EMTALA

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Specializes in ER.

I'm working a travel position. An intoxicated woman came in requesting detox, and staff told her they don't provide that service, but XXX hospital in YYY city does, you should go there. Patient left because she was told we couldn't help. Sounds like a violation to me...

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Agree that she should've  received a proper MSE (and whatever stabilization appropriate).

On the other hand, an acquaintance recently needed to get their loved one to detox so they went to the ED. They were there for 12+ hours for the MSE and medical clearance process and then discharged to follow up immediately at a detox facility that could have accomplished everything start to finish. So from a practical (and maybe healthcare cost) standpoint it probably isn't always the best way. It was a long day that just as well could have started at the 2nd place and they would have gone there had they known.

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Agree that she should've  received a proper MSE (and whatever stabilization appropriate).

On the other hand, an acquaintance recently needed to get their loved one to detox so they went to the ED. They were there for 12+ hours for the MSE and medical clearance process and then discharged to follow up immediately at a detox facility that could have accomplished everything start to finish. So from a practical (and maybe healthcare cost) standpoint it probably isn't always the best way, but the law is there to protect from abuses. It was a long day that just as well could have started at the 2nd place and they would have gone there had they known.

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JKL33 said:

Agree that she should've  received a proper MSE (and whatever stabilization appropriate).

On the other hand, an acquaintance recently needed to get their loved one to detox so they went to the ED. They were there for 12+ hours for the MSE and medical clearance process and then discharged to follow up immediately at a detox facility that could have accomplished everything start to finish. So from a practical (and maybe healthcare cost) standpoint it probably isn't always the best way. It was a long day that just as well could have started at the 2nd place and they would have gone there had they known.

Great point.  Also there is a difference between saying "we won't see you here" and "we'll be happy to see you but in the end you'll have to go to ________ anyway".  The difference in refusing treatment versus giving them information to make an informed decision.  Also agree that it depends on whether the MSE has been done.   

 

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Yes. It is an EMTALA violation and it happens daily at detox and psych facilities when people are declined for lack of insurance. So the most vulnerable, who obviously cannot obtain insurance because the are unemployed, lost their reason and homes can't go around purchasing insurance.

On the other hand, hospitals cannot provide free services to everyone who walks in. The would go bankrupt in a heartbeat.

Someone needs to fix the entire system.

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feelix said:

It is an EMTALA violation and it happens daily at detox and psych facilities when people are declined for lack of insurance.

Those entities are (likely) not subject to EMTALA.

Quote

This law requires Medicare-participating hospitals with emergency departments to screen and treat the emergency medical conditions of patients in a non-discriminatory manner to anyone, regardless of their ability to pay, insurance status, national origin, race, creed or color.

https://www.acep.org/life-as-a-physician/ethics--legal/emtala/emtala-fact-sheet/

Quote

In 1986, Congress enacted the Emergency Medical Treatment & Labor Act (EMTALA) to ensure public access to emergency services regardless of ability to pay. Section 1867 of the Social Security Act imposes specific obligations on Medicare-participating hospitals that offer emergency services to provide a medical screening examination (MSE) when a request is made for examination or treatment for an emergency medical condition (EMC), including active labor, regardless of an individual's ability to pay. Hospitals are then required to provide stabilizing treatment for patients with EMCs.

https://www.cms.gov/medicare/regulations-guidance/legislation/emergency-medical-treatment-labor-act

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feelix said:

EMTALA applies to acute psych too.

It can, but many times does not.  All depends on specifics of how they are categorized and how they operate.

 

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