emtala question

[Uptoherern]

This is a little complicated, so bear with me!

I recently transferred (by BLS ambulance) a pt from our ER to a sister facility (the hospitals are owned by the same company). The pt. was transferred to the intake and assessment area of the behavioral health unit for evaluation to determine if he qualified to be admitted to the detox unit. This was not a Dr. to Dr. transfer. The pt. signed discharge paperwork from our ER, with the instructions that he go to detox. All of his paperwork, labs, etc. from our ER were faxed to the Intake and Assessment RN at the other facility. She then called and told our secretary that they would accept him. The secretary then called for transport and I was told the BLS ambulance would arrive in 15 minutes. I immediately called the other facility to give report to the RN (the ONLY RN there). I was told she was with a client, and they would have her call me back. Well...........the ambulance arrived before she called me back. I figured I'd send him, because I expected to be able to give report before he got there, and they were expecting him anyway. There really wasn't anything to give her report about, because supposedly that is why the entire chart was faxed to her in the first place. I just wanted to let her know I'd given one add'l dose of Ativan before he left. Long story short, on my third call to her, she was finally done with the client, and I gave her my brief little update. She then states she thinks that the patient is already there, and it was an emtala violation for me not to have given her report before he arrived. I don't think she will actually report me, she was sort of laughing, but you never know.

One of the other docs said, don't worry. The guy was actually DISCHARGED from the ER, and told to get to detox. We just arranged the transportation, and just fill out the Cobra forms on everything, even though this was not a doc to doc.

Any help? I'm just hoping she lets it slide, but think I can defend myself if she doesn't.

What a pain in the puttooty. If I hadn't had to call 3 times to give report, none of this would matter. Geuss next time, I'll just have to make the ambulance wait if they will).

[Uptoherern, RN]

I have not heard anything (in a week) about this incident, so am fairly certain that I am ok. My major question was if it is an emtala requirement for there to be a nurse to nurse report. I have not been able to find any rule that says this needs to be done anywhere. I know one person that replied to this post says it is not a requirement. I always thought it was. But, again, my position is that this pt. was discharged, and being discharged, was only sent to the sister facility as a referral for detox. What a mess it is when the federal government steps in.

as an aside..........I heard recently that here in Az we are getting illegal immigrants that are showing up in ER's with notes from their cardiologists in mexico. the note basically says that the pt. needs a cardiac bypass. because of emtala, they cannot be refused. Of course the hospitals are never reimbursed. I also learned that if an ambulance is coming from mexico into AZ code 3 (lights and sirens), the boarder crossing guards cannot stop it. The ambulances are allowed across the boarder, and of course once they are onto hospital grounds, the pt. must be treated for their emergency. One of the Tucson hospitals recently had major problems with non insured illegal aliens...............thought they might have to close. any thoughts?

[TinyNurse, RN]

no worry....... in our Ed we also document results of when attempted to call and when accepted.

[veetach]

we NEVER call report when a patient is transferred to a behavioral health/detox facility. We discharge them and they are transported. Anyway, it is a COBRA violation not to call report, isnt EMTALA concerned with the pt receiving care on the grounds of your hospital??? so many initials so little time. :rotfl: :rotfl: :rotfl:

[TinyNurse, RN]

don't you feel weird when you have to chart 3 times that "attempted to call report" I know i do but do it nonetheless