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[Editor’s note: This month’s issue includes the first of an ongoing series that will address reader questions about the Emergency Medical Treatment and Active Labor Act (EMTALA). If you have a question you’d like answered, contact Staci Bonner, Editor, ED Management, 280 Nassau Road, Huntington, NY 11743. Telephone: (631) 425-9760. Fax: (631) 271-1603. E-mail: StaciBonner@aol.com.]
Q: When the ED calls for a consult, can the on-call physician send his or her physician assistant (PA)?
A: Not unless the hospital puts the PA on the on-call list, if appropriate from a medical point of view, according to Gloria Frank, JD, president of EMTALA Solutions, an Ellicott City, MD-based consulting firm and former lead enforcement official on EMTALA for the Baltimore-based Health Care Financing Administration (HCFA). The hospital would have to delegate specific responsibilities to the PAs for screening and stabilization when medically appropriate, based on the patient’s symptoms and condition, says Frank. "The delegation would have to be in the bylaws or other document approved by the hospital governing body," she adds. "They would have to be careful about any state law restricting PA practice."
If a physician is on call and sends a PA instead, the hospital should have written policies regarding what kind of discipline will result, such as referral to peer review, Frank advises. "If the hospital has to transfer the patient because the on-call physician did not come in, the hospital must report the name of the on-call to the receiving hospital," she says. "The receiving hospital, in turn, must report the incident to HCFA."
[For more information about EMTALA, contact Gloria Frank, JD, EMTALA Solutions, P.O. Box 1340, Ellicott City, MD 21041. Telephone: (800) 972-7916 or (410) 480-9111. Fax: (410) 480-9116. E-mail: email@example.com. Web: www.gloriafrank.com.]