What is EMTALA?

The Emergency Medical Treatment and Active Labor Act Patient Anti-Dumping Law Created to prevent hospitals from: Rejecting patients Refusing to treat them or Transferring them to "charity or county hospitals” ……..Because they are unable to pay!

Four Main Points of EMTALA

• Medical Screening Exam • Stabilizing Care • Accurate On Call System • Appropriate Transfers

Medical Screening Exam (MSE)

• Defined: A process to determine if an individual has an Emergency Medical Condition (EMC) regardless of ability to pay.

• The MSE must be provided in the same manner to all!

• Failure to provide a MSE is a major cause of EMTALA violations!

Is Triage the same as a MSE?

NO!!!! • Triage merely determines the “order” in

which patients will be seen. – A french word meaning: to separate or sort.

• Not the presence of an Emergency Medical Condition.

On- Call MD’s

• Under EMTALA, hospitals with dedicated Emergency Department’s are required to maintain a list of MD’s who are On-Call for duty and provide treatment necessary to stabilize an individual.

• On-Call MD’s shall respond “within a reasonable time”

Can you Pay? Do you have Insurance?

• EMTALA (Federal Law) states a hospital may NOT delay a MSE in order to inquire about a patient’s method of payment, primary care physician, demographics or insurance status!

• California Law requires that emergency services must be provided without first questioning a patient’s ability to pay!

Transfers • An appropriate transfer of an unstabilized patient

MUST meet four criteria: 1. Provision of treatment within the capacity of the

hospital to minimize risks of transfers 2. Acceptance by a receiving hospital that has available

space and qualified personnel to provide treatment 3. Transfer of all medical records related to the

emergency condition 4. Use of qualified personnel, equipment and

transportation

Pregnant Patient in the ED

• An ED nurse will assess all presenting patients upon presentation to the Emergency Department.

• Pregnant patients are triaged to the ED or to Labor and Delivery for a medical screening exam (MSE).

Pregnant Patient in the ED

• Patients greater than 20 weeks gestation, medically stable (absence of an emergency medical condition) and have a pregnancy related complaint with potential for fetal compromise (i.e.) GYN/GU complaint, diabetic ketoacidosis, vaginal bleeding, hypertension/headache, edema, back pain, vomiting/dehydration) are immediately transferred to Labor and Delivery.

Pregnant Patients will be evaluated in the ED if:

• 1. Greater than 20 weeks gestation, medically stable and have a non-pregnancy related complaint (i.e. URI symptoms, orthopedic injury, toothache, minor injuries/illness). If any question, assume pregnancy related.

• 2. Less than 20 weeks gestation and medically stable

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Pregnant Patients will be evaluated in the ED (continued)

• 3. Medically unstable pregnant patient regardless of gestational age (i.e. compromised airway, respiratory distress, hypotension, severe altered mental status, meet trauma activation criteria, precipitous/imminent delivery).

Pregnant Patients Remaining in the ED for care

• Patients greater than 20 weeks gestation that remain in the ED for non pregnancy related care will have fetal heart tones (FHT) obtained and documented by the ED nurse.

• L&D RN may be contacted for assistance.

Call to Action

• Communication between the two departments is the responsibility of the ED Triage nurse and the Lead nurse in L&D.

Penalties- OUCH!

• If there is a confirmed EMTALA violation, several penalties may occur: – CMS may suspend or terminate the hospital’s

agreement and funding – Civil Money penalties may be imposed:

• Up to $50,000 per violation for the hospital • $5,000 to the MD per violation

– Bad Press… – Potential bad outcome with additional litigation

on a personal level

EMTALA QUIZ

• Choose the correct answer to the questions on the following slides.

• The correct answer will be on the next slide.

1.Which of the following is the federal law governing patient transfers?

a.Emergency Medical Treatment

Accountability and Liability Act b.Emergency Medical Triage and Access

Liability Act c.Emergency Medical Treatment and

Active Labor Act d.Emergency Medical Triage and

Accountability Labor Act

Which of the following is the federal law governing patient transfers?

c. Emergency Medical Treatment and Active Labor Act

Which of the following best describes the components of a medical screening exam (MSE)?

a) Initial triage exam b) Basic history and physical examination

performed by the ED MD or qualified medical person.

c) Elements necessary to determine whether an emergency medical condition (EMC) exists.

d) Examination performed by the emergency medical services personnel

Which of the following best describes the components of a medical screening exam

(MSE)?

c. Elements necessary to determine whether an emergency medical condition (EMC) exists.

Triage and the Medical Screening Exam are considered the same.

a.True b.False

Triage and the Medical Screening Exam are considered the same.

b. False

A pregnant patient presents to the ED with complaints of vomiting is immediately transferred to Labor and Delivery if:

a) Anytime b) Gestation is less than 20 weeks c) Gestation is greater than 20 weeks

A pregnant patient presents to the ED with complaints of vomiting is immediately

transferred to Labor and Delivery if:

c. Gestation is greater than 20 weeks

Fetal heart tones (FHT) will be obtained and documented on all pregnant patients greater than 20 weeks gestation remaining in the ED. a) True b) False

Fetal heart tones (FHT) will be obtained and documented on all pregnant patients

greater than 20 weeks gestation remaining in the ED.

a. True

Who’s responsible for obtaining fetal heart tones (FHT) on the pregnant patient in the ED? a) ED RN b) LD RN c) Both RNs

Who’s responsible for obtaining fetal heart tones (FHT) on the pregnant patient in the

ED?

c. Both RNs