Reader question

EMTALA: False labor requires docs to certify

Question: What does Emergency Medical Treatment and Labor Act (EMTALA) say about false labor? If the patient is in false labor, it seems that EMTALA does not apply. But what is required to determine that it is indeed false labor and not true labor?

And since the final EMTALA rule says it does not apply once the patient is admitted, does that include admission to the obstetrics unit?

Answer: The Centers for Medicare & Medicaid Services (CMS) has different expectations for determining false labor and true labor, says Daniel J. Sullivan, MD, JD, FACEP, president of the Sullivan Group, a consulting company in Oak Brook, IL, that specializes in EMTALA interpretation. He answered the question at the recent meeting of the American Society for Healthcare Risk Management (ASHRM) in Nashville, TN.

"Any qualified medical provider [QMP], like a labor and delivery nurse, can determine that the patient is in labor," he says. "But a physician must certify that the patient is in false labor."

The distinction was made in a Jan. 16, 2002, memorandum from Steven A. Pelovitz, director of the Survey and Certification Group for CMS, reference number S&C-02-14. (The memorandum was cited again in a Nov. 7, 2003, letter to State Survey Agency Directors as guidance for interpreting the final EMTALA rule.) Pelovitz explains that "medical personnel who are qualified by a hospital to conduct appropriate medical screening examinations’ including QMPs can examine a woman and make a diagnosis that a woman is in true labor since true labor is considered an emergency medical condition. The regulation at § 489.24 (b) specifies, however, that a woman experiencing contractions is in true labor unless a physician certifies that . . . the woman is in false labor.’ Therefore, when a QMP diagnoses a woman to be in false labor, a physician is required to certify that diagnosis before the patient can be discharged."

So CMS sets the bar higher when you’re deeming the patient to be in false labor and therefore EMTALA wouldn’t apply. But CMS will allow the physician to certify the false labor later, after someone else presumably has made that call in the heat of the moment. Sullivan acknowledges that this is a "strange" instruction from CMS, but he says it implies that EMTALA requires a high level of certainty before turning a patient away with false labor.

As for the question about whether EMTALA no longer applies once a patient is admitted to the obstetrics unit, Sullivan says the answer is much simpler. The final rule clarified that EMTALA no longer applies once a patient is admitted, but it included a major exception for obstetrics.

"The regs specifically say that obstetrics is covered by EMTALA even after admission," he says.