Critical Care Plus: ED-to-ED Transfer Not Always an EMTALA Violation
Critical Care Plus: ED-to-ED Transfer Not Always an EMTALA Violation
State Law Must Be Followed, Unless It Conflicts
As hospitals struggle to comply with aspects of the Emergency Medical Treatment and Labor Act (EMTALA), one thorny issue is whether patients can be transferred from an ICU of one hospital to the emergency department of another hospital, based on an accepting physician’s request.
In part, the answer to this question lies with state regulations, since several states take the position that transfers to the ED from an ICU represent a transfer to a lower level of care or an abandonment of the patient, says Stephen Frew, JD, risk management consultant at Physicians Insurance Co. of Wisconsin, based in Loves Park, Ill.
Hospitals are required to comply with their state laws and regulations, to the extent that they do not conflict with EMTALA requirements, he explains. "This requirement then makes this type of transfer a violation in those states that have the rule," he says.
Frew recommends checking with your state hospital inspector to determine your state’s regulations regarding transfers. However, Frew adds that EMTALA does not specifically forbid transfers to the ED. In fact, he says recent citations suggest that if there is a long transfer or deterioration, the ED should provide a medical screening examination to the transfer patient before sending patients to the floor.
EMTALA requires that the receiving hospital accept the patient, but it does not specifically indicate who the accepting person is, says Frew. "Some states require an accepting physician in addition to the EMTALA requirement," he adds. "In the absence of state standards, EMTALA does not say where or how the patient must be accepted."
Frew emphasizes that EMTALA requires that the hospital provide necessary further care and stabilization of patients who are known to have an unstable or emergency medical condition. "These terms are defined by law and are much broader than medical terminology," he notes. "It is relatively safe to state that all patients coming from an ICU in need of a higher level of care have an emergency medical condition and are unstable, as defined by EMTALA."
The Centers for Medicare & Medicaid Services will look at whether the hospital promptly and appropriately provided necessary evaluation and stabilizing care to the transfer patient, says Frew. "If that care is rendered, it is unlikely in most states that the hospital would be cited," he says.
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