[Editor’s note: This column is part of an ongoing series that addresses readers’ questions about the Emergency Medical Treatment and Labor Act (EMTALA). If you have a question you’d like answered, contact Greg Freeman, Editor, ED Management, 3185 Bywater Trail, Roswell, GA 30075. Telephone: (770) 998-8455. E-mail: Free6060@bellsouth.net.]

Question: What does the final EMTALA rule say about taking time to consult with the patient’s personal physician? I’ve heard that the rule says something about how you can’t inappropriately delay treatment to make that call. So what’s an "inappropriate delay?"

Answer: EMTALA always has allowed emergency physicians to contact a patient’s private physician for more information, but the recently released final rules make it even easier.

The change is one more refinement that makes EMTALA a bit less burdensome and difficult, says Charlotte Yeh, MD, FACEP, Centers for Medicare & Medicaid Services (CMS) regional administrator in Boston and an emergency physician.

Other changes in the final rule eased the obligation of hospitals to provide EMTALA screenings and care for anyone who shows up near the hospital property, and hospitals were given more flexibility to devise physician on-call schedules, she explains.

Most of the changes in the final rule were intended to clarify confusing points that had surfaced in the first years of EMTALA compliance, Yeh says.

The CMS intended the same improvement when it reworded the part regarding personal physician contacts.

"People weren’t sure if you could use a physician assistant or nurse practitioner for the communication between the private physician and the emergency department," Yeh says. "The final rule makes it clear that you can."

CMS officials never really had any problem with nonphysician emergency staff contacting the private physician, she says, but the language originally specified that only physicians could make the call. The final rule specifies that "an emergency physician is not precluded from contacting the patient’s physician at any time to seek advice or information regarding the patient’s medical history and needs that may be relevant to the medical screening and treatment of the patient, as long as this consultation does not inappropriately delay required screening services or stabilizing treatment."

It goes on to say that "the prior authorization policies apply equally to hospital services, physician services, and nonphysician practitioner services," and "nonphysician practitioners [physician assistants and nurse practitioners], should be permitted to initiate such contacts. . . ."

An inappropriate delay is not defined specifically, but Yeh says the rule is clear that this provision is intended for the emergency physician to obtain information necessary to provide the best care for the patient. The emergency physician is expected to use his or her professional judgment in determining whether a delay for contacting the personal physician is justified by the need for more information about the patient.

Beyond that, an ED can only get in trouble by somehow tying the phone call to an inquiry about the patient’s ability to pay, she says. Section 1867(h) of the act specifically prohibits a delay in providing required screening or stabilization services to inquire about the individual’s payment method or insurance status. 


For more information, contact:

Charlotte Yeh, MD, FACEP, Regional Administrator, Centers for Medicare & Medicaid Services, Boston Regional Office, JFK Federal Building, Room 2325, Boston, MA 02203.