Under EMTALA, we're required to Triage, Provide a Medical Screening Examination and Stablize. Once a patient is deemed medically stable, we have fulfilled our EMTALA requirement. Although I know that doesn't end our obligation. What if after the Medical Sceening Exam it's determined that the patient is NOT SICK? Are we in terms of Civil and Ethical Practice basis required to provide care for them?
Here's my real world example. A patient's chief complaint was Fever 98.9 degrees and Rhinitis for 30 minutes prior to arrival, no history, no medications, no other complaints, no other symptoms, no recent travel, no sick exposures. Just was worried that he or she was coming down with the Swine Flu that had been in the Media. The CDC recommends that we only do Viral Swabs for H1N1 if the patient is very symptomatic, very sick and will be admitted to the Hospital, we are not to do a swab on every single person who is concerned about H1N1. We get these presentations constantly, I believe due to the Media coverage of the Swine Flu.
This is one doctor's regular approach: Viral Swab for Influenza, IV, IV fluids 1 Liter, Labs- CBC, Chem Panel and Urinalysis and Tylenol orally, then repeat vital signs per protocol (for him, it's every 15-30 minutes). Prescription home for Sudafed, Motrin and Tylenol.
Another doctor sees this as a Not Sick patient, and will discharge this patient home with the recommendation of Tylenol and Ibuprofen if a Fever does start, and to see the Primary Doctor in a few days just for follow up.
Which doctor's treatment is Right? I say doctor #2's treatment was more Ethical as the patient was Not Sick and hence, we should not treat someone who is Not Sick, that is part of our obligation. Although Doctor#1 would never be sued due to he covered every possible base imaginable, while doctor #2 could have complaints from people who didn't feel enough was done. Are we obliged to do, or should we do Diagnostics, Medications and Prescripations for Not Sick people? Is Legal Medical Practice, ie: what was done by doctor #1, where a doctor is so worried about a Lawsuit that his or her orders, even if not clinically indicated, will cover ever possible Legal Base, Right?
Specializes in ER, Trauma, ICU/CCU/NICU, EMS, Transport.
The doctor has to make the determination if the patient is emergent or not. Since opinion differs with each doctor, they are both right (although I'm with you, the patient didn't need an iv etc). The media has done the public another huge disservice with all the hubub about swine flu.
I know this may be off topic, but, LilgirlRN - what do you mean by:
"The media has done the public another huge disservice with all the hubub about swine flu."
Sounds like you need the QMP or ESP process....using the ESI five-level acuity system, all 4s and 5s in our ED are QMP eligible. The ED phsyican provides the MSE - if no EMC (emergency medical condition) exists, then the patient is visited by registration. They are given the choice to pay their co-pay if they want to stay and see the physician for tx anyways - or a lump sum if they have no insurance. If they can't/won't pay then they are let go with a not that states that the patient chose not to be treated by the phsyician. Perfectly legal and cost-effective. We have a list of QMP exclusions - basically old people, babies...and a list of medical complaints that are no brainer emergencies anyways.
Specializes in ER, Trauma, ICU/CCU/NICU, EMS, Transport.
Sounds like you need the QMP or ESP process....using the ESI five-level acuity system, all 4s and 5s in our ED are QMP eligible. The ED phsyican provides the MSE - if no EMC (emergency medical condition) exists, then the patient is visited by registration. They are given the choice to pay their co-pay if they want to stay and see the physician for tx anyways - or a lump sum if they have no insurance. If they can't/won't pay then they are let go with a not that states that the patient chose not to be treated by the phsyician. Perfectly legal and cost-effective. We have a list of QMP exclusions - basically old people, babies...and a list of medical complaints that are no brainer emergencies anyways.
I know of a local facility doing something similiar...
1) Triage pt
2) MD notes pt meets criteria for "frequent flyer" or repeat customer; uses a stringently defined criteria set by administrative policy (IE number of visits, nature of visits etc)
3) Pt in room, MD performs medical screening exam, documents "no emergency condition present"
3) Before any further treatment is rendered, billing/registration sees pt in room and discusses that since this is not an "emergent" visit, payment arrangements must be made before further treatment. Pt's copayment is determined or if uninsured a $100 deposit.
4) If pt pays or makes arrangements, treatment continues at the discretion of the MD.
Works okay so far but we find the inclusion/exclusion criteria (over 65, medicare, children, etc) allows many that we think would qualify to not qualify - so it actually rarely gets used.
BUT it has been VERY NICE to see the administration support this move and make it policy.
pt meets criteria for "frequent flyer" or repeat customer; uses a stringently defined criteria set by administrative policy (IE number of visits, nature of visits etc)
It doesn't need to be just the "frequent fliers".
Patients of all kinds without "emergent" conditions begin the "QMP" process- medication refills, pregnancy tests, chronic pain issues: (neck, back, orthopedic problems), routine labs, dermatology issues and so on.
You receive a "medical screening exam" and that's it. You can elect to stay and you're treated like an outpatient clinic would proceed. Payment, copay, deposit or out the door you go to follow up with your PMD.
Sounds like you need the QMP or ESP process....using the ESI five-level acuity system, all 4s and 5s in our ED are QMP eligible. The ED phsyican provides the MSE - if no EMC (emergency medical condition) exists, then the patient is visited by registration. They are given the choice to pay their co-pay if they want to stay and see the physician for tx anyways - or a lump sum if they have no insurance. If they can't/won't pay then they are let go with a not that states that the patient chose not to be treated by the phsyician. Perfectly legal and cost-effective. We have a list of QMP exclusions - basically old people, babies...and a list of medical complaints that are no brainer emergencies anyways.
"Standard of care" is defined by experts, professionals, professional organizations, educational entities and peer leaders.
"Expectation of care" is defined by the public at large and what they perceive as what should be done - the public (nor the jury) sets the standard. The jury may subcumb to it at the hands of a skillful prosecution or defence, but precedence is NOT set in the courtroom which establishes "standard of care"...some lawyers may tell you that it does, but it does't.... the experts (et al) set and re-establish the standard during each testimony.
PS: you still haven't given me any citations or references for your statements...
If you want a specific citation to an article that says the standard of care is what people say it is, then I can't give you one. I'm not saying a person will certainly win, I'm saying that they can make the argument. Under what I understand of tort law, the plaintiff has to show that the defendant fell below the standard of care, and the plaintiff can use current practices and call witnesses to testify as to what the standard of care is.
mwboswell
561 Posts
I know this may be off topic, but, LilgirlRN - what do you mean by: