When exactly is a physician 'on call'?
In the preamble to the new Emergency Medical Treatment and Labor Act (EMTALA) regulations of 2003, some commenters stated that some physicians may choose to come to a hospital to see private patients at times when they are not shown as being on call under the listing the hospital maintains for EMTALA purposes, notes Alan Steinberg, Esq., an attorney with Horty Springer in Pittsburgh. The commenters believed such physicians should not be considered to be on call under EMTALA simply because they come to the hospital under these circumstances.
Here is CMS' response:
"We understand that physicians may sometimes come to a hospital to see their own patients, either as part of regular rounds or in response to requests from the patient or the patient's family, and agree that visits of this type should not necessarily be interpreted as meaning that the physician is on call. On the other hand, some physicians have in the past expressed a desire to refuse to be included on a hospital's on-call list but nevertheless take calls selectively. These physicians might, for example, respond to calls for patients with whom they or a colleague at the hospital have established a doctor-patient relationship, while declining calls from other patients, including those whose ability to pay may be in question. Such a practice would clearly be a violation of EMTALA. Because it may be difficult to distinguish the two practices from one another outside the context of a careful review of patient records, we are not making any revision to this final rule based on this comment. However, we will keep it in mind as we develop the interpretative guidelines and training materials for implementing EMTALA."
Steinberg understands CMS' response to warn against the practice of "cherry picking." CMS affirms that a physician who is not the designated, on-call physician does not place herself on general on-call duty when the physician goes to see her own private patients in the ED or elsewhere, he says.
However, Steinberg adds, CMS states that an EMTALA violation occurs when a physician refuses to be on the unassigned patient/ED on-call list but continues to take call for his own patients or those of a colleague. The pertinent guidelines' provision also states this, he notes, although in a much truncated form.
How is anyone to know that to fully understand this particular guideline requires specific knowledge of the preamble to the 2003 regulations? There is no good way to know this, Steinberg insists, unless you understand that to fully understand EMTALA, you may have to know the act, the regulations, the guidelines, CMS' EMTALA letters, its 1999 EMTALA advisory bulletin, and other such materials.
In the preamble to the new Emergency Medical Treatment and Labor Act (EMTALA) regulations of 2003, some commenters stated that some physicians may choose to come to a hospital to see private patients at times when they are not shown as being on call under the listing the hospital maintains for EMTALA purposes, notes Alan Steinberg, Esq., an attorney with Horty Springer in Pittsburgh.You have reached your article limit for the month. Subscribe now to access this article plus other member-only content.
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