EMTALA Q&A
January 1, 2002 3 minutes read
EMTALA Q&A
[Editor’s note: This column is part of an ongoing series that will address reader questions about the Emergency Medical Treatment and Labor Act (EMTALA). If you have a question you’d like answered, contact Editor Staci Kusterbeck. Telephone: (631) 425-9760. Fax: (631) 271-1603. E-mail: [email protected].]
Question: If a patient has a severe laceration that requires suturing by a specialist within eight hours, is it OK to discharge the patient from the ED to go to a private practitioner’s office? And if so, may the patient be discharged to travel by a private car?
Answer: This question is specifically addressed in the Code of Federal Regulations 489.20(r)(2), says Denise Casaubon, RN, owner and president of DNR Consultants, a Fountain Hills, AZ-based company specializing in health care corporate compliance. The regulation requires "a list of physicians who are on call for duty after the initial examination to provide further evaluation and/or treatment necessary to stabilize and individual with an emergency medical condition."
The interpretive guidelines for this section address services for which physicians are on call, says Casaubon. "They state that when a physician is on call in an office setting, it is not acceptable to refer an emergency case to their office for examination and treatment," she adds.
She reviews the scenario on the previous page: If a patient had a facial laceration that required treatment by a physician who specialized in plastic surgery, it was determined that the hospital had a plastic surgeon on call, and the treatment of laceration was considered emergent, then the plastic surgeon would be required to come to the hospital to treat the patient, and the patient should not be sent to the physician’s office. "I can only think of three examples where it would be acceptable in the above situation to send the patient to the physician’s office," says Casaubon. They are as follows:
1. The physician is in a hospital-owned office that is contiguous to or on the hospital campus.
2. The hospital does not have a plastic surgeon on call, but the physician’s office agreed to treat the patient after it was determined the patient was stable to be transported.
3. The patient is determined not to have a diagnosis that is considered an emergency medical condition.
She adds that the transportation issue is addressed in section 489.24(d)(2)(iv), which states, "The transfer is effected through qualified personnel and transportation equipment, as required, including the use of necessary and medically appropriate life support measures during transfer."
Casaubon says, "If the treating practitioner determines it is safe for the patient to go for treatment by private car, then that is acceptable as long as the documentation in the medical record supports this decision."
Question: Our satellite ED transferred a patient with an obvious clinical pneumothorax to the main site without calling in a technician to do a chest X-ray at 4 a.m. to confirm the diagnosis. We were cited for failure to complete a full medical screening examination (MSE). Is the satellite ED required to fully complete the MSE?
Answer: According to Jonathan D. Lawrence, MD, JD, an ED physician and medical staff risk management liaison at St. Mary Medical Center in Long Beach, CA, the citation seems inappropriate based on the facts presented. "If a pneumothorax is clinically evident, an X-ray is not required to diagnose the emergency medical condition, unless protocols for the nonphysician MSE examiner require the X-ray," says Lawrence.
In other words, if a physician performs the MSE and determines that there is a pneumothorax, a certain degree of discretion is permitted as to whether an X-ray is ordered, he explains. "No such luxury exists for nonphysicians if the protocol calls for an X-ray for chest pain or shortness of breath," he cautions. However, if a chest X-ray is within the capabilities of the satellite and the protocol calls for the X-ray, it must be performed, says Lawrence.
Sources
For more information about EMTALA, contact:
• Denise Casaubon, RN, DNR Consultants, 16217 Balsam Drive, Fountain Hills, AZ 85268. Telephone: (480) 816-6695. Fax: (480) 836-8185. E-mail: [email protected].
• Jonathan D. Lawrence, MD, JD, Emergency Department, St. Mary Medical Center, 1050 Linden Ave., Long Beach, CA 90813. Telephone: (562) 491-9090. E-mail: [email protected].
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