EMTALA question

Jolie, BSN · Mar 8, 2007

I don't believe so.

As I understand it, EMTALA requires hospitals to accept, examine and stabilize patients, and sets guidelines for transfers.

I don't believe it mandates that individual physicians (other than ER staff) take consults or see patients they don't wish to see, regardless of the reason.

TazziRN, RN · Mar 8, 2007

Yes and no. Since the first ER was unable to clear the pt because of lack of surgeon, the surgeon at the second place did violate EMTALA. However, since the ER accepted, the violated was voided. If the ER had also declined, then a violation would have occured.

meandragonbrett · Mar 8, 2007

If the ER had also declined, then a violation would have occured.

Isn't this true only if this ER (transfer to) was a higher level of care? Or did I read this wrong?

TazziRN, RN · Mar 9, 2007

Yes, higher level of care, and in this case the second ER was a higher level of care since the first one didn't have a surgeon.

neneRN, BSN, RN · Mar 9, 2007

I'm not clear, did the second ER accept the pt (i.e., ED doc/house supervisor at receiving hospital gave approval before pt actually transferred)or did the first ER just send the pt without official acceptance because the surgeon didn't respond? A pt can't just be sent to another ER, has to be accepted by receiving.

BELCJ · Mar 9, 2007

Emtala deals with patient care associated with their ability to pay. If the ER doc had said "we have a self pay patient needing surgery", and the OC doc had refused to come in and treat, then YES he would be in violation of EMTALA. The OC not responding to the first ER is just a matter of the OC being a jerk. If the patient is Medicare, the first ER will be rolled into the second bill anyway, so basically, no harm, no foul. There should definitely be an incident report however since the patient had to be transferred and there could have been risk. Medical Staff needs to be made aware.

pkapple · Mar 9, 2007

Potentially EMTALA violation. The first hospital had an OC surgeon, the surgeon did not respond-he may very well have to answer to Emtala violation. If a OC doc refuses to come in it is a def violation on the doc and the hospital. Of course all may claim inability to contact this doc, but if he was OC he must be available and must respond. If he was not OC and is just a local surgeon then no violation exists. The first hospital and the second are mandated to report this however. It is a violation to NOT report a potential violation. Call your risk manager NOW

Gromit · Mar 9, 2007

ugh, what a tangled mess. And imagine, if the surgeon had just got over himself and just called the ER back, this wouldn't even be an issue.

hogan4736, BSN, RN · Mar 13, 2007

I'm not clear, did the second ER accept the pt (i.e., ED doc/house supervisor at receiving hospital gave approval before pt actually transferred)or did the first ER just send the pt without official acceptance because the surgeon didn't respond? A pt can't just be sent to another ER, has to be accepted by receiving.

the second ER accepted the pt, doc to doc...

THAT'S the problem...The poor pt could have gone to preop...instead he went to another ER, received another ER charge, and got to wait for 3 hours before going to the OR...

Small minded surgeon, small town crap!

suzanne4, RN · Mar 13, 2007

As long as the patient was accepted by the second hospital physician in the ER, then EMTALA is not involved.

However, I would make sure that this was discussed with Risk Management Dept at your facility as well as the Chief of Surgery. It is inappropriate to be on-call and not be available. One thing if they are in the OR with another patient, but something else when they just to not call back. This is something that can be done by your Director of the Emergency Dept and usually will get things done. And if so, this physician can be removed from getting any referrals from the ER in the future. When you hit them in the wallet, it usually will shake things up.