EMTALA

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EMTALA

• Grove City Medical Center
• Julie Ryhal RN, BSN, MEd

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What Is It??

• EMTALA - The Emergency Medical Treatment
• and Active Labor
  Act.
• Its not a federal malpractice law but rather a
  federal anti-discrimination law to protect people
  who cannot afford emergency services.

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What We Need To Do

• 1. Provide a medical screening examination by a
  qualified healthcare provider for each person
  presenting to the emergency department.
• 2. Provide stabilization and make medically
  appropriate transfers.
• 3. Transfer patients only for care that we can
  not provide here or per the patients request.
• 4. Obtain and document acceptance from the
  receiving facility.
• 5. Document sufficient information to
  substantiate the appropriate nature of the
  transfer.

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DEFINITIONS

• Dedicated Emergency Room
• Is licensed by the state as an emergency
  department.
• Holds itself out to the public as providing
  emergency care.
• Has provided at least 1/3 of its outpatient care
  for ER treatment in the prior year.
• Medical Screening Exam
• The process required to reach within reasonable
  clinical confidence that an emergency medical
  condition does or does not exist. This is not the
  nursing triage, it must be completed by a
  physician or other qualified licensed
  practitioner.

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• Stable Patient
• Means that no deterioration of the condition is
  likely to result from or occur during the
  transfer of an individual.
• The final decision as to whether or not a patient
  is stable is made by the treating physician.
• Emergency Medical Condition
• A condition with acute symptoms of sufficient
  severity that in the absence of immediate medical
  attention could place the persons health in
  serious jeopardy.

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What We Must Do

• Post signs in the ED specifying the rights of
  individuals with emergency conditions and women
  in labor
• Maintain medical records for 5 years
• Maintain a list of on-call physicians
• Maintain a central log of who came to the ED
  seeking treatment
• Provide appropriate medical screening examination
• Accept appropriate transfers of individuals with
  medical conditions within our capabilities of
  treating
• Provide appropriate transfer to another facility
• Adopt and enforce policies and procedures to
  comply with EMTALA ( ADMIN 3.14)

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What Else??

• Must have an accepting physician
• Must have an appropriate mode of transportation
• Must have documented consent to transfer
• Must send all medical records with the patient

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Transfer of an Unstable Patient

• Can we transfer and unstable patient??
• YES if..
• The individual requests a transfer after being
  informed of the risks.
• The physician signed the certification that the
  benefits of transfer outweigh the risks.
• Treatment has been provided to minimize the risks
  of transfer.
• All pertinent records are sent to the receiving
  facility.
• The consent of the receiving facility has been
  obtained.
• Ensure the transfer of the unstable individual
  is effected through qualified personnel and
  transport equipment.

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EMTALA VIOLATION.

• A violation can result from
• Transferring an unstable patient
• Without obtaining consent of the receiving
  facility
• That is at risk of deteriorating due to or during
  transfer
• Refusal to provide stabilizing treatment to a
  patient with an emergency medical condition.
• Failure of the on-call physician specialist to
  respond, evaluate and assist in the treatment and
  stabilization of the patient.

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QUESTIONS ANSWERS
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?

• Does EMTALA apply to inpatients?
• No
• Is a laboring woman considered stable?
• Any woman experiencing contractions is considered
• unstable but may be transferred
  if there is a
• distinct medical benefit to the
  transfer. She
• should be examined by a
  physician before
• she is discharged or transferred.

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?

• What if a patient refuses treatment?
• Staff must indicate in writing
• The risks/benefits of the examination or/and
  treatment
• The reason for refusal
• A description of the exam treatment
• Steps taken to secure a written informed refusal
  if it was not secured.

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?

• How do we handle a patient who is on the property
  but not in the ED?
• If a person is anywhere on hospital property and
  presents themselves in need of care, the employee
  who is present should accompany that person to
  the ED.
• Hospital property means the hospitals main
  building, parking lot, sidewalk and any building
  owned by the hospital that is within 250 yards of
  the hospital.

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?

• How do we handle someone who presents themselves
  at one of our off campus departments?
  (Clintonville, Slippery Rock)
• Unless that off campus area has an emergency
  department, they do not have to abide by EMTALA.
  They should refer to their policies on how to
  handle a medical emergency.

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?

• What are the possible consequences of an EMTALA
  violation?
• The hospital and/or physician can be fined up to
  50,000.
• The hospital may be terminated from its Medicare
  Provider agreement.
• The physician may be excluded from Medicare and
  Medicaid programs.
• The patient who suffers personal injury may sue
  the hospital in civil court.

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?

• Where can I find more information?
• Policies NURS 3.23 and ADMIN 3.14
• The EMTALA Answer Book by Mark M. Moy located
  in the Emergency Room
• The CMS Hospital Conditions of Participation and
  Interpretive Guidelines ask your manager.
• Ask Brad Vansickles VP of Operations and Patient
  Safety ext 7183

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REFRENCES

• The CMS Hospital Conditions of Participation and
  Interpretive Guidelines, HCPro, 3/2010 edition.
• The EMTALA Answer Book, Mark M. Moy, Aspen
  Publishers, 2011.