EMTALA Scenario Analysis

EMTALA Scenario Analysis

Access to emergency healthcare services remains central to community health preservation efforts. The Emergency Medical Treatment and Labor Act (EMTALA) is an example of a congressional enactment that ensures public access to emergency healthcare services regardless of an individual’s ability to pay. It applies to all Americans, not just Medicaid beneficiaries. These provisions require that all hospitals with emergency departments provide medical screening examinations for any patients presenting to the ED who request such services (Hsuan et al., 2019). It also prohibits such settings from declining to examine or manage patients presenting with emergency medical conditions. This paper analyzes a scenario using the EMTALA provisions.

The Case Summary

The case scenario is of a patient presenting for emergency services with a severed ear. The ED physician at the receiving hospital calls for an arranged EMTALA-qualified transfer to a second hospital, but the ENT physician on call declines to accept the transfer, claiming that the patient does not need a higher level of care. The ENT physician also admits to being unavailable for six hours, having taken three glasses of wine. Upon receiving the patient records sent by the first hospital, the ENT physician states that the ear looks salvageable at the ED. Hire our assignment writing services in case your assignment is devastating you. We offer assignment help with high professionalism.

The Decision to Reject the Patient

Rejecting the patient in the case scenario presented will not constitute a violation of the EMTALA’s provision by the second hospital. EMTALA directs all hospitals with emergency departments to provide medical examination screening and treatment to all patients presenting with and requiring emergency healthcare services (Terp et al., 2019). EMTALA provision on the transfer of patients from one EMTALA-qualified hospital to another requires that consent is obtained from the receiving hospital. Additionally, the receiving hospital must have specialized capabilities and capacity to handle the patient being transferred to them. Hospitals are also expected to determine the qualifications and functional capabilities, often with medical staff scheduled to perform medical screening examinations before accepting a transfer from another hospital (Terp et al., 2019). This was, however, not the case in the case scenario presented.

The physician on call declined to accept the transfer. Transferring the patient without the physician’s consent may, in this case, not be appropriate. The ENT physician at the second hospital also admitted to having three glasses of wine and would be unavailable for six hours. This points to the diminished functional capacity of the physician to perform a medical screening examination. The wait for the ENT physician’s availability is also long and may be riskier for the patient.

The ED physician at the hospital also had a justified course of managing the patient. While this act gives no precise definitions of what constitutes emergency healthcare, this legal statute implores healthcare givers to follow standards of care for managing all patients presenting for emergency care (Terp et al., 2019). The presenting case was of a patient who had a severed ear. The ENT physician reported that the care required was not of a high level. Additionally, upon reviewing the patient’s medical report, I found that there was no justified course for the ED physician at the receiving hospital not to provide emergency care to the patient. The ENT physician of the second hospital further noted that the patient’s ear looked salvageable and could be managed by a physician at the ED. For these reasons, the healthcare administrator of the second hospital is justified in declining the transfer and rejecting the patient.

The Decision I Would Make as the Administrator

The healthcare administrator of the hospital to which the transfer is being sought is confronted with the choice of either accepting the transfer request or rejecting it. The best decision in this regard is to reject the patient and communicate the reasons for rejection to the receiving hospital. This is because the hospital has a diminished capacity to handle the patient owing to the unavailability of the ENT physician on call for six hours. Shenoy et al. (2022) report that the hospital’s lack of capacity to manage a presenting case warrants a rejection of an EMTALA transfer. The ED physician of the hospital to which the patient is presenting should be informed of the same in this respect.

Preventing This Type of Situation from Recurring in the Future

The case scenario represents typical violations of the EMTALA provisions as well as a lack of hospital and caregiver accountability in implementing these provisions. According to the EMTALA provisions, hospitals with emergency departments are required to perform medical screening examinations on their patients. Attending physicians, as well as hospital administrators, are, in this regard, implored to abide by these provisions. This was, however, not the case in the hospital to which a patient with a severed ear presented. The ED physician in the hospital arranged for a transfer without probable cause as the presented case did not require high-level care and could be handled by a physician at an emergency department. The ENT physician at the second hospital was also not available to attend to the patient in time. Several measures can be implemented consistently to enhance physicians’ accountability for this act.

Enhancing physicians’ knowledge and perception of EMTALA provisions remains critical in enhancing their accountability to the EMTALA provisions. Hsuan et al. (2019) report that while healthcare administrators shoulder the responsibility of accepting and rejecting patients’ admissions, physicians and other healthcare providers also need to be knowledgeable in these provisions. This warrants structured education to physicians and other caregivers on the EMTALA provisions. In these educative programs, they will be informed on the provisions of this act and its significance in preserving community lives. Subsequently, this will minimize physician-related EMTALA violations and enhance their accountability in providing emergency care to all.

Aligning Medicare and Medicaid payment systems with EMTALA may also facilitate easy patient transfer between hospitals. Hsuan et al. (2019) report that while EMTALA conditions healthcare facilities to provide emergency care to all patients, including non-profitable patients, it places undue financial pressure on these hospitals. This increases non-compliance with these provisions. Mandating Medicaid reimbursements for EMTALA medical screening would encourage hospitals to perform medical screening for EMTALA patients and encourage them to better document these screening procedures. Additionally, making changes to the disproportionate share of hospital (DSH) payment under the Medicaid program to cover up for the uncompensated care that sometimes characterizes emergency care services may be necessary for the efforts to encourage hospitals to provide emergency healthcare (Hsuan et al., 2019). Reversing this reduction will see hospitals providing care for uninsured patients increase and is therefore warranted in increasing compliance with EMTALA provisions. Permitting informal mediation between hospitals may also be important in preventing the situation seen in the case. Pre-existing hospital relationships will have an impact on their patients’ transfer systems and subsequent compliance with the EMTALA provisions. This is because pre-existing relations will affect how hospitals report borderline EMTALA violations. Informal mediation provides a platform for effective communication between hospitals and enables the reporting of EMTALA violations and the dissemination of information. Amending EMTALA to permit such medications may prevent future violations.

Increasing the hospital’s role in EMTALA training and dissemination of information on EMTALA may also be valuable in preventing repetitions in the occurrences depicted in the case. Hospitals, in this regard, are expected to be proactive in training their staff on EMTALA provisions and evaluate and identify which physicians are aware of these provisions and who require education on the same. This may eliminate their vulnerability to civil and administrative liabilities for EMTALA violations accustomed to physician-related violations. Additionally, hospitals can require proof from physician’s associations that physicians contracted are knowledgeable in EMTALA. Hospitals can also emphasize to their physicians that they are not immune to civil and administrative liabilities for EMTALA violations and that if they contravene the EMTALA provisions, they will be subject to fines and other disciplinary measures. These efforts will likely enhance physicians’ and hospitals’ accountability to EMTALA and prevent scenarios witnessed in the case.

A Scenario When the Hospital A Physician Would Be Concerned about an EMTALA Situation

Several scenarios in the presenting case would present an EMTALA situation to the physician in the first hospital, Hospital A. The first scenario is when the presenting patient does not require high-level care, as alluded to by the ENT physician in the second hospital, Hospital B. EMTALA provision mandates ED physicians to perform medical screening examinations on all patients requesting emergency healthcare services (Katz & Wei, 2019). The ED physician is, in this instance, required to perform medical screening for the patient and provide the required care to them. EMTALA also requires that before a transfer, the attending physician should provide a probable cause of the transfer detailing that the benefits of the transfer outweigh the risk of not transferring. This may be the case when the presenting complaint cannot be handled in the receiving ED and when the patient is not satisfied with the level of care in the primary hospital. The physician in this hospital will be concerned with an EMTALA situation if the benefits of not transferring the patients do not outweigh the risks and if there is no proof that the patient is unsatisfied with the care provided in the hospital.

Conclusion

In summary, the case presented is a replica of how EMTALA provisions apply in conventional care processes. EMTALA violations remain common in many hospitals. As a result, expanding physicians’ knowledge of these provisions may enhance their accountability when providing care. It will also ensure that they abide by these provisions.

References

Hsuan, C., Horwitz, J. R., Ponce, N. A., Hsia, R. Y., & Needleman, J. (2019). Complying with the emergency medical treatment and Labor Act (EMTALA): Challenges and solutions. Journal of Healthcare Risk Management, 37(3), 31–41. https://doi.org/10.1002/jhrm.21288.

Katz, M. H., & Wei, E. K. (2019). Emtala—a noble policy that needs improvement. JAMA Internal Medicine, 179(5), 693. https://doi.org/10.1001/jamainternmed.2019.0026

Shenoy, A., Shenoy, G. N., & Shenoy, G. G. (2022). The impact of EMTALA on Medical Malpractice Framework Models: A Review. Patient Safety in Surgery, 16(1). https://doi.org/10.1186/s13037-022-00325-w.

Terp, S., Wang, B., Burner, E., Connor, D., Seabury, S. A., & Menchine, M. (2019). Civil monetary penalties resulting from violations of the Emergency Medical Treatment and labor act ( EMTALA ) involving psychiatric emergencies, 2002 to 2018. Academic Emergency Medicine, 26(5), 470–478. https://doi.org/10.1111/acem.13710.

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Write a 1,000-1,250 word paper in which you analyze a scenario using the Emergency Medical Treatment and Active Labor Act (EMTALA).
You are the administrator on call for Hospital A and are responsible for accepting and rejecting patients. You receive a call at 2:00 a.m. from Health Hospital B regarding a patient with a severed ear.

EMTALA Scenario Analysis

The ED physician is calling to arrange an EMTALA-qualified transfer from his hospital to yours, but the ENT physician on call at your hospital is refusing to accept the transfer, stating that the patient does not need a higher level of care.
You call your ENT on call, and he admits he has just had three glasses of wine and will not be available for about 6 hours. You electronically send him the record that Health Hospital B would send with the patient. The ENT physician advises that the ear looks salvageable and could easily be sutured in any ED. The ED physician at Health Hospital B is very nervous about the possibility of an EMTALA violation.
1. If you decide to reject the patient, is this a violation of EMTALA? Explain.
2. What decision will you make as the administrator? Explain.
3. Based on this scenario, what could be implemented to prevent this type of situation from occurring in the future?
4. Under what scenario would the Hospital physician be concerned about an EMTALA situation?
Prepare this assignment according to the guidelines found in the APA Style Guide, located in the Student Success Center.