But the inspection report noted that federal regulations and the hospital`s own policies require the patient to undergo a medical screening examination. The guidelines clearly distinguish between a medical examination and triage. A screening examination is defined as the process required to determine whether or not there is a medical emergency with reasonable clinical certainty. This can represent a spectrum ranging from a brief medical history and physical examination to a complex process that involves completing high school education and/or procedures. In contrast, triage only determines the order in which patients are seen, not the presence or absence of an emergency. A medical emergency condition is defined as “a condition manifested by acute symptoms of sufficient severity (including severe pain) so that the absence of immediate medical care can reasonably be expected to result in a serious endangerment of the person`s health [or the health of an unborn child], a serious impairment of bodily functions or a serious dysfunction of the organs of the body”. For example, a pregnant woman suffering from an emergency situation must be treated until the end of childbirth, unless a transfer under the law is appropriate. The guidelines confirm that a hospital has only two options compared to a patient who has determined an emergency condition after an examination. Either the hospital can offer treatment to stabilize the condition and then release or transfer the patient, or the hospital can appropriately transfer an unstabilized patient to another medical facility if the state of emergency still exists.
If an unstabilized patient is to be transferred, the four regulatory requirements for “appropriate transfer” must be met (see Section II above); The patient cannot simply be referred once the initial requirement for an appropriate transfer (i.e. treatment to minimize the risk of transfer) has been met. In making its decision, Sixth Circuit relied heavily on its previous involvement in Cleland v. Bronson Health Care Group, 917 F.2d 266 (1990), in which it reaffirmed the obligation of the anti-dumping law to conduct an “adequate medical examination” (see 42 U.S.C. Interpreted section 1395dd(a)) as requiring an applicant to prove an unreasonable reason why he or she received less attention when presented to the hospital emergency room. As the Supreme Court described, Cleland`s court was “concerned that Congress` use of the word `reasonable` in section 1395dd(a) could be misinterpreted to allow federal liability under EMTALA for violations covered by the state`s professional misconduct law.” According to the guidelines, a “hospital with an emergency room” is defined as a hospital that provides emergency medical care services to the extent of its capabilities and the absence of an established emergency room (i.e., In a defined area of the facility), there is no indication that emergency services are not being provided. When a hospital (including a psychiatric hospital) provides emergency services for medical, psychiatric or drug addiction emergencies, it is required to comply with all the requirements of the anti-dumping law to the extent of its capabilities and abilities. If a screening examination or stabilization requires additional services available only in facilities outside the hospital emergency room, the hospital will be deemed to comply with the anti-dumping law as long as the patient is referred to a hospital-owned facility that is adjacent (i.e., any area of the hospital or hospital-owned facility on land that touches land; on which the emergency room of a hospital is located) or part of the “campus” of the hospital and under the provider number of the hospital. In addition, if a patient is sent to another location for screening or treatment in such circumstances, it must be the case that: (i) all persons with the same disease are transferred to that location, regardless of their ability to pay; (ii) there is a bona fide medical reason for transferring the patient; and (iii) qualified medical personnel accompany the patient.
The emergency room medical director told inspectors that emergency physicians generally do not leave the emergency room to respond to emergencies. The emergency room director said paramedics are empowered to decide when a patient should be transferred, and they have done so appropriately in this situation. This memorandum provides an up-to-date overview of several recent developments regarding the application of the Patients Anti-Dumping Act, the Emergency Medical Treatment and Active Work Act or “EMTALA” (Social Security Act, § 1867; 42 U.S.C§ 1395dd) (the “Anti-Dumping Act”). In order for a patient to be considered stable for transfer from one institution to another, the attending physician must: (i) establish with reasonable clinical certainty that the patient is expected to leave the hospital and be admitted to the second facility without significant deterioration in health; and (ii) reasonably assume that the receiving facility is able to treat the patient`s condition and any reasonably foreseeable complications of that condition. In terms of psychiatric disorders, a patient is considered stable for transfer if he is protected and prevented from injuring himself or others. If there are differences of opinion between the attending physician and an external physician on the patient`s condition for transfer, the medical judgment of the attending physician usually prevails over that of the external physician. However, citations for clinical components of the law, such as the inability to conduct adequate medical screening and limit transmission until a patient is stabilized, increased as a proportion of all citations over the decade studied. According to Dr. Terp: “In particular, this finding raises the question of whether EMTALA has actually achieved its initial objectives of reducing patient dumping or improving access to high-quality emergency care. The hospital was cited for violating a federal law against the Anti-Dumping Patient Act that prohibits hospitals from transferring patients to other hospitals without conducting a medical screening examination to ensure they are stable for transfer. .