The Emergency Medical Treatment and the EMTALA Rule
Ethical challenges are among some of the strongest and most consistent trends in modern-day medicine. Ethical problems arise in the daily practice of medicine, educational practices, and in the conducting of research. As a result, it is dire that physicians to understand the role of relevance ethics in their professional lives (Bitterman, 2006). One particular area of ethics that continues to upset doctors is the ethical delivery of hospital-based emergency services primarily through the close inspection of the Emergency Medical Treatment and Labor Act (EMTALA). It is a federal law that dictates that any patients brought to an emergency department to be accepted and treated regardless of their insurance status, health conditions, or the ability to pay (American College of Emergency Physicians, 2016). The EMTALA places three core mandates on physicians. These include the duty to accept patients in transfer from less capable facilities, the obligation to perform medical screening examination, and the requirement that a hospital provides on-call physician services to the emergency department to help in stabilizing patients with emergencies or help accept patients in a transfer. In any way, refusing to receive in-patients with emergencies in a transfer, devising ways to avoid on-call duties, and avoiding the application of EMTALA all comprise violations of the law, and can attract adverse consequences (Peth, 2004). The central objective of this paper is to address a situation that entails EMTALA and the ethical delivery of hospital emergency services. It will analyze the situation, discuss how it is impacted by the EMTALA, and the best decisions that can be made from an administrator’s capacity.
In the given scenario, an emergency department physician’s assistant has called a hospital in which I am the administrator on call to arrange an EMTALA transfer of a patient in need of urgent medical attention following a broken arm. The orthopedic physician on-call at my hospital has refused to accept the transfer stating that the patient does not require specialized care. He says the fracture is not displaced and can thus be splinted, seen, and addressed by the local hospital making the call. Following this situation, the emergency physician at my hospital is nervous about the possibility of an EMTALA violation. The concern is whether an EMTALA violation occurred or not.
As a matter of fact, the EMTALA provisions were violated in the scenario presented. In its broadest sense, the EMTALA requires physicians of a higher level hospital to help in emergency situations by ethically administering care upon receiving a request from a lower level hospital. The EMTALA defines an emergency as a medication condition that manifests itself by acute symptoms of sufficient severity. These include severe pain, and where an absence of immediate medical attention could result in placing an individual’s health in danger, serious dysfunction of bodily organs, or impairment in bodily functions (American College of Emergency Physicians, 2016). In the scenario presented, the local hospital calling to arrange for EMTALA transfer had already assessed the patient and declared his condition as an emergency and requiring immediate attention from a higher level hospital. According to the law, the EMTALA applies when an individual comes to the emergency department, which has been defined as a specially equipped and staffed area of the hospital used especially during the initial assessment, medication, treatment of outpatients for emergency medical conditions (Bitterman, 2006). Since my hospital is well equipped to handle medical emergencies, it is obligated under the EMTALA and has a duty to receive and attend to patients from lower-level hospital-based facilities. As such, there was no reason for the orthopedic physicians at my hospital to reject the transfer and justifying with inappropriate reasons. The scenario was overall unethical and could result in various consequences.
The situation is impacted by law, EMTALA, in different ways, but primarily because various adverse effects are likely to arise. The law states that where an emergency department has violated the EMTALA, penalties may occur in different forms. These are termination, fines, and litigations (Bitterman, 2006). Firstly is termination in which a hospital’s or physician’s Medicare provider agreement may be terminated such that the hospital or physicians are no longer in a capacity to provide health care services (Bitterman, 2006). Secondly are fines, which can be either hospital fines or physician penalties. Hospital fines may be up to $50,000 per violation for a hospital with more than 100 beds and up to $25,000 for a hospital with fewer than 100 beds. Similarly, physician fines for physicians including on-call physicians may be up to $50,000 per violation (American College of Emergency Physicians, 2016). Finally are litigations. The violating hospital may be sued for personal injury in a civil court under the private cause of action.
In the scenario presented, whether a violation has occurred or is presumed to have been transpired, various decisions can be made in a bid to avoid any penalties. Firstly, as the administrator, I would report the scenario to the state surveyors and the Center for Medicare and Medicaid Services (CMS). I would file a report within 72 hours to say that my hospital received a call from a local hospital requesting to make an EMTALA transfer. I would state that my hospital did not accept the transfer because it found it inappropriate or did not have necessary facilities to handle an emergency of that nature. Even though this is self-reporting, it would be an easy way to avoid penalties for violating EMTALA (Peth, 2004). Secondly, I would train and retrain my hospital’s physicians so as to reduce the chances of the incident recurring. From time to time, I would train my staff to help them know to whom, when, and where the EMTALA applies. Training would be useful in helping the employees stay complaint (Bitterman, 2008). Even if staff fails to comply, the documented training will help insulate me from the actions of a rogue physician who negligently and knowingly violates the policies after being trained.
Thirdly, I would decide to post the required EMTALA signs in the dedicated emergency departments and the associated waiting areas. I would ensure that all physicians are familiar with the rights guaranteed in the signs (Bitterman, 2008). Fourthly, I would maintain written policies, which would be a way of encouraging staff to comply and establish the basis for correction when the staff fails to comply. With written policies, it would be easy to avoid penalties from regulators when a rogue employee makes a violation (Bitterman, 2008). Finally, I would decide to encourage physicians to do what is best for the patients. Ultimately, EMTALA is all about patients (Peth, 2004). If my hospital’s doctors do the best towards patients, it would be easy to avoid significant EMTALA liabilities even if there is a violation.
In conclusion, the paper discussed the application of the EMTALA rule in the administration of emergency medical services. The paper analyzed the scenario presented, and concluded that it violated the EMTALA rule. The reason for the stance is that despite being an equipped and staff hospital capable of handling emergency services to patients, it escape its role thereby placing the patient’s health in danger. Following the scenario, the hospital and its involved physician are subject to various adverse consequences.
American College of Emergency Physicians, (2016). EMTALA. American College of Emergency Physicians. Retrieved November 18, 2016 from https://www.acep.org/news-media-top-banner/emtala/
Bitterman, R. A. (2006). EMTALA and the ethical delivery of hospital emergency services. Emergency Medicine Clinics of North America, 24(3), 557-577.
Bitterman, R. A. (2008). Transferring patients: EMTALA rule to apply to those needing more care. ED Legal Letter, 19(6), 61-64.
Peth, H. A. (2004). The emergency medical treatment and active labor act (EMTALA): guidelines for compliance. Emergency Medicine Clinics, 22(1), 225-240