Court suggests EMTALA could apply to inpatients
The Emergency Medical Treatment and Labor Act (EMTALA) has posed liability risks for hospitals for many years, but EMTALA obligations have been limited mainly to the emergency department (ED). Now a recent decision by a federal district court in Texas suggests that the law could be applied much more broadly to inpatients as well.
The decision reminds hospitals to be extra vigilant in documenting the appropriateness of admitting as inpatients those patients who present in the emergency department and the appropriateness of ultimate discharge following inpatient admission, says Nathan A. Kottkamp, JD, a partner with the law firm of McGuireWoods in Richmond, VA.
“This decision suggests that the rule is not as final as many of us thought it was,” he says.
The court issued a memorandum opinion and order concluding that, as a matter of law, EMTALA may continue to apply under circumstances in which a patient is seen in an ED and then admitted to the hospital as an inpatient, Kottkamp explains. The patient alleged that after he was admitted, the hospital tried repeatedly to transfer him because he had no insurance and that those attempts violated EMTALA. (The ruling is available online at http://tinyurl.com/emtaladecision. See below for a summary of the case.)
“The court denied the defendant hospital’s motion to dismiss the plaintiff’s EMTALA claim based on the key fact that the patient had been admitted as an inpatient to the hospital,” Kottkamp says.
That was a substantial deviation from previous Centers for Medicare and Medicaid Services (CMS) guidance on EMTALA. As recently as Feb. 2, 2012, CMS reaffirmed, in a proposed rule, that a hospital’s obligation under EMTALA ends either when the individual is stabilized or when the hospital admits the patient in good faith as an inpatient to continue providing stabilizing treatment. “CMS said that EMTALA no longer applied if a patient was admitted in good faith to a hospital,” Kottkamp says. “They made it very clear that you can’t just mark someone as being inpatient for an hour and then discharge them.
Shenanigans like that wouldn’t get around the rule. But if it was a legitimate inpatient admission, EMTALA just stops.”
Now that might not be the case. “We’re looking now at whether the statute, which does not have an inpatient exception, trumps that CMS guidance,” he says. “That’s pretty scary.”
The court stated that an EMTALA claim cannot be barred “simply because a patient has been admitted to a hospital as a bona fide inpatient.”
Because the court found that, at this stage of the case, the plaintiff pleaded sufficient facts to state a plausible claim that his condition was never stabilized, it must be left to judge or jury to determine whether the defendant hospital’s actions constitute a violation of EMTALA, Kottkamp says.
This recent decision serves as a reminder that the application — or nonapplication, as the case may be — of EMTALA to inpatients is not well settled, Kottkamp says. Therefore, hospitals should be especially careful to document their actions any time a patient presents to the facility through the ED. In light of this decision, hospitals should be doubly sure that they are documenting the reasons for admission through the ED so that, at a minimum, you can prove that it was a good faith admission, Kottkamp says. Once the patient is admitted, if the patient needs to be transferred or there is any other situation in which EMTALA could be raised, the documentation should be exceptional, he urges.
“This is a scary proposition for risk managers that a patient can be admitted to the hospital for a month and if he’s unhappy with his discharge in some way, there can be an EMTALA violation,” Kottkamp says. “That changes everyone’s approach to EMTALA. That’s a pretty big deal.”
Source
- Nathan A. Kottkamp, JD, Partner, McGuireWoods, Richmond, VA. Telephone: (804) 775-1092. E-mail: [email protected].
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