Recent OIG Settlement Underscores Need for Strong EMTALA Policies

PUBLISHED: Aug 21, 2017
Relevant to: Critical Access Hospitals, Hospitals

In June of this year, the Office of Inspector General (OIG) entered into an almost two million dollar settlement with AnMed Health in Anderson, South Carolina, the largest Emergency Medical Treatment and Labor Act (EMTALA) related fine ever levied by OIG.

The settlement agreement resolved OIG allegations that, in 36 incidents, AnMed violated EMTALA.

In these incidents, individuals presented to AnMed's Emergency Department (ED) with unstable psychiatric emergency medical conditions. Instead of being examined and treated by an on-call psychiatrist, and despite empty beds in its psychiatric unit to which the patients could have been admitted for stabilizing treatment, the patients were involuntarily committed and kept in AnMed's ED for between 6 and 38 days each. OIG provided an example of one of the incidents they investigated:

A patient presented to AnMed's ED via law enforcement with psychosis and homicidal ideation and was involuntarily committed. The patient did not receive psychiatric examination or treatment by available AnMed psychiatrists and was not admitted to the psychiatric unit for stabilizing treatment. Instead, the patient was kept in the ED for 38 days and, at one point, was seen by a psychiatrist from another facility that was familiar with her condition. The psychiatrist prescribed a variety of medications for agitation. The patient eventually was discharged home.

At the end of 2016, OIG issued new regulations that increased the civil monetary penalty amounts for EMTALA violations and also reinforced (at § 1003.140(2)) the need to disclose potential violations to OIG through the Self Disclosure Protocol and fully cooperate with OIG’s review and resolution of the disclosure. This recent settlement underscores the seriousness with which OIG evaluates EMTALA violations.

Key points of the EMTALA include:

  • Medical Screening Exam: a patient presenting to the emergency department requesting help for a mental, physical or obstetrical emergency must be given an emergency medical screening exam.This exam cannot be delayed to collect payment or ascertain insurance coverage.
  • Emergency Department Log Book Documentation: Each patient presenting to the emergency department must be recorded into a central log.
  • Patient Transfer: In brief, a patient may only be transferred after the Medical Screening Exam determines the patient is stable. Hospitals must ensure multiple criteria are met prior to a patient transfer from the emergency department.
  • Signage: Signs should be posted informing patients of their rights under EMTALA.
  • 250-Yard Rule: Emergency Department staff should respond to all emergencies presenting themselves on the hospital campus – i.e., main buildings, structures, ancillary buildings and any area within 250 yards of the hospital.

Included with today’s notice is an example policy related to EMTALA. This week, StayAlert! will delve into EMTALA specifics including the Medical Screening Exam, Patient Transfers and the Self Disclosure Protocol.

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