Chief Compliance and Ethics Officers Health Care

1.  Is this EMTALA? What say you?

Posted 6 days ago

Hello...

I have a tricky scenario...  Looking for opinions.

A patient was treated in the ED for a laceration to the hand.  Received stitches.  Was given instructions to return in 7 to 10 days to the attached provider clinic to have them taken out.  Or that they could have them taken out by their regular PCP if they have one.

A week later the patient presents to the nurses station.  Indicates that they thought they were to return there to have their stitches taken out.  The nurse at the station (Who also covers the ED.. we're a very small shop) sends the patient to the clinic to have the walk-in provider take the stitches out.

Is this internal EMTALA?    We've been having quite the debate about this.  A couple of side items to take note... we do not have triage in our ED.  Our bylaws indicate a midlevel or physician must complete any MSE that is performed.  Our nurses do not perform MSE's. 



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Jessica Mollenkamp
Compliance Officer
Goodland Regional Medical Center
Goodland,KS
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2.  RE: Is this EMTALA? What say you?

Posted 6 days ago

Jessica, I don't believe EMTALA is invoked because she did not present with a medical emergency, but would be interested to hear what other's think...

 

Thank you!

 

Cinda

 

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3.  RE: Is this EMTALA? What say you?

Posted 6 days ago
1.  Not sure what you mean by "internal EMTALA"?

2.  I don't believe this is an EMTALA issue - the patient is not presenting with an "emergency" condition, they are not stating they have an urgent condition, and it is apparent ("I need my stitches removed") that this is not an emergency.

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David Garrison CHC,CHPC
Compliance/Privacy Officer
SEARHC
Juneau,AK
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4.  RE: Is this EMTALA? What say you?

Posted 6 days ago

There are several of us that are working and putting our heads together on this investigation as to whether it was or not.  I'm not sure I agree with their general consensus, which is why I'm asking you fine folks.

The consensus of my co-workers is that it is EMTALA because the patient was 'discouraged' from being treated in the ED, and we did not do a MSE to determine that there was no EMC present.  I'm having a hard time wrapping my head around the concept that we would have a person that presented with a request to take stiches out, be seen by our ED midlevel... (who isn't necessarily in the building all the time, we would have to call them up to have them screen this patient) to only be told that they could be treated in the clinic.

Help me with this... I'm having a hard time finding a leg to stand on with this.  The consensus is that because the nurse didn't walk the patient back and do a MSE in the ED prior to sending the patient to the clinic... it's EMTALA.  One of my statements is that it is obviously not an EMC, nor was the patient requesting treatment for an EMC... and the counter argument is that there should have been an MSE to determine the presence (or lack thereof) of an EMC.



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Jessica Mollenkamp
Compliance Officer
Goodland Regional Medical Center
Goodland,KS
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5.  RE: Is this EMTALA? What say you?

Posted 6 days ago
Here is some sections from a reference that I have (hope it's still current), that might help.

Interpretive Guidelines @489.24(c)

Any individual with a medical condition that presents to a hospital's ED must receive an MSE that is appropriate for their medical condition. The objective of the MSE is to determine whether or not an emergency medical condition exists. This does not mean, that all EMTALA screenings must be equally extensive. If the nature of the individual's request makes clear that the medical condition is not of an emergency nature, the MSE is reflective of the individual presenting complaints or symptoms. A hospital may, if it chooses, have protocols that permit a QMP (e.g., registered nurse) to conduct specific MSE(s) if the nature of the individual's request for examination and treatment is within the scope of practice of the QMP (e.g., a request for a blood pressure check and that check reveals hat the patient's blood pressure is within normal range). Once the individual is screened and it is determined the individual has only presented to the ED for a nonemergency purpose, the hospital's EMTALA obligation ends for that individual at the completion of the MSE. Hospitals are not obligated under EMTALA to provide screening services beyond those needed to determine that there is no EMC.

Furthermore, a hospital may be exempted from its EMTALA obligations to screen individuals presenting to its dedicated emergency department if the individual had a previously scheduled appointment.

If an individual presents to a dedicated emergency department and requests services that are not for a medical condition, such as preventive care services (immunizations, allergy shots, flu shots) or the gathering of evidence for criminal law cases (e.g., sexual assault, blood alcohol test), the hospital is not obligated to provide a MSE under EMTALA to this individual.

From your scenario, it appears the provider told the patient to return to the "attached clinic" as an option to have the stitches removed.  I don't think because the patient showed up at the wrong desk for a "follow-up" that this would be an EMTALA issue.

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David Garrison CHC,CHPC
Compliance/Privacy Officer
SEARHC
Juneau,AK
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6.  RE: Is this EMTALA? What say you?

Posted 3 days ago

Interpretive guidelines §489.24(c) addresses this issue

Deborah Dabbs MBA, CHC, CHPC, CHRC, MT(ASCP)SM

Compliance Manager

University Medical Center

Office: 806-761-0994

Fax: 806-761-0991

http://www.compliancecertification.org/Portals/2/Images/CHC/logo-chc-sm.gifhttp://www.compliancecertification.org/Portals/2/Images/CHPC/logo-chpc-sm.gifhttp://www.compliancecertification.org/Portals/2/Images/CHRC/logo-chrc-sm.gif

 






7.  RE: Is this EMTALA? What say you?

Posted 3 days ago
Edited by Caitlyn Kinney 3 days ago
I would not think that this is an EMTALA violation. The patient was just confused about where they were supposed to go and were directed to the correct place. If someone is scheduled for say a surgery at a hospital and comes to the emergency room check-in desk instead because they misunderstood the instructions they were given or were lost it does not make sense to process them as an emergency patient. The appropriate course of action would be to tell them where they need to go instead of spending time doing a medical evaluation. Now if the patient was showing signs of having an emergency medical condition or asked to be seen by an emergency physician for a screening then that would be different.

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Caitlyn Kinney
Concord,MA
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