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[Editor’s note: This column 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. Phone: (770) 998-8455. E-mail: Free6060@ bellsouth.net.]
Question: We’re debating two questions in our hospital regarding when EMTALA applies. First, does the law apply to patients who only are "holding" in the ED because there are no beds available in the hospital? And does it apply when an air ambulance uses our helipad but does not bring the patient to our ED?
We sometimes let air ambulances use our helipad as a courtesy when they’re transferring patients to ground transport that will take them to another hospital.
Are we supposed to do an evaluation and establish that the patient is stable before leaving our property?
Answer: EMTALA does not apply in either case, says Daniel J. Sullivan, MD, JD, FACEP, president of the Sullivan Group, a consulting company in Oak Brook, IL, that specializes in EMTALA interpretation. Sullivan addressed the same questions recently at the meeting of the American Society for Healthcare Risk Management (ASHRM) in Nashville, TN.
These situations were clarified in the final EMTALA rule, he says. Up to that point, most analysts agreed that EMTALA applied while the patient was still in the ED for any reason, but Sullivan says the final rule takes a more reasonable stance that recognizes the reality of how patients often are boarded in the ED.
"It is clear now that EMTALA does not apply to patients admitted to the hospital but holding in the ED," he continues. "Previously, this was dependent on whether the patient was stable; but the final regulations say EMTALA does not apply if the patient has been admitted and is only in the ED because there’s no bed available elsewhere in the hospital."
The question regarding air ambulances is a little more tricky, but Sullivan says you’re still in the clear. You can allow air ambulances to use your helipad without taking on an EMTALA obligation for their patients, he says. The key is that the helicopter is using your landing pad only as a practical measure to get the patient elsewhere, as opposed to bringing the patient to you for care.
"When an air ambulance uses your heliport only for convenience, the patient has not come to your ED,’ and that is the pertinent definition that determines whether your EMTALA obligation is triggered," he explains.
"The helicopter didn’t stop at your hospital because the patient was in cardiac arrest and needed to get into your ED right away. If it stopped just because you have a heliport and the destination hospital doesn’t, that’s just a convenience and the patient has not come to you and requested treatment," Sullivan adds.
In a similar vein, your ED has no EMTALA obligation when an air ambulance stops at your hospital to pick up blood or other needed supplies before flying on to its destination, he notes.
EMTALA should not prevent the hospital from extending that courtesy to air ambulances, Sullivan says.
For more information on EMTALA, contact: