EMTALA Q&A
July 1, 2002
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 Staci Kusterbeck, Editor, ED Management, 280 Nassau Road, Huntington, NY 11743. Telephone: (631) 425-9760. Fax: (631) 271-1603. E-mail: [email protected].]
Question: If a patient is coming to the ED from an extended care facility on the hospital campus for reinsertion of a percutaneous endoscopic gastrostomy (PEG), can we direct that patient to our other campus ED that is about two miles down the road?
Answer: According to Jonathan D. Lawrence, MD, JD, FACEP, the answer starts with another question: Why the other campus? If facility one lacks the capability to perform the reinsertion procedure, transfer to another facility is permitted so long as the benefits outweigh the risks and the patient or his or her representative consents to the transfer, he explains.
If facility one never has the capability, the extended care facility should be directed to develop a policy to always send these type of patients to facility two. If facility one has the capability, but the on-call physician refuses to come in to perform the procedure, that on-call physician has violated EMTALA, says Lawrence.
If the extended care facility patients actually are inpatients on the campus when a new emergency occurs (for example, the PEG comes out), then Lawrence notes that inpatients are not covered by EMTALA except under a very limited circumstance.
He explains that if the extended care facility bills under the same Medicare provider number as the hospital, these patients generally are not covered by EMTALA. Any reasonable policy to provide care in a timely manner is all that is required, he says. If the extended care facility is a totally separate facility with its own Medicare provider number, Lawrence says that the facility must have a policy in place to cover these events. "Is the patient "coming to the emergency department" if they are already a resident on the campus?" he asks. "A good case could be made that they are not."
Another issue is who is requesting care for these patients, says Lawrence. In most patients with PEGs, it will be a nurse or physician at the facility who is acting as the patient’s representative, he says. "Certainly a meeting between administrators can resolve the matter to arrange the best place for PEG replacement," says Lawrence. He offers two suggestions: admitting the patient directly to the gastrointestinal lab or having the extended care facility call first to check on facility availability.
However, Lawrence notes that the new proposed EMTALA regulations indicate that patients already on campus are not "coming to the ED" if a new emergency develops, such as a PEG falling out. "Therefore, EMTALA would not apply, and arrangements in the best interests of both the patient and the hospital can be made," he says.
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