Bradley attorney Travis Lloyd was quoted in Healthcare Risk Management on understanding EMTALA obligations.
While the core obligations of EMTALA are well understood by most hospitals, the devil is in the details, said Lloyd. Many key terms like “emergency medical condition” and “medical screening examination” and key concepts like appropriate stabilization and transfer are defined in ways that give hospitals and practitioners discretion to make appropriate clinical judgments, he explained.
Many hospitals have struggled with managing patients who present with behavioral health issues, Lloyd said, noting how a South Carolina hospital made headlines last year when it entered into a $1.3 million settlement with OIG to resolve allegations that it had failed to properly handle behavioral health patients presenting at its ED.
“In each instance, the patient was involuntarily brought to the hospital’s emergency department, often by law enforcement,” Lloyd said. “While the hospital had an inpatient behavioral health unit, the unit had a policy of only admitting patients that are voluntarily committed. Instead of admitting the patients, the hospital allegedly held them for extended periods of time in the emergency department while it tried to stabilize them or have them transferred.”
There also continues to be uncertainty about the application of the law to urgent care centers, particularly those owned by hospitals, Lloyd said. In many instances, the analysis comes down to whether the urgent care center is held out to the public as a place that provides care for emergency medical conditions on an urgent basis without requiring an appointment, often a highly fact-intensive inquiry.
If it is so held out, the facility constitutes a “dedicated emergency department” for EMTALA purposes and will be subject to the law’s substantive requirements, he explained.
“One of the major competing priorities is specialist availability. CMS [Centers for Medicare & Medicaid Services] has made clear that it expects a hospital to strive to provide adequate specialty on-call coverage consistent with the services provided at the hospital and the resources the hospital has available,” Lloyd said. “Meeting this requirement can be difficult for small hospitals located in rural areas as well as large hospitals with highly specialized service offerings. In addition, arrangements through which hospitals pay physicians to provide call coverage must be carefully structured in view of fraud and abuse laws, like the Stark Law and Anti-Kickback Statute.”
The complete article, “EMTALA Violations Persist as Hospitals Cope with Overload,” appeared in the May 2018 issue of Healthcare Risk Management.