Transcript EMTALA - UCLA Health

The Rules become “Reality EMTALA”
Carole A. Klove, RN, JD
Chief Compliance Officer and Privacy Officer
(310) 825-7166
[email protected]
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History
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EMTALA – “Anti-Dumping Act”
Amended 1988 & 89
Final rule 1994
Amended 2002
Interpretation published November
2003
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What Changed?
CMS changed how the
regulations are interpreted
and enforced
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What did not Change?
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EMC
Documentation
Stabilization
Signage
Transfer elements
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Medical records
Central log
Sanctions
Reporting
Private lawsuits
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Basic Rules of the Road
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EMTALA applies to
• Individuals presenting to a “dedicated
emergency department”
• Off campus facilities and departments
defined as “dedicated emergency
departments”
• Hospital owned ambulances – ground
and air
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Basic Rules of the Road
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EMTALA does not apply to
• Outpatient settings
• Individuals who are inpatients
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“Individual”
Comes to the DED
• With respect to an
individual who is
not a patient, the
individual presents
to the DED
requesting
evaluation or
treatment of a
medical condition
Prudent layperson
observer
• Individual on
hospital campus
requesting
treatment for an
EMC; or
• A prudent layperson
observer believes
the individual needs
evaluation for EMC
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Dedicated Emergency
Department
Meets at least one of the following:
• Licensed under applicable state law as
an ED
• Held out to the public as a place that
provides care on an urgent basis
without requiring an appointment, or
• During the previous calendar year at
least 1/3 of all the outpatient visits were
for the treatment of emergency medical
conditions
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Hospital Owned & Operated
Ambulance
The examination or treatment of an
individual in a ground/air ambulance
owned & operated by a hospital is
not subject to EMTALA, if it operates:
• under community wide EMS protocols
• at the direction of an MD who is not
employed or affiliated with the hospital
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Diversion
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The hospital directs the ambulance
to another facility because it does
not have the capacity or capability to
accept any additional emergency
patients
Is this appropriate?
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Requirements
Stabilization
Screening
Transfer
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Screening
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Anyone presenting to the DED or hospital
campus requesting treatment for a medical
condition is entitled to a medical screening
examination (MSE)
The MSE involves a process of sufficient
scope to conclude, with reasonable clinical
confidence, whether an emergency
medical condition does or does not exist
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Change in Interpretation
If an individual comes to the
dedicated emergency department
and the nature of the request is clear
that the condition is not an
emergency, the requirement is to
perform a screening appropriate for
any individual presenting in the same
manner.
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Stabilization
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Provision of treatment for the EMC to
ensure, within reasonable medical
probability, that no material deterioration of
the condition is likely to result from, or
occur during, the transfer of the patient.
In the case of a woman in labor, the
woman’s medical condition shall be
considered stabilized if the woman has
delivered the child and the placenta.
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Transfer
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An appropriate transfer includes
determining capacity & capability
• Receiving hospital has the capacity,
e.g., beds to provide medical treatment
• Receiving hospital has the capability to
provide specialized services by qualified
personnel
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Record Requirements
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Hospitals shall maintain the following
records & retain them for at least 5
years
• Physician on call list
• Central log
• Transfer records
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On Call
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“Best meets the need”
Roster requirements
Elective surgery & back up call
Frequency of call
Emergency physician & on call
disagreements
Disparate response to requests
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Now that you know the Rules….
Reality EMTALA
Scenario No. 1
 A patient is brought to a community
hospital by a family member via
private car. The family member
found the individual “down”. X-rays
depict a sub-arachnoid hematoma.
There is no neurosurgeon on call.
 What are your options?
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Now that you know the Rules….
Reality EMTALA
Scenario No. 2
 A 13 year old female is brought into the
ED by the police under legal hold
(detainment). It is determined by the ED
attending that the child needs a psych
consult. The psych consult determines
that the child is a danger to herself.
Parents cannot be located and you do not
have an adolescent psych unit.
 What do you do?
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Now that you know the Rules….
Reality EMTALA
Scenario No. 3
 A 42 year old mill worker presents with a
significant crushing trauma injury to the
hand and partially amputated digits. The
emergency physician examines the patient
and determines a hand and vascular
consult is needed as part of the MSE. The
vascular surgeon refuses to come to the
ED.
 What do you do?
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Now that you know the Rules….
Reality EMTALA
Scenario No. 4
 During a recent evening shift, an
employee of your hospital is exposed
to a needle stick and presents to the
Emergency Department.
 What obligations are now triggered?
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Key Points
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Maintain a central log & on call list
Determine chief complaint & level of
urgency (triage)
Define who can perform the MSE
Do not delay the MSE to verify
method of payment, obtain insurance
approval, etc.
Perform medically indicated tests to
rule out or confirm EMC
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Key Points
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Stabilize the patient
Confirm capability & capacity when
considering transfer
Document risks & benefits to support
need for transfer
Provide appropriate transport
Maintain records for at least 5 years
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EMTALA…the Potential Punishment for
Failure to Follow the Regulations
• Potential fine of up to $50,000 per
patient incident
• Termination from Medicare and
Medicaid
• Potential lawsuit for civil damages
• Potential civil rights violations
• Individual MDs can also be fined
up to $50,000 per incident
• Publication of the violation and
penalty
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Questions & Answers
Carole A. Klove, RN, JD
Chief Compliance Officer and Privacy Officer
(310) 825-7166
[email protected]
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