The Emergency Medical Treatment and Active Labor Act EMTALA The Emergency Medical Treatment and Active Labor Act Guidelines for Compliance A MEMBER OF THE MONTEFIORE HEALTH SYSTEM 1

HISTORY Act was enacted to legislation in 1986 The basis was to prevent injury to patients arising from treatment delays and to guarantee access to emergency medical services without regard to economic payment status Enforcement of the Act can result in severe penalties against the hospital or MD with fines up to $50,000 per violation with suspension from federal Medicare and State Medicaid programs A lot going on is an understatement Multiyear to accomplish, to see impact This year: Cancer Center; Major Mod……Radiology Many years in progress: Expansion of Tertiary Services

EMTALA The Act applies to all hospitals that participate in Medicare program Four legal duties of the EMTALA Act: Medical screening requirement Necessary Stabilizing treatment Restricting transfers until stabilized Duty to accept and appropriate transfer 1. 1. 2. 3. 4.

MEDICAL SCREENING REQUIREMENT: EMTALA 1. MEDICAL SCREENING REQUIREMENT: Any individual who comes to the Emergency Department or Labor & Delivery requesting treatment for medical condition, the hospital must provide for appropriate medical screening examination (MSE) to determine whether or not an emergency condition exists. A lot going on is an understatement Multiyear to accomplish, to see impact This year: Cancer Center; Major Mod……Radiology Many years in progress: Expansion of Tertiary Services

EMTALA 2. NECESSARY STABILIZING TREATMENT: The individual comes to the hospital and the hospital determines that the individual has an emergency medical condition, the hospital must stabilize the medical condition and treatment or transfer the patient to another medical facility who has the ability to treat. For example, transfer for a higher level of care or for a service we do not provide.

EMTALA 3. RESTRICTING TRANSFERS UNTIL STABILIZED: The hospital may not transfer the individual unless the person has been notified of the risks of transfer and sign consent by patient or family. The MD has signed a certification the benefits outweigh the risks The transfer is appropriate The specialized hospital has accepted an appropriate the transfer.

The provider will check the reason Transfer Consent Form The provider will check the reason for the transfer. Consent must be signed by one of following: the patient and/or a legally responsible party. If unable to sign: you must check the box indicating the patient unable to sign. If the patient refuses exam, treatment, or transfer

Transfer Consent Form TRANSFER CONSENT The risks and benefits of the transfer section are filled out and be condition specific. Check off boxes for section marked “Conditions of an Appropriate transfer” Name of receiving facility and name of accepting physician must be documented

TRANSFER CONSENT Provider will check off always the “reason for transfer”. Consent must be signed by one of following: the patient and/or the surrogate decision maker. If unable to sign: you must check the box indicating the patient unable to sign, and indication who the provider spoke of if possible.

TRANSFER CONSENT The risks and benefits of the transfer section are filled out and be condition specific. Check off boxes for section marked “Conditions of an Appropriate transfer” Name of receiving facility and name of accepting physician must be documented

Against Medical Advice For the Emergency Department The transfer form section ; “ Patient Refuses Examination, Treatment or Transfer” must be completed. For Inpatients: AMA Form should be completed and signed by MD. AMA intervention is documented by both RN and Provider in the EMR

AMA Form for Inpatient Must be Completed by Provider

Duty to Accept Transfer 4. Duty to Accept Transfer The receiving hospital has the available space and personnel to treat this patient. The receiving hospital has agreed to accept the patient . All records have been sent with qualified personnel and transport equipment. The hospital must maintain an on call list of physicians to provide necessary treatment.

EMTALA for Pregnant Women in Active Labor Upon presentation to Labor and Delivery, the patient Requires a medical screening examination (MSE) by qualified Medical personnel (QMP). Refer to the policy Obstetric Standard of Care including Medical Screening Exam.

EMTALA Hospitals must post signs specifying the rights of individuals in regards to treatment and whether they participate in Medicaid The hospital must maintain the medical records of all transfers, on call list of physicians and a central log on any person seeking assistance and their outcome.

EMTALA A hospital must report to CMS when it suspects an improperly transferred person The hospital must maintain updated policies and procedures regarding EMTALA

EMTALA At White Plains Hospital, all entrances to the ED and Labor and Delivery contain signage that explain a person’s right to medical screening exam and state whether the hospital participates in Medicaid. The Hospital maintains a log of all patient’s presenting for Emergencies, Evaluation, Treatment, and Assessment of Labor. The Log includes: Date, time, name, date of birth, presenting problem, diagnosis, treatment rendered and disposition.

Summary All patients who enter the ED or Labor and Delivery will be entered into the department centralized log. All patients will receive a medical screening evaluation For patient transfers, the transfer form will completed with explanation of risks and benefits and signed by an attending. If patient is unable to sign and no legal responsible party can be reached , the unable to sign box will be checked.

Summary For patients that leave against medical advice or left without being seen: Transfer section for refusal of treatment will be completed AMA form completed and computer documentation For patients registered and not present for triage , a note will be placed in the chart.

REFERENCES www.acep.org Peth, Howard “The Emergency Medical Treatment and Active Labor Act (EMTALA): Guidelines for compliance “ in Emergency Medicine Clinics of North America Feb 2004, Vol 22,No. 1 p. 225-239

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