability of sending these children for outpatient lab tests and X-rays without involving the ED and can administer antibiotics in their own offices. If the children are being sent to the ED, they are there for emergency care and must receive an MSE like any other patient, he points out. Lawrence concludes that the pediatricians must be educated on EMTALA requirements. "There is plenty of literature to show them from the federal government addressing exactly this type of situation," he says. "The pediatricians must either conform to EMTALA or make other arrangements for these children," he explains.
Question: If an accepting physician tells us to send the patient to the ED and verbally agrees to see the patient there, do we still need to get acceptance from the accepting ED and give report?
Answer: No, according to Lawrence, explaining that EMTALA allows acceptance on behalf of a hospital by the physician who intends to take care of the patient. "Whether we like it or not, that may not be the emergency physician, and the patient may end up in a busy ED with no beds available," he says.
Lawrence underscores that separate acceptance by the receiving ED is not required. "Also, no formal oral report is required from the sending ED to the receiving ED," he says. He notes that EMTALA does require the sending hospital to make and send copies of all charts, labs, X-rays, electrocardiograms, and other diagnostic tests. Lawrence adds that common courtesy requires good communication between all parties: the sending ED and ED physician, the receiving ED and ED physician, the accepting physician, and nursing personnel. n
Source
For more information about EMTALA, contact: Jonathan D. Lawrence, MD, JD, FACEP, Emergency Department, St. Mary Medical Center, 1050 Linden Ave., Long Beach, CA 90813. Telephone: (562) 491-9090. E-mail: [email protected].
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