More info on EMTALA

  1. I am looking for some clarification on some EMTALA guidelines and I can't seem to find where to go with questions. Does anyone know? For example, if a pt presents to L&D in no obvious distress, with c/o painless uc's (or even no uc's) and just wants her cervix checked to see if she is dilating, is it a violation to suggest that she go to her OB's office, without checking her? There seem to be so many "gray areas." I would love it if someone could tell me a website, phone number, address, anything where I could go to get some questions answered!!!!
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    About at your cervix

    Joined: Dec '00; Posts: 291; Likes: 34
    Labor, Delivery, Post Partum and Newborn RN
    Specialty: 10 year(s) of experience in OB, Post Partum, Home Health


  3. by   fiestynurse
    Here is a very good site re: the new EMTALA language.

    What are the provisions for pregnant women in active labor?

    Note that the determination of whether a woman in labor falls under the definition of "emergency medical condition" is determined by consideration of time factors -- whether there is adequate time to effect a "safe transfer" to another hospital before delivery. (If the woman is not in labor, that is, is not having contractions, then she does not fall under the terms of the statute unless her condition fits the general definition of "emergency medical condition" under the first paragraph for some other medical reason.)

    Do all patients in active labor need to be admitted? It is common for patients to present with "false labor" or in the very early stages of true active labor, and certainly it is not necessary to admit all such patients. EMTALA clearly requires an examination ("medical screening examination") to determine the stage of labor, in order to make the determination of whether the patient has reached the level at which a safe transfer cannot be effectuated. If the patient is at the stage at which a safe transfer could be arranged, she can be discharged without a violation of EMTALA.

    This can be one of the most problematic areas of application of the language of EMTALA. Since a seemingly safe and normal course of labor can suddenly take a turn for the worse, it can often be very difficult to determine precisely where the line for "safe transfer" is crossed. As with the application of the other key language of the statute, the determination of where the line is located is ultimately a medical decision.

    [ June 16, 2001: Message edited by: feistynurse ]
  4. by   kennedyj
    It is important to know that active labor isn't defined by having contractions alone. There needs to be cervical change. When a woman in labor comes in, we do a 20 minute NST, check her cervix and may have her walk if her cervix is closed or hasn't changed since her last visit. If she is ruptured she gets admitted. If she returns after walking, maybe have her shower, and if no cervical change and she just wants to get some rest- Morphine works great. This is what we usually do. However in the military facilities there is no money/insurance issues.
  5. by   fiestynurse
    In light of what kennedyj just stated above, about the difficulty of not being able to always clearly tell if someone is in active labor. I would say that it would be a violation of EMTALA to send a patient that presents to L&D, "in no obvious distress," to her doctor's office to have her cervix checked. This would be "patient dumping" as defined by the statute.

    The following is some additional EMTALA language that may be helpful.

    The EMTALA statute defines the relevant terms thus:
    The term ''stabilized'' means, with respect to an emergency medical condition described in paragraph (1)(A), that no material deterioration of the condition is likely, within reasonable medical probability, to result from or occur during the transfer of the individual from a facility. . .
    * * *

    The term ''emergency medical condition'' means - (A) a medical condition manifesting itself by acute symptoms of sufficient severity (including severe pain) such that the absence of immediate medical attention could reasonably be expected to result in -

    (i) placing the health of the individual [ ] in serious jeopardy,
    (ii) serious impairment to bodily functions, or
    (iii) serious dysfunction of any bodily organ or part. . .

    [ June 17, 2001: Message edited by: feistynurse ]
  6. by   woopcrane
    Unfortunately the COBRA law simply states if the women is having contractions....

    It does not define active labor vs. latent labor vs. braxton hicks contractions.

    It simply states contractions as the defining condition.

    Hospitals interpret this in various ways. One interpreted it in its strictest manner, and would admit persons in early latent labor.

    Here is an example of a law with inadequate defining factors
  7. by   kennedyj
    I like that one! Labor is labor is labor!!!! The patients needs should come first. Hard to believe anyone would actually send someone away. Especially with todays greedy hospital settings