EMTALA Scenario Analysis
Margaret Carver
Grand Canyon University
7/27/2020
The Emergency Medical Treatment and Labor Act (EMTALA) is a federal law that was passed in 1986 by the congress. It states that anyone who comes to the emergency department should be stabilized, and or treated, despite their insurance status, or their ability to pay. If a hospital is not in the capacity to treat or stabilize a patient, or upon the request of the patient, they should transfer a patient to an appropriate facility for further treatment. The EMTALA act was created to give the public access to emergency services, regardless of their ability to pay.
EMTALA covers every person in the state, making it a non-discrimination statute. This act states that “While a doctor has every right to deny treatment for various reasons, they can’t refuse to treat a person with life-threatening or serious injuries even if they don’t have health insurance or the ability to pay.” (Brown, & Brown, 2019). In case of an EMTALA violation, various penalties might be applied. This includes the revocation of the hospital, and or the physician’s agreement and license for Medicare providers. Health facilities may be faced with fines of up to $50000 for each violation, and $25000 in case the hospital has less than 100 beds. For physicians, they may have fines of up to $50000 per violation. These charges include on-call physicians.
If you decide to reject the patient, is this a violation of EMTALA?
In this case, if I reject the patient, this is not a violation of the EMTALA law. The current hospital where the patient is has the capability of treating the patient’s injury, therefore it will not be a violation of EMTALA. The patient in question is currently admitted to the emergency room of hospital B and has access to an ENT physician. Even though the physician in hospital B is nervous, he is in a position to treat the patient, by performing sutures.
The EMTALA law has cases where a violation is approved. To prove that this was a violation of EMTALA, the patient must confirm that the hospital where he was at the emergency room is a Medicare-participating hospital and that it is covered by EMTALA, hence operating an emergency department. The patient should have gone to the hospital seeking treatment, and or the hospital did not give the patient appropriate treatment according to the condition, or the patient was discharged or turned away without being stabilized or treated. Most of the states in the United States have recently come to terms with these federal requirements on the EMTALA law (Hsuan, Horwitz, Ponce, Hsia, & Needleman, 2018).
Following the above explanations, it would have been a violation of EMTALA if the patient was transferred. In this case, his injury does not need any further level of care, hence there was no need for hospital transfer to a higher level hospital. Looking at this case, as the administrator, I think the physician is trying to transfer the patient because of his nervousness in treating him.
What decision will you make as the administrator?
As the hospital administrator for hospital A, I know this is no violation of EMTALA. Therefore, I will reject the patient. The physicians in hospital A have looked at the medical records of the patient and confirmed that the patient does not need any further treatment or care. This patient can be treated in hospital B. therefore, the patient will not be transferred from hospital B to hospital A. I will not call the hospital ENT specialist to treat the patient as he has been drinking alcohol. The ENT might not be in a good position for making decisions and treating patients, as he is under the influence. This could result in danger to the patients and the hospital at large.
According to the American Medical Association code of medical ethics, 2016, “Substance Abuse” section, “It is unethical for a physician to practice medicine while under the influence of a controlled substance, alcohol, or other chemical agents which impair the ability to practice medicine.” Therefore, I will look for another ENT in the facility to ensure that a correct call was made by the ENT under the influence of alcohol.
Based on this scenario, what could be implemented to prevent this type of situation from occurring in the future?
The first thing to do to prevent this from happening in the future is to educate physicians and other medical practitioners about EMTALA policies. Therefore, I will offer staff training where all staff members are taught everything about EMTALA. In these sessions, I will ensure the staff learns about the three main obligations of the hospital, which are giving treatment to any patient who comes seeking a medical examination or treatment, regardless of whether the emergency condition is in place, treatment and or stabilization must be offered for all existing medical conditions, regardless of the patient’s ability to pay, and lastly, hospitals are allowed to transfer patients to a higher level of care hospitals if they cannot take care of the patients (Bitterman, 2002). Hospitals should also report in case they receive a patient who has been transferred in an unstable condition, as this is a violation of EMTALA.
Staff should also be trained on the proper medical ethics and policies for the staff who are on call. This will prevent future cases where a physician gives advice when they are under the influence of alcohol.
Under what scenario the Hospital a physician would be concerned about an EMTALA situation?
If the patient needed a higher level of care or treatment, then hospital A would have been more concerned about his condition, hence considering to accept the transfer. The higher level of care needed by the patient should also be provided by hospital A, to raise an issue of concern. In either case, if hospital B would not have been in a position to treat the patient, then they would consider the transfer. Above all, the Emergency Medical Treatment and Labor Act was put in place to ensure that hospitals do not overwork other hospitals by dumping patients to them or turning patients away (Zibulewsky, 2001).
References
American Medical Association. (2016). AMA code of medical ethics. American Medical Association.
Bitterman, R. A. (2002). Providing emergency care under federal law: EMTALA. Dallas (Tex), 7.
Brown, H. L., & Brown, T. B. (2019). EMTALA: The Evolution of Emergency Care in the United States. Journal of Emergency Nursing, 45(4), 411-414.
EMTALA (Emergency Medical Treatment and Labor Act). Retrieved from http://newsroom.acep.org/2009-01-04-emtala-fact-sheet
Hsuan, C., Horwitz, J. R., Ponce, N. A., Hsia, R. Y., & Needleman, J. (2018). Complying with the Emergency Medical Treatment and Labor Act (EMTALA): challenges and solutions. Journal of Healthcare Risk Management, 37(3), 31-41.
Zibulewsky, J. (2001, October). The Emergency Medical Treatment and Active Labor Act (EMTALA): what it is and what it means for physicians. In Baylor University Medical Center Proceedings (Vol. 14, No. 4, pp. 339-346). Taylor & Francis.