ACEPNOW.COM has published a new article echoing and expanding on a previous Medlaw.com warning that signs announcing a limitation on pain medications in the ED violate a 2013 advisory from CMS. EDs have continued to post the signs in reliance on endorsements by various groups, including state ACEP chapters, often believing the signs comply with EMTALA because of the endorsements.
I recommend EDs review the article and the Medlaw.com posts. The article can be found at
ED Waiting Room Posters on Prescribing Pain Medications May Violate EMTALA
The original Medlaw.com article can be found at http://www.medlaw.com/drug-policy-signs-violate-emtala-says-cms/
An article with an example of sign language that violates the advisory can be found at http://www.medlaw.com/example-of-ed-sign-that-violates-emtala-under-cms-guidance/
I take the position that signs do not deter drug seeking conduct and expose the ED to potential citations, fines, and lawsuits. They should be removed, as should any sign that might be construed by a patient or CMS investigator as a discouragement from staying for a complete medical screening exam. This includes notices of what insurance plans you participate in (negative inference that other plans are NOT accepted), Medicaid posters warning that non-emergency visits will not be paid, and “Co-Pay Required At Time Of Service” signs that are located in areas where they may be seen prior to the provision of the medical screening exam required by EMTALA.
While ED physician concerns about DEA attitudes on pain killer prescribing practices are not entirely without cause, there have been no DEA actions against emergency physicians for prescribing medically appropriate medications following an appropriate EMTALA medical screening examination. It always helps to thoroughly document the visit. By the same token, use of appropriate pain killers that are non-narcotic along with specialty consultations and referrals do not automatically violate EMTALA. The key is the thorough exam and documentation to support the medical basis for the physician’s decision.