DN1
Slide 1 DN1 Emergency Medical Treatment and Active Labor Act Deirdre Newton, 8/24/2012
Costs associated with health insurance plans and the increased numbers of uninsured or underinsured persons seeking medical care became a concern for health care organizations. ERs began turning away patients who could not pay.
Hospitals built under the Hill-Burton Act (1946) were obliged to offer emergency treatment to those unable to pay. EMTALA, enacted in 1986, extended that obligation to all hospitals that participate in Medicare programs. Hospitals are required to screen and treat patients with emergency medical conditions regardless of their ability to pay.
To ensure an adequate first response to a medical crisis for all patients. to prevent hospitals from dumping indigent patients.
To comply with EMTALA, a hospital must: Screen patients to determine whether a medical emergency exists, Stabilize patients with medical emergencies, Restrict transfer of non-stabilized patients to 2 circumstances.
DN3 Originally, the emergency department was defined as a specially equipped and staffed area of the hospital (that) used a significant portion of the time for initial evaluation and treatment of outpatients and emergency medical conditions More recently, the EMTALA definition of the emergency department has expanded.
Slide 6 DN3 The first paragraph doesn't really help, just define "dedicated emergency department" to include a place licensed as an ED, holds itself out as providing emergency care, 1/3 of outpatient visits are for treatment of emergency medical conditions. Deirdre Newton, 8/24/2012
On-campus property is based on the 250- yard rule Off-campus property which includes certain provider-based treatment and diagnostic facilities, primary care centers, and urgent care facilities that are not part of the hospital or emergency room complex.
DN4 The hospital must provide a medical screening exam to any patient who requests treatment (regardless of that patient s ability to pay) to determine whether a medical emergency condition exists. The exam should be comparable to an exam offered to other patients presenting similar symptoms.
Slide 8 DN4 If "a reasonably prudent layperson observer would believe, based on the person's appearance or behavior, that the individual needs emergency examination or treatment" then a request for treatment has been made on the individual's behalf Deirdre Newton, 8/24/2012
An emergency medical condition is the presence of acute symptoms of such severity that the absence of immediate medical attention could reasonably be expected to result in Placing an individual s health in serious jeopardy, Serious impairment to bodily functions, Serious dysfunction of any bodily organ or part.
With respect to a pregnant woman who is having contractions, an emergency medical condition is one in which: There is inadequate time for safe transfer to another hospital before delivery; or Transfer may pose a threat to the health or safety of the woman or the unborn child.
If an emergency medical condition exists, the hospital must: Provide treatment until the patient is stabilized. Then transfer the patient to a medical facility that is better able to provide the necessary treatment.
Provide medical treatment, if possible, to minimize the risk of transfer, Obtain patient s written consent for transfer, Provide signed certificate of transfer, Assure that the transfer takes place with qualified personnel and equipment, Send copies of medical records related to the emergency condition.
Have available space and qualified personnel for treating the patient, Agree to accept transfer of the patient and to provide appropriate medical treatment. Regional referral centers and hospitals with specialized capabilities cannot refuse to accept an appropriate transfer if they have the capacity.
Non-stabilized patients may be transferred ONLY IF: The patient (or someone acting on the patient s behalf) requests a transfer in writing after being informed of the risks involved and the hospital s duty to treat under EMTALA, or A physician certifies that the medical benefits expected from transfer outweigh the risks involved in the transfer.
Termination of the hospital or physician s Medicare provider agreement. Hospital fines up to $50,000 per violation Physician fines up to $50,000 per violation The hospital may be sued for personal injury under private cause of action A receiving facility can bring suit to recover damages if financial loss resulted
HHS may fine and penalize a physician who: Fails to respond to an emergency while oncall, Fails to perform a screening exam, Fails to inform emergency patients of the risks and benefits of transfer, Signs a transfer certification when he or she can reasonably be expected to know that the risks outweigh the benefits.
Hospitals must track the disposition of all patients Notification of patient rights under EMTALA are to be posted in each area where emergency treatment is rendered. Hospitals have a responsibility to report any situation in which a possible EMTALA violation may have occurred.
HOSPITAL MANUAL (HM)#: 90-11-07 Speaks to the specific requirements when considering transfer of patients to other facilities.