Which sites fall under the 250-yard rule?

Now that the Emergency Medical Treatment and Active Labor Act (EMTALA) has expanded to include locations within 250 yards of the hospital’s main campus, ED managers have the burden of determining exactly which sites are covered, says Stephen Frew, JD, risk manager at Physicians Insurance Co. of Wisconsin, based in Loves Park, IL, and former president of the Rockford, IL-based Frew Consulting Group, which specialized in EMTALA compliance.

"Much of the confusion is over which locations are covered by the rule and which ones are not," he reports. This is particularly problematic with medical buildings, private testing areas, subcontracted services, and hospitals that have multiple corporate entities, he says.

The Centers for Medicaid & Medicare Services web site featured a posting to explain the regulation in July 2001, notes Frew. "The clarifications basically reiterate that the private offices of independent physician practices are not covered," he says. "That produced no changes in our recommendations."

East Jefferson General Hospital in Metairie, LA, has several facilities that are not located within the hospital itself, including adult day care, occupational medicine, and physician offices, says Trudy A. Meehan, RN, CHE, administrative director of the ED. "Also within the 250 yards is a fast-food restaurant, a pharmacy chain store, and three multilevel garages owned by the hospital," she says. "Needless to say, developing our policy was interesting."

First, the hospital determined that the pharmacy and restaurant were not part of the response area, says Meehan. She notes that EMTALA says that hospitals are not responsible for private businesses not owned by the hospital or public thoroughfares that fall into the 250-yard radius.

However, Meehan goes by the rule of thumb "when in doubt, respond." "The bottom line is, if we are uncertain as to whether the area falls into our domain, we respond," she says. "While I don’t expect staff to go into a busy street, they are capable of rendering first aid while waiting for EMS to respond, if that is indicated."

The No. 1 priority is to take care of the patient, stresses Meehan. "I don’t want to be the feature on the 6 o’clock news as the hospital that refused to provide care because it was outside our domain," she says. "After the fact, we can pursue how we might do it better the next time."