An advisory opinion from CMS to the South Carolina Hospital Association has nixed the growing practice of posting drug dispensing policy statements in the waiting area to warn pain patients that they are not going to get pain drugs that are common drugs of abuse. The goal of such signs is to discourage drug seekers into leaving the ED, or at least to reduce patient expectations that they will get drugs.
CMS pointed out that EMTALA includes pain and symptoms of substance abuse in its list of emergency medical conditions and that all patients are to receive an appropriate medical screening examination.
The EMTALA violation is predicated on the long-standing CMS position that any sign that discourages a patient from completing the medical screening process is a violation of the EMTALA rules. Prior rulings have cited hospitals for signs mentioning co-pays, deductibles, charity care, and other reference to payment issues. Rulings have also banned display of signs that warned Medicaid patients that they would be responsible for non-emergency charges. CMS has labeled the signs “coercive”.
While acknowledging the problem with drug seeking conduct, CMS warned against signs or policies and protocols that restrict patient access to appropriate medical screening and medically appropriate pain killers or impede professional judgment in individual cases. CMS endorsed the educational material found on signs, but noted that the material is not to be posted in areas where presenting patients will see them prior to medical screening.
UPDATE: 1/23/2014 – ACEP ARTICLE http://www.acepnow.com/article/ed-waiting-room-posters-prescribing-pain-medications-may-violate-emtala/