If you decide to reject the patient, is this a violation of EMTALA?
No, rejecting the patient from Hospital B will not be a violation of the EMTALA. This is because EMTALA has given out proper guidelines that have to be followed for a patient to be transferred from one Hospital to another. As the administrator of the facility rejecting the patient’s admission to our facility will not be a violation of EMTALA because the patient is in another healthcare facility where they can receive medical attention and treatment. The physician in the facility has the capability of providing medical services to the patient injury, so the situation is not alarming. The patient is in an emergency room, and the physician in the facility can be accessed although the physician is nervous about doing the medical procedure, this means the physician can perform the process, but the only problem is that the physician is worried. As the administrator of the facility, it will be unethical if I allowed the transfer of the patient to our facility because the patient will not be able to get the services they require on time.
The physician at hospital B is under the influence of alcohol, which is contrary to the rules and regulations put by EMTALA when performing a medical procedure. Therefore, if the patient is allowed, then the Hospital will be placing the patient’s life in danger because they will not get the medical service as required. The physician’s judgment might be impaired by the substance abuse causing more harm to the patient. Hospital A does not provide higher care than hospital B; therefore, there will be no need to transfer the patient. According to my observation, hospital B can do the medical process, but they want to move the patient to hospital A because the physician is nervous, which is not a genuine reason to accept the transfer.
What decision will you make as the administrator?
As the administrator of the facility, I will reject the admission of the patient to our facility, knowing that my actions are not against EMTALA. After the physician has reviewed the patient’s medical records in our facility, it was proven that the patient could be treated in their current healthcare center. Consequently, this means there was no need to transfer the patient because the same service can be provided in the Hospital the patient is currently admitted. In such a situation, I will take action on the matter for the physician to explain the reasons as to why he took alcohol, and yet he was on call. The drinking behavior of the ENT while on call was unethical because this could be putting patients’ lives in danger in case the Hospital has an emergency because substance abuse could end up impairing the physician’s judgment.According to code of medical ethics in the America medical association section, E-8.15 entitles “substance abuse” it is unethical for any medical staff or physician to practice medicine when they are under the influence of alcohol or under control of any substance abuse that might end up impairing their ability to practice medicine. Because the ENT was under the influence of alcohol and was not available, I would inquire and request another ENT to avail themselves and be ready if need be.
Health
Based on this scenario, what could be implemented to prevent this type of situation from occurring in the future?
As the administrator, I will come up with better measures that will ensure the incident does not reoccur again. First, I will make sure all the medical staff, including physicians, are aware of the policies that have been put in place by EMTALA and its severity. I will organize for a workshop and training program that will educate staff members on the rules and regulations that have been put in place by EMTALA and ensure they understand them. I will also ensure physicians are aware of the three hospital obligations that have been put in place by EMTALA.
Hospital with extraordinary capability has a responsibility to accept transfers from Hospital that that has less ability. A hospital that has more advanced technologies and medical physicians should be ready at all times to help and take requests from hospitals with less capability. This will help in saving the lives of patients by allowing them to get services that are not provided in the Hospital with fewer abilities. A hospital should always keep records and report any incident where they believe a patient who was in unstable condition was transferred to their facility according to EMTALA. As an administrator, I would ensure all the staff in the facility are trained on policies, procedures, and ethics. The training will ensure it educated health facilities staff on their responsibilities while on call and what they are not supposed to do. The training of the staff members, including physicians, will include the unethical practice of substance abuse like alcohol when they are on duty or on call. The staff will also be educated and reminded on the dangers of substance abuse when they are on request or on duty.
Under what scenario would the Hospital A physician be concerned about an EMTALA situation?
If hospital A feels like the patient in hospital B needs higher care than what is provided in hospital B, then they will consider accepting the transfer of patients from hospital B to their facility. If hospital A is providing high care than what is being offered by hospital B, then hospital A will have to accept the patient’s admission in their facility. If hospital B never had the required technology or physician to treat the patient’s condition, then hospital A can consider admitting the patient. Laws that have been put in place by EMTALA makes it clear by guiding healthcare facilities on what to do and avoid dumping patient to other healthcare facilities. The EMTALA law provides guidelines that have to be followed, ensuring all the hospitals take responsibility for their actions.
References
(n.d.). Retrieved from http://www.emtala.com/faq.htm
(n.d.). EMTALA (Emergency Medical Treatment And Labor Act). Retrieved from http://newsroom.acep.org/2019-01-04-emtala-fact-sheet
Kahntroff, J., & Watson, R. (2019, January 1). Refusal of Emergency Care and Patient Dumping. Retrieved from https://journalofethics.ama-assn.org/article/refusal-emergency-care-and-patient-dumping/2019-01
Peterman, J. F. (2015, January 1). Should physicians be allowed to use alcohol while on call? Retrieved from https://jme.bmj.com/content/31/1/21