Summary of EMTALA Conference Call
With Gloria Frank, HCFA, March 17, 1999
Q1: Is a signed certification of the risks and benefits of a transfer required before a hospital can transfer a stable patient?
Answer: No. Note: While there are no magic words that need to be included on a particular medical chart before a transfer is properly made, the patient’s medical chart should definitely contain statements or notes written by a medical doctor directed towards the stability of the patient.
Q2: Are any offsite facilities or clinics exempt from EMTALA’s mandates?
Answer: Yes. EMTALA only applies to an off-site facility or clinic if the offsite facility or clinic is owned and operated by the parent hospital and the off-site facility or clinic uses the same provider number as the parent hospital.
Q3: If a psychiatric patient is chemically or physically restrained before a transfer, has the hospital effectively "prevented [the patient] from harming themselves or others?"
Answer: Maybe. If a psychiatric patient only has psychiatric problems, the use of restraints can often prevent a patient from harming him/herself or others. Note: Psychiatric patients can also have physical problems, however. In such a case, restraints could needlessly mask or worsen a patient’s underlying medical condition. Thus, before a psychiatric patient can be properly transferred, a medical doctor should address and stabilize all of a patient’s medical conditions.
Q4: Has HCFA formally adopted a position concerning whether EMTALA applies to inpatient admissions?
Answer: No, not yet. HCFA and OIG are currently formulating their national, formal position on this issue. Note: Pending such a national formal position, providers should contact their regional office to ascertain their regional offices’ position on this issue. Some regional offices have asserted that EMTALA applies to a limited class of inpatients. To my knowledge, some of the regions occasionally take a case where the patient was an inpatient for a short period of time and was never stabilized. Overall, providers may want maintain the status quo until HCFA sets forth a national, formal position on this issue.
Q5: Has HCFA penalized any receiving hospitals for failing to report a suspected inappropriate transfer?
Answer: Yes. HCFA has penalized a few hospitals for failing to report a suspected inappropriate transfer.
Q6: Can a receiving hospital take longer than 72 hours to report a suspected inappropriate transfer if the receiving hospital cannot complete its investigation within 72 hours?
Answer: Yes. The 72-hour rule set forth in the preamble of the regulations is not the law. As a consequence, HCFA has only looked to the 72-hour language as a guideline. Additionally, there are no recorded instances of a receiving hospital being penalized for failing to report a suspected inappropriate transfer if the receiving hospital indicated that it was still investigating the suspected inappropriate transfer.
Q7: In light of the fact that MCOs continue to deny payment for screenings, is HCFA contemplating publishing any new regulations or asking Congress to enact legislation that compels MCOs to pay for screenings?
Answer: HCFA recognizes that certain MCOs refuse to pay for screenings. Nevertheless, EMTALA is the law and it clearly requires a hospital to provide a screening to any individual who presents with an emergent or pre-emergent condition, regardless of that individual’s ability to pay or choice of insurance companies. Note: Most emergency departments get into trouble when they "encourage" patients to leave by informing the patient that their insurance will not cover the visit/screening. This does not mean that staff cannot answer a patient’s questions concerning payment, however; rather it means that staff should clearly inform the patient that the hospital has a legal obligation to screen the patient.
Q8: Does EMTALA require a hospital to perform a screening when a police department or prison official attempts to present a detainee or prisoner to the emergency department for a routine blood test, urinalysis exam, or physical exam?
Answer: No. Use of the emergency department for non-emergent care procedures (flu shots, blood tests, urinalysis exams, etc.) does not implicate EMTALA. Note: However, if the patient, while receiving a blood test, for example, complains about another condition, EMTALA is implicated and the emergency department needs to screen the patient.
[In her recent review of this summary, Ms. Frank offered the following additional comment: This issue is not yet settled. A policy statement is being developed which will address this among other issues. It is likely that HCFA will conclude that when the police bring in a drunk driving suspect for an blood alcohol draw, the hospital must abide by EMTALA and screen. In that case, the person may not be competent to ask for a screening and symptoms of intoxication may be masking symptoms of another medical problem. Also, the person may not be intoxicated at all, but rather suffering from a different medical problem.]
Q9: If a patient presents at an offsite facility or clinic of a parent hospital, is that patient "com[ing] to the emergency department" within the meaning of EMTALA?
Answer: No, not necessarily. EMTALA only applies to an off-site facility or clinic if the offsite facility or clinic is owned and operated by the parent hospital and the off-site facility or clinic uses the same provider number as the parent hospital.
Q10: Does an offsite facility or clinic, such an urgent care center, which is using the same provider number as the parent hospital, have to maintain a log-in sheet and screen "drop-ins" who do not present with an emergent or pre-emergent condition?
Answer: No. EMTALA does not require every offsite facility or clinic to transform itself into an emergency department. Rather, HCFA is looking for accountability. If a patient presents with an emergent or pre-emergent condition at an offsite facility or clinic, the offsite facility or clinic should not turn the patient away. Instead, the offsite facility or clinic should treat the patient or call 911 or the parent hospital to arrange for an appropriate transport. EMTALA does not obligate the offsite facility or clinic to send the patient to the parent hospital if the protocols for the local emergency medical system dictate that the patient should be taken to another hospital.
[Ms. Frank also advised that this issue will be addressed in the policy statement under development. She cautioned that for now the off-site facility should consider it appropriate to call 911 only when in the best interest of the patient.]