In This Issue:
- EMS In The ED Leads To "Parking" Violation
- My Secret Sources
- My Upcoming Clinic RM Book
EMS In The ED Leads To "Parking" Violation
In recent months, I have been receiving complaints and questions from readers about growing problems of ambulances being forced to wait for hours to get anyone in the ED to look at their patients or move them to beds or gurneys. Apparently, I have not been the only one to hear about these "Parking" Violations because at least one regional CMS office has issued an EMTALA warning on the issue:
Date: December 14, 2005|
To: Region IV Hospitals
From: Ann M. Pfeiffer, RN, MSN, FNP
Region IV EMTALA Team
Subject: “Parking” of EMS Patients in Hospitals
The Centers for Medicare and Medicaid Services (CMS) has learned that several hospitals routinely prevent Emergency Medical Service (EMS) staff from transferring patients from their ambulance stretchers to a hospital bed or gurney. Reports include patients being left on an EMS stretcher (with EMS staff in attendance) for extended periods of time. Many of the hospital staff engaged in such practice believe that unless the hospital “takes responsibility” for the patient, the hospital is not obligated to provide care or accommodate the patient. Therefore, they will refuse EMS requests to transfer the patient to hospital units.
This practice may result in a violation of the Emergency Medical Treatment and Labor Act (EMTALA) and raises serious concerns for patient care and the provision of emergency services in a community. Additionally, this practice may also result in violation of the Conditions of Participation for Hospitals.
Under EMTALA, a patient is considered to have “presented” to a hospital when a patient arrives on hospital grounds (defined as the main hospital building and any hospital owned property within 250 yards of the main hospital building) and a request is made on the individual’s behalf for examination or treatment of an emergency medical condition. A patient who arrives via EMS meets this requirement when EMS personnel request treatment from hospital staff. Therefore, the hospital must provide a screening examination and stabilizing treatment, if necessary, to resolve the patient’s emergency medical condition. CMS does not recognize the distinction some hospital staff are trying to make in identifying EMS versus Hospital responsibility for a patient already in the facility.
This applies to patients transferred to a receiving facility under EMTALA as well. A hospital that delays the screening examination or stabilizing treatment of a patient who arrives via transfer from another facility by not allowing EMS to leave the patient could also be in violation of EMTALA.
Our office recognizes the enormous strain and crowding many hospital emergency departments face every day. However, this practice is not a solution. “Parking” patients in hospitals and refusing to release EMS equipment or personnel jeopardizes patient health and impacts the ability of the EMS personnel to provide emergency services to the rest of the community.
The Atlanta Regional Office welcomes the opportunity to work with provider organizations to develop a legal and effective way to manage the larger issues raised by this practice.
You should also be aware that we are receiving questions from air medical and transport ambulance personnel about the growing practice of hospital personnel abandoning the transport team to care for the patient for extended periods prior to transport. This is the equivalent of "Exit Parking" and raises similar EMTALA compliance concerns.
Under EMTALA, the transferring hospital and physician:
- Must provide all necessary stabilizing care to minimize the risks of transfer
- Must provide signature to the transport certificate at the time of transport
My Secret Sources
In November I promised to answer readers' questions about how I find the information that I report to you. Well, after a little delay due to L4-L5
disc issues, I am going to "tell all" as promised.
- A great many of the items I get are from my clients' EMTALA problems that I am asked to come in and fix. I clean up the information so that it is not readily identifiable and share it with you.
- I request Freedom of Information records from the Feds on citations -- anyone can do this, but it can be very expensive, and the Feds are very slow to release the information. As an example, a request I made last March still has not been answered, although it has been acknowledged.
- I get questions and tips from my readers that alert me to problems or resources. As an example, when I answered a question for a reader, they shared the CMS letter with me in return.
- I have a lot of website resources -- most of these are on the links posted on the medlaw.com website for your reference.
- I use a tool to speed up my website visits. This tool opens all of my regular resource sites with one click of the mouse. I set up the sites I want to check daily on one button, weekly on another, and monthly on a third. This helps my failing memory a lot. This is a tool I can share with you without any cost and it is available through a link via my website at www.medlaw.com/clickstart.zip.
- What is my real secret tool? The one tool that I stumbled on that is a LIFESAVER for me is a commercial program called "Search Automator" which drills down to exactly what I need from many different search engines in seconds. It is not that you cannot find this information without this tool, because your CAN. It is simply a major time saver, which is why I like it, plus it is really pretty cheap. Information on this commercial product is available via a forwarding link from my site at www.medlaw.com/search/.
My Upcoming Clinic RM Book
For those of you with involvement with clinics and physicians offices that don't have the benefit of a dedicated risk manager, I will be publishing a resource for those folks that is scheduled to come out this month. I will notify you when that is available.
Best Wishes For The New Year
Stephen A. Frew JD
For more information on EMTALA check out my latest EMTALA book at