Question: Transfer of Care & EMTALA

[AnthonyM83]

We've had a few discussions at work about EMTLALA, but don't think any of us fully understand it.

Is it accurate to say that once you've arrived at a hospital with a BLS patient and realized they're overcrowded (say a 3 -4 hour wait) you can't leave and take your patient to another ER EVEN IF YOU HAVEN'T GIVEN A VERBAL REPORT YET?

I was taught transfer of care occurs when you give the verbal report...our managers also told us we can't go to another ER once we arrived b/c it would be transferring care from hospital back to EMT (to a lower level of care)...BUT if we haven't given a report, yet, I understand why it would be transferring to a lower level of care if the hospital never had care yet...if they never knew you had even arrived.

Any difference if it's an ALS pt?

[Just Plain Ruff]

EMTALA and COBRA

Once you have brought a patient on to the hospital grounds then that hospital is responsible for that patient. Period. At least that's what our COBRA/EMTALA rep told us.

It's referred to as Anti-dumping.

Once you are on hospital grounds and some COBRA/EMTALA reps have told us that if you are within sight of the hospital then you are on their grounds but that rarely sticks.

What the hospital has to do to comply with EMTALA/COBRA is to perform a qualified medical screening of the patient, provide appropriate treatment to the patient and provide a appropriate transfer to a appropriate secondary facility. There must be Doctor to doctor communication and acceptance of the patient at a 2nd facility, Nurse to nurse contact to give report and then a qualified transport to that 2nd facility.

You cannot leave that hospital until those items above are completed.

Now if your patient says, I don't want to stay here and they are on your gurney then the hospital is still required by law to fulfill the parts of the above paragraph. If they just let the patient go then they can be fined up to 50K per occurrence and Administrators do not like to have to sign a 50 thousand dollar check to COBRA/EMTALA. It also looks bad and people equate that fine to that hospital dumping patients.

Sooooo, to make a long story short, if you arrive on a hospital grounds and decide to take the patient elsewhere due to a long wait or the patient wishing to go elsewhere, in a nutshell, You Can't. If you do you will run the risk of alienating the hospital and also getting your tail in trouble.

If the patient refuses to stay at that hospital then they can sign an AMA form and go to another hospital but more often than not the patients insurance will refuse to pay any of the bill because the patient refused medical advice. The bill might be paid but it will be after a long protracted battle with the insurance companies.

Another wrench in the mix will be the 2nd recieving facility, if the steps to transfer are not taken and you just leave then that receiving facility will more than likely cry "COBRA" violation and report the first hospital to the reporting agency and a huge investigation will ensue, trust me I know this one as I or another co-worker have been invovled in at least 5 investigations in the past that I know of.

So to make a long story short (too late), once you are on hospital property, you have effectively turned over care to that ER even if you have or have not given a report. The report has nothing to do with it. Once the ambulance turns onto the hospital property you are effectively wards of the hospital until they determine what happens to that patient.

Special note: This also applies to helipads on hospital property you use for landing zones. COBRA/EMTALA have let us know that even though we use the helipad for landing zones to get the patient from the ambulance to a specialty center, if that helipad is on hospital property, you are effectively under the hospital's umbrella and that hospital has to abide by the transfer requirements set forth in my first paragraph or two.

In all reality, COBRA/EMTALA are not going to cause a stink if it was in the patients best interest. The only time a cobra investigation really gets initiated is if someone reports a violation to COBRA. Then the investigation occurs, if no report then no investigation. They really do have better things to do than to investigate, than to go out and search instances where the best interest of the patient was taken into account. If a report is not made then no violation occurred is what the COBRA Rep told me.

Sorry to ramble on but I hope I answerd your question. Oh One other thing - HUGE CAVEAT TO ALL THIS -- I was told by a COBRA rep that different reps look at things differently. One may be completely by the book and be a rules nazi while another one 300 miles away might have a completely different way of looking at things. It depends on the investigator on how stringent they apply the rules. they apparantly have quite a bit of leeway to look at things. So your investigator might look at things in a wholly by the book way and investigate every little complaint and suggest fines on every occurrence or your investigator might say, "how did it affect the patient" and go by that mindset.

[Ridryder 911]

Very good points and + 5 for a good comments. I like to add, one should give a verbal report to staff. Until there has been such report and you leave the patient without formally addressing to the staff, one could be charged with abandonment. Yes, even if the patient is in the hospital. The same if you dropped the patient in the lobby without telling and giving a report to another equal or higher trained. The key word is they assume care ...not that you just have the patient in the hospital setting... you can book out of there.

One can only imagine, if you place a cardiac in the hall and no one assumed care and was not informed about it.. only later to find that patient had coded.. there would be less medics.

R/r 911

[elvismedic]

Ruff,

Thanks for the info. I thought EMTALA was an anti-dumping law but did't fully understand it. I knew hospitals had a duty to act and was told by an ED that they use a distance of 500 feet from hospital grounds. Thanks again for the info Elvis

[brentoli]

Can you clarify refrence the heli-pad for me? I am confused. Does that mean we can not call a helicopter to meet us at the hospital pad, with out the pt going through the ED first?

[Ridryder 911]

Can you clarify refrence the heli-pad for me? I am confused. Does that mean we can not call a helicopter to meet us at the hospital pad, with out the pt going through the ED first?

Yes, you can meet a helicopter to meet you, as long as they (Hospital) has not made contact or accepted patient as such. You are using the pad as a meeting place only. This has been thoroughly discussed with EMS helicopters and EMTALA and they agree. There is no contract or agreement between hospital and patient.

The "outside" areas are involving parking lot and centers owned by the hospital such as clinics etc.

R/r 911