[Editor’s note: This column is 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 Editor Staci Kusterbeck. Telephone: (631) 425-9760. Fax: (631) 271-1603. E-mail: StaciKusterbeck@aol.com.

Also in this issue, see EMTALA Questions and Answers from the Centers for Medicare and Medicaid Services on definition of campus, when EMTALA is triggered, screening, staffing, use of EMS/911, transfer, signage, and responsibility for administrative requirements of EMTALA.]

Question: When may a patient be transferred to a physician’s office for definitive care?

Answer: When the physician’s office has necessary equipment that is not available anywhere in the hospital, such as eye equipment, and all other medical conditions have been dealt with, the Baltimore, MD-based Centers for Medicare and Medicaid Services (CMS) has allowed transfers to the physician’s private office — if they are treated and documented as a transfer to another hospital for higher level of care, says Stephen Frew, JD, president of the Rockford, IL-based Frew Consulting Group, which specializes in compliance with EMTALA. "That includes transport by ambulance unless refused in writing by the patient," he adds.

Question: Once a patient is admitted, under what timeframe must an attending physician see the patient?

Answer: CMS does not specify rules (yet) on this, but delays in seeing admitted patients have resulted in citations, Frew reports.

"I generally favor all admissions to critical care units be seen within 60 minutes," he says. "I also suggest that the hospital have a short time frame for admissions to pediatrics and a definite requirement for admission to other units. Relying on the 24-hour H&P rule is not sufficient, in my opinion."


For more information about EMTALA, contact:

Stephen Frew, JD, Frew Consulting Group, 6072 Brynwood Drive, Rockford, IL 61114. Telephone: (815) 654-2123. Fax: (815) 654-2162. E-mail: sfrew@medlaw.com.

American Health Consultants (AHC), publisher of ED Management, has published A Comprehensive Guide to EMTALA. The publication reviews basic aspects of EMTALA plus some intricacies, such as transfers and the responsibilities of off-site locations. It identifies the key requirements of EMTALA, analyzes practice behaviors to determine compliance, and explains EMTALA considerations pertinent to patient transfers. The $269 publication offers 3.5 CE and CME contact hours. Also, AHC has scheduled an EMTALA teleconference. Contact:

• AHC Customer Service. Telephone: (800) 688-2421. Fax: (800) 284-3291. E-mail: customerservice@ahcpub.com.