EMTALA andAMH’s New EMTALA Policy:

What General Medical Staff Members Need to Know

Background

l EMTALA is the Emergency Medical Treatment and Active Labor Act (1986)

l It was enacted in response to the practice by some hospitals of turning away uninsured and indigent patients in need.

l A number of these patients either died or were seriously compromised.

Basic Requirement

Provide an appropriate medical screening to determine if an emergency medical condition exists.

And If its does,

Either stabilize the patient’s condition

or transfer the patient in accordance with EMTALA

When an individual comes to the hospital for emergency care, the hospital must:

Basic Requirement

l In addition, EMTALA imposes several other requirements on the hospital, its employees and its medical staff - not just the ED staff.

l In December 2004, the federal Center for Medicare and Medicaid Services (CMS) directed AMH to make changes in its EMTALA policies and practices, and to provide further training to its employees and medical staff.

AMH’s New EMTALA Policy

• AMH has now adopted a newEMTALA Policy.

• Admin Policy #2070

What the General Medical StaffNeeds to Know

The Medical Screening Exam

4 When an individual comes to the hospital for emergency care, the hospital must provide the individual with an appropriate medical screening examination (MSE), within the capability of the ED (including ancillary services routinely available to the emergency department) to determine whether an emergency medical condition exists.

The Medical Screening Exam

“Comes to the hospital for emergency care” means the individual

(a) has presented at the ED, or at any other hospital-operated location on the hospital's campus, and either:

– requests examination or treatment for a medical condition

– has such a request made on his or her behalf, or

– a prudent layperson observer would believe, based on the individual's appearance or behavior, that the individual needs examination or treatment for a medical condition; or

(b) Is in an ambulance on hospital property for presentationfor examination and treatment for a medical conditionat a hospital's emergency department.

The Medical Screening Exam

A person who comes to any part of the hospital or its campusand asks for, or appears to need, emergency care, triggers the requirement to provide a Medical Screening Exam, and then if warranted, stabilization or transfer.

IMPORTANT - Note that EMTALA obligations do not just apply to persons who come to the Emergency Department

The Medical Screening Exam

4 The MSE must be performed by an Emergency Physician, (or by a resident under the direction of one)

4 Accordingly, if you encounter a person (other than an inpatient) who requests or appears to need emergency medical treatment:– OPD: If you are in an outpatient department either notify the

ED of the possible emergent need of the individual, or request the unit clerk / receptionist to do so.

– Non-clinical area: If you are in a non-clinical area of the hospital campus, either direct, escort or transport the person to the ED, or request Security to do so. If necessary, call 911 as well as the ED.

The Medical Screening Exam

Emergency Medical Condition” means -

4 A medical condition manifesting itself by acute symptoms of sufficient severity (including severe pain, psychiatric disturbances and/orsymptoms of substance abuse) such that the absence of immediate medical attention could reasonably be expected to result in --

– Placing the health of the individual (or, with respect to a pregnant woman, the health of the woman or her unborn child) in serious jeopardy;

– Serious impairment to bodily functions; or

– Serious dysfunction of any bodily organ or part; or

4 With respect to a pregnant woman who is having contractions--

– That there is inadequate time to effect a safe transfer to another hospital before delivery; or

– That transfer may pose a threat to the health or safety of the woman or the unborn child.

Stabilizing Treatment and Transfer

4 If the MSE indicates that the individual has an emergency medical condition, then the appropriate hospital staff must do one of the following, as medically indicated, and without regard to the individual’s ability to pay:

– Provide further medical examination and treatment as required to stabilize the emergency medical condition;

– Transfer the individual to another medical facility, in accordance with EMTALA standards; or

– Admit the individual as an inpatient.

On-Call Coverage

4 If you are on-call, you have an obligation under EMTALA to come to the ED when requested by an ED physician to do so.

4 If you fail to come to the ED when called you are subject to:

– Penalties imposed by CMS (Up to $50,000)

– Sanctions imposed by the AMH Medical Staff

On-Call Coverage

4 The ED Physician determines whether the on-call MD is needed only for a phone consult, or is needed to come to the ED to assess and/or treat the patient.

4 In either event, on-call MDs must respond by phone within 30 minutes of being called.

4 On-call MDs who are directed to come to the ED must arrive within 60 minutes of their phone response, unless the ED physician who requested the consult specifies a different time requirement.

4 The ED Physician is required to document requests and response times.

On-Call Coverage

4 Second Call Plan (In the event that the on-call physician cannot respond):– ED staff will phone the on-call group office

manager/answering service and ask the responder to contact the group's back up on-call physician.

– If that is not successful or inadvisable to the ED physician, the ED physician will select another appropriate sub specialist for consultation;

– If that approach is not successful or inadvisable to the ED physician, the ED physician will contact an MD in the chain of departmental command.

– If all of these efforts fail, the patient will be transferred to another appropriate hospital..

On-Call Coverage

4 The ED physician may not refer an unstabilized individual to the on-call physician's office for treatment of an emergency medical condition.

4 In such instances, the on-call physician must come to the ED.

Other Policy Provisions

4 AMH’s EMTALA Policy also addresses:– The need for a Central Log of individuals who come to the

hospital for emergency care– The need for appropriate signs notifying individuals of their

EMTALA rights– The requirement of staff to report EMTALA violations, and

protections for persons who so report.

Other Policy Provisions

4 You can review the full AMH EMTALA Policy on the NEH Website– Go to nehealth.com– Click on “Online services,” then “Physicians Only”, then

EMTALA Policy