Emtala Case Study

HIM 6545 Week 3 Discussion
EMTALA
David Buckley
To discuss the scenario presented regarding EMTALA, I thought a definition of EMTALA would be a good starting point. According to Oachs and Watters, EMTALA is an acronym for the Emergency Medical Treatment and Labor Act, enacted in 1986 by congress as part of the Consolidated Omnibus Budget Reconciliation Act (COBRA), and is also known as the patient antidumping statute (Oachs and Watters, 2016). In our readings, it is discussed that the main reason for EMTALA, by Congress, was to ensure public access to emergency medical services regardless of ability to pay. Section 1867 of the Social Security Act imposes specific obligations on Medicare-participating hospitals that offer emergency services
to provide a medical screening examination (MSE) when a request is made for examination or treatment for an emergency medical condition (EMC), including active labor, regardless of an individual’s ability to pay (CMS.gov, 2017).
According to our scenario, while we do not know the specifics of the problem the pregnant woman called in to Clinic A’s emergency room for, one would have to assume it was of adequate severity that she made the decision to call an ED. By referring the patient to another hospital in another city, Clinic A’s Physician’s Assistant, who was on call, violated EMTALA in a number of ways. The first violation The Department of Health would have issue with pertains to section 1867 and deals with requirements of medical screening examinations for medical conditions when requested by a patient regardless of ability to pay, as well as necessary steps to stabilize a patient’s condition first and then facilitate appropriate transfer if the situation necessitates it (CMS-1063F, 2012). Instead, the Physician’s assistant, for whatever reason, basically dumped the presenting patient to another facility which is in violation of EMTALA. Perhaps Hospital B was better suited to handle the patient’s problem, but not following proper protocol and doing a medical examination and stabilizing treatment, an appropriate transfer was not made and Clinic A would be most likely be cited for this. A third citation could possibly be for civil monetary penalties as described under section 1867(d) which allows for monetary penalties for negligently failing to appropriately screen an individual seeking medical care (CMS-1063F, 2012).
In this scenario, the pregnant woman’s request for medical help triggered EMTALA obligations which the Physician’s assistant did not initiate.
To investigate this incident, I would begin by collecting the facts of the situation as it happened from both the Physician’s assistant and the patient involved. I would also review company policy and procedure which must be in place as mandated by the Act. I would also question the employee on policy and procedure to assess their understanding procedures in place and to determine if modifications are needed in employee training in this area. Then, an audit should be performed to determine if this is a onetime event or an ongoing concern.
Pregnancy can present unique concerns pertaining to EMTALA. CMS has developed an EMTALA website with a FAQ section for guidance. Regarding pregnancy and especially those in labor, the following information is provided:
What are the provisions for pregnant women in active
labor?
Note that the determination of whether a woman in labor falls under the definition of "emergency medical condition" is determined by consideration of time factors -- whether there is adequate time to effect a "safe transfer" to another hospital before delivery. (If the woman is not in labor, that is, is not having contractions, then she does not fall under the terms of the statute unless her condition fits the general definition of "emergency medical condition" under the first paragraph for some other medical reason.)
Do all patients in active labor need to be admitted?
It is common for patients to present with "false labor" or in the very early stages of true active labor, and certainly it is not necessary to admit all such patients. EMTALA clearly requires an examination ("medical screening examination") to determine the stage of labor, in order to make the determination of whether the patient has reached the level at which a safe transfer cannot be effectuated. If the patient is at the stage at which a safe transfer could be arranged, she can be discharged without a violation of EMTALA.
This can be one of the most problematic areas of application of the language of EMTALA. Since a seemingly safe and normal course of labor can suddenly take a turn for the worse, it can often be very difficult to determine precisely where the line for "safe transfer" is crossed. As with the application of the other key language of the statute, the determination of where the line is located is ultimately a medical decision (EMTALA.com, 2017).
You can see in the second paragraph above that a medical screening examination is required to make the best possible patient outcome decisions from there. This was not done by Clinic A. Perhaps a survey taken by employees regarding EMTALA and required procedure might be a way to discover any inadequacies in company training that need to be addressed to prevent a similar situation from
happening.
Has anyone in class had direct experience with EMTALA in any way, and if so what was the outcome?
References
Centers for Medicare and Medicaid Services. (2012). CMS-1063F Retrieved from https://www.cms.gov/Regulations-and-Guidance/Legislation/EMTALA/downloads/CMS-1063-F.pdf
Centers for Medicare and Medicaid Services. (2012). Emtala overview. Retrieved from https://www.cms.gov/Regulations-and-Guidance/Legislation/EMTALA/index.html?redirect=/emtala/
EMTALA.com (2017). Retrieved from http://www.emtala.com/faq.htm
Oachs, P., & Watters, A. (2016) Health information management; Concepts, principles, and practice (5th ed.). Chicago, IL: AHIMA Press.