EMTALA

1. EMTALA Grove City Medical Center Julie Ryhal RN, BSN, MEd

2. What Is It?? EMTALA -The Emergency Medical Treatment and Active Labor Act. It’s not a federal malpractice law but rather a federal anti-discrimination law to protect people who cannot afford emergency services.

3. What We Need To Do 1. Provide a medical screening examination by a qualified healthcare provider for each person presenting to the emergency department. 2. Provide stabilization and make medically appropriate transfers. 3. Transfer patients only for care that we can not provide here or per the patient’s request. 4. Obtain and document acceptance from the receiving facility. 5. Document sufficient information to substantiate the appropriate nature of the transfer.

4. DEFINITIONS • Dedicated Emergency Room: • Is licensed by the state as an emergency department. • Holds itself out to the public as providing emergency care. • Has provided at least 1/3 of its outpatient care for ER treatment in the prior year. • Medical Screening Exam: • The process required to reach within reasonable clinical confidence that an emergency medical condition does or does not exist. This is not the nursing triage, it must be completed by a physician or other qualified licensed practitioner.

5. Stable Patient: • Means that no deterioration of the condition is likely to result from or occur during the transfer of an individual. • The final decision as to whether or not a patient is stable is made by the treating physician. • Emergency Medical Condition: • A condition with acute symptoms of sufficient severity that in the absence of immediate medical attention could place the person’s health in serious jeopardy.

6. What We Must Do… • Post signs in the ED specifying the rights of individuals with emergency conditions and women in labor • Maintain medical records for 5 years • Maintain a list of on-call physicians • Maintain a central log of who came to the ED seeking treatment • Provide appropriate medical screening examination • Accept appropriate transfers of individuals with medical conditions within our capabilities of treating • Provide appropriate transfer to another facility • Adopt and enforce policies and procedures to comply with EMTALA ( ADMIN 3.14)

7. What Else?? • Must have an accepting physician • Must have an appropriate mode of transportation • Must have documented consent to transfer • Must send all medical records with the patient

8. Transfer of an Unstable Patient • Can we transfer and unstable patient?? YES – if….. • The individual requests a transfer after being informed of the risks. • The physician signed the certification that the benefits of transfer outweigh the risks. • Treatment has been provided to minimize the risks of transfer. • All pertinent records are sent to the receiving facility. • The consent of the receiving facility has been obtained. • Ensure the transfer of the unstable individual is effected through qualified personnel and transport equipment.

9. EMTALA VIOLATION…. • A violation can result from: • Transferring an unstable patient: • Without obtaining consent of the receiving facility • That is at risk of deteriorating due to or during transfer • Refusal to provide stabilizing treatment to a patient with an emergency medical condition. • Failure of the on-call physician specialist to respond, evaluate and assist in the treatment and stabilization of the patient.

10. QUESTIONS & ANSWERS

11. ? • Does EMTALA apply to inpatients? • No • Is a laboring woman considered stable? • Any woman experiencing contractions is considered unstable but may be transferred if there is a distinct medical benefit to the transfer. She should be examined by a physician before she is discharged or transferred.

12. ? • What if a patient refuses treatment? • Staff must indicate in writing: • The risks/benefits of the examination or/and treatment • The reason for refusal • A description of the exam & treatment • Steps taken to secure a written informed refusal if it was not secured.

13. ? • How do we handle a patient who is on the property but not in the ED? • If a person is anywhere on hospital property and presents themselves in need of care, the employee who is present should accompany that person to the ED. • Hospital property means the hospital’s main building, parking lot, sidewalk and any building owned by the hospital that is within 250 yards of the hospital.

14. ? • How do we handle someone who presents themselves at one of our off campus departments? (Clintonville, Slippery Rock) • Unless that off campus area has an emergency department, they do not have to abide by EMTALA. They should refer to their policies on how to handle a medical emergency.

15. ? • What are the possible consequences of an EMTALA violation? • The hospital and/or physician can be fined up to $50,000. • The hospital may be terminated from its Medicare Provider agreement. • The physician may be excluded from Medicare and Medicaid programs. • The patient who suffers personal injury may sue the hospital in civil court.

16. ? • Where can I find more information? • Policies – NURS 3.23 and ADMIN 3.14 • “The EMTALA Answer Book” by Mark M. Moy located in the Emergency Room • The CMS Hospital Conditions of Participation and Interpretive Guidelines – ask your manager. • Ask Brad Vansickles VP of Operations and Patient Safety – ext 7183

17. REFRENCES: • The CMS Hospital Conditions of Participation and Interpretive Guidelines, HCPro, 3/2010 edition. • The EMTALA Answer Book, Mark M. Moy, Aspen Publishers, 2011.