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Kreisman explained that, like any patient presenting to the ED, psychiatry patients are covered under EMTALA. As such, they are subject to the same requirements of an appropriate medical screening, stabilizing treatment, and appropriate transfer.
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Given the fact that most emergency medicine residencies now include ultrasound in their training, and the use of ultrasound in EDs is clearly increasing, one obvious liability risk involves misreads of ultrasound examinations performed in the ED.
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One of the major issues currently facing emergency ultrasound is credentialing, according to Leonard Bunting, MD, FACEP, assistant professor of emergency ultrasound at Wayne State University and emergency ultrasound director at St. John Hospital & Medical Center, both located in Detroit, MI.
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This is the second of a two-part series on documentation and ED liability. This month, we cover liability risks when the ED physician or nurse's documentation is inconsistent with documentation by other caregivers. Last month, we reported on the legal risks of inadequate documentation and information that should not be omitted.
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The abuse of drugs and alcohol is a significant and troubling problem within the medical community.
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A common diagnostic dilemma for emergency medicine physicians is the patient who presents with a painful testicle. Frequently, the presentations of the various conditions that cause scrotal pain and most frequently testicular torsion fail to "conform to the accepted clinical picture."
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Margaret Bergin, an attorney with Palumbo Wolfe in Phoenix, AZ, and a former hospital risk manager, says the longer the psychiatric patient is allowed to remain in an ED without mental evaluation, the higher the possibility that the patient will leave against medical advice (AMA).
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If a psychiatric patient harms himself or someone else after being transferred or discharged from your ED, can he or she successfully sue for malpractice? If so, would a jury agree that the ED was at fault? That depends, in large part, on the details contained in the patient's chart.
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Leslie S. Zun, MD, chairman of the department of emergency medicine at Rosalind Franklin University of Medicine and Science in North Chicago, IL, says that if a patient discharged from the ED later commits suicide, "there are a number of issues that can place the emergency physician at risk." Zun gives these five major areas of risk involving ED psychiatric patients:
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A 25-year-old male patient is brought to an ED because of suicidal statements made to his ex-wife. The patient arrives via police escort and is placed in a room. The ED nurse assesses the patient, who denies suicidal ideation or intent. Although the man admits to drinking alcohol, he does not appear to be overtly intoxicated and is coherent. The ED is extremely busy, and the physician assistant (PA) picks up the chart.
