Discuss Tthe following- Scenario: You are the administrator on call for a local

Question

Discuss Tthe following- Scenario: You are the administrator on call for a local hospital and you receive a call at 2:00 a.m. from another local hospital regarding a patient with a broken upper arm. The ED physician's assistant is calling to arrange an EMTALA transfer from his hospital to yours, but the orthopedic physician on call at your hospital is refusing to accept the transfer, stating that the patient doesn't need a higher level of care. When you ask him about that, he tells you the fracture is not displaced, and can be splinted and seen in the office. The ED physician at your hospital is very nervous about the possibility of an EMTALA violation.

1) Write an analysis of the situation, how it is impacted by EMTALA, and what decision you will make as the administrator, along with your rationale and thought process.

Explanation / Answer

The Emergency Medical Treatment and Active Labor Act is a statute which governs when and how a patient may be (1) refused treatment or (2) transferred from one hospital to another when he is in an unstable medical condition. EMTALA was passed as part of the Consolidated Omnibus Budget Reconciliation Act of 1986, and it is sometimes referred to as "the COBRA law". The main purpose of this act is to prevent hospitals from rejecting patients, refusing to treat them, or transferring them to "charity hospitals" or "county hospitals" because they are unable to pay or are covered under the Medicare or Medicaid programs. This purpose, however, does not limit the coverage of its provisions

Medicare-participating hospitals that offer emergency services to provide a medical screening examination (MSE) when a request is made for examination or treatment for an emergency medical condition (EMC), including active labor, regardless of an individual's ability to pay. Hospitals are then required to provide stabilizing treatment for patients with EMCs. If a hospital is unable to stabilize a patient within its capability or if the patient requests, an appropriate transfer should be implemented. One usually thinks of transfers in terms of sending the patient to another facility, but any discharge home from the ED (or actually from any part of the hospital) is interpreted as a transfer. It is assumed that the ED physician's evaluation concluded that the patient either had no EMC or that the EMC had been stabilized. It also is assumed that the documentation reflects this.

In this case the local hospital transferring a patient with a broken upper arm and it is a not a serious condition. A broken arm is a common injury and is usually a consequence of a fall with an outstretched hand, a car crash or some other type of accident. So refused treatment in this case is not considered as EMTALA violation. Substantive deviation from a hospital's or ED's written protocol can be considered as evidence in an EMTALA violation and also may be used in state malpractice cases. In that report (given by another hospital) they clearly mention that the patient is a upper arm broken patient, so there is no specific serious condition was present in this incident due to this reason ED physician in your hospital not impacted by EMTALA violation.

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