[Editor’s note: This column is part of an ongoing series that will address reader questions about the Emergency Medical Treatment and Labor Act (EMTALA). If you have a question you’d like answered, contact Staci Kusterbeck, Editor, ED Management, 280 Nassau Road, Huntington, NY 11743. Telephone: (631) 425-9760. Fax: (631) 271-1603. E-mail: StaciKusterbeck@aol.com.]

Question: If direct admit patients are held in the ED because inpatient beds aren’t available, must the ED physician see the patient?

Answer: This is a definite gray area, warns Gloria Frank, JD, former lead enforcement official on EMTALA for the Centers for Medicaid & Medicare Services (CMS) and former owner of EMTALA Solutions, an Ellicott City, MD-based consulting firm.

"This is risky if the patient waits a long time," Frank says. "It’s better to have the doctor look at the patient right away." However, there are exceptions to this rule, according to Mary Kay Boyle, RN, JD, risk manager at North Penn Hospital in Lansdale, PA. "For instance, persons presenting for collection of forensic evidence do not necessarily trigger EMTALA," she says.

Boyle adds that the key to this question is what is the purpose for the visit to the ED. "If there is a request for a medical screening exam or treatment of an emergency medical condition, then EMTALA does apply," she says. In this particular case, the patient is presenting to the ED because of a bed shortage, she notes. If the patient has been screened by the admitting physician, the condition is stabilized and orders generated, the patient need not be seen by the ED physician, says Boyle.

"The admitting physician already has performed that function, and it is just like any other admission to the hospital," she explains. "If the patient has not been screened or is unstable, the patient would either need to be seen by the ED physician or the admitting physician, and in a timely manner," says Boyle. Further, if the admitting physician does not respond in a timely manner, the ED physician will be held accountable for the screening and care of the patient, Boyle says.