We had a patient in our ER this evening who presented with dehiscence of a ventral hernia repair which was done at another facility several days ago. Patient and his family were adamant they did not want to return to that facility. The ER physicians called all the surgeons of our facility in an attempt to help this patient and all referred this patient back to the surgeon who did the original surgery. They even attempted to contact another facility who also referred him back to the original facility.
My question: I know we like to refer surgical cases back to the original surgeon, however, if we can perform the surgery here, and the patient does not wish to return to that surgeon, are we not obligated under EMTALA to provide those services?
ANSWER: You are correct. The fact that the patient is presenting with complications of prior surgery performed elsewhere is irrelevant under EMTALA. Your facility is required to render stabilizing care to patients who present at your facility. The only two exceptions would be if your facility lacked the capability to perform the necessary care which would require you to make an appropriate transfer, or if the patient requested transfer back to the original hospital and that hospital accepted the patient in transfer.
A secondary issue might be to question the refusal of transfer from the third hospital. In this case, since your facility could not declare this an EMTALA transfer because you had the capacity to render care and transfer would not be permitted by EMTALA, this was probably one of the few cases where the third hospital could refuse the transfer request without EMTALA compliance concerns.