EMTALA

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Information about EMTALA
Science-Technology

Published on March 29, 2008

Author: coptermedic

Source: authorstream.com

The following program is presented as an online Continuing Medical Education (CME) offering:  The following program is presented as an online Continuing Medical Education (CME) offering It is intended to follow the participant’s registration and submission of a pretest You can learn more about the program’s educational objectives and CME information by following this link Course Credit:  Course Credit This activity has been planned and implemented in accordance with the Essential Areas and Policies of the Iowa Medical Society (IMS) by ACUTE CARE, INC. ACUTE CARE, INC. is accredited by the Iowa Medical Society (IMS) to provide continuing medical education for physicians. ACUTE CARE, INC. designates this educational activity for a maximum of 2 AMA PRA Category 1 Credits™. Physicians should only claim credit commensurate with the extent of their participation in the activity. EMTALAEmergency Medical Treatment and Active Labor Act:  EMTALA Emergency Medical Treatment and Active Labor Act Online Continuing Medical Education Presenter: Paul Hudson, Chief Operating Officer EMTALA and the Emergency Department:  EMTALA and the Emergency Department The Emergency Medical Treatment and Active Labor Act (EMTALA) establishes specific responsibilities for physicians attending to the Emergency Department patient. EMTALA and the Emergency Department:  EMTALA and the Emergency Department "Emergency Department" is actually an inexact term, in that the provisions of the law apply to patients who present, on hospital property, for purposes of examination and treatment of medical complaint. EMTALA and the Emergency Department:  EMTALA and the Emergency Department Hospital property includes patients attended to by the staff of hospital-based ambulance services. EMTALA and the Emergency Department:  EMTALA and the Emergency Department Hospital property includes the arrival of an ambulance in the Emergency Department's entry with a patient who was not expected or diverted to another facility by direct radio contact. Overview:  Overview EMTALA establishes the following general requirements: Medical Screening Examination Necessary Stabilizing Treatment Restricting Transfers Until Stabilization Appropriate Transfer Medical Screening Examination:  Medical Screening Examination Medical Screening Examination:  Medical Screening Examination A hospital that operates an emergency department must provide a medical screening examination to anyone on whose behalf a request is made for examination or treatment. Medical Screening Examination:  Medical Screening Examination EMTALA describes the need for an examination of each patient for the purpose of determining if that patient possesses an "emergency medical condition" . Emergency Medical Condition:  Emergency Medical Condition An emergency medical condition is defined as a medical condition manifesting itself by symptoms of sufficient severity such that the absence of immediate medical attention could reasonably be expected to result in 1. Placing the health of the individual or with respect to a pregnant woman, the health of the woman (or her unborn child) in serious jeopardy; ... Emergency Medical Condition:  Emergency Medical Condition An emergency medical condition is defined as a medical condition manifesting itself by symptoms of sufficient severity such that the absence of immediate medical attention could reasonably be expected to result in 2. Serious impairment of bodily functions; or 3. Serious dysfunction of any bodily organ or part. Emergency Medical Condition:  Emergency Medical Condition Active Labor A pregnant woman who is having contractions is said to be in true labor unless a physician certifies that, after a reasonable time of observation, the woman is in false labor. Medical Screening Examination:  Medical Screening Examination A large number of EMTALA investigations arise because on-call physicians refuse to come in to see the patient, come in late, or order the patient transferred without coming in to stabilize the patient. On-Call Physicians:  On-Call Physicians Generally, on-call physicians are expected to attend the patient physically. If the on-call physician refuses to attend to the patient or fails to appear within a reasonable time this fact must be reflected in the patient record and transfer materials. Furthermore, the hospital's records must reflect quality assurance and disciplinary records regarding the incident. Necessary Stabilizing Treatment:  Necessary Stabilizing Treatment Necessary Stabilizing Treatment:  Necessary Stabilizing Treatment If the individual has come to the hospital and the hospital has determined that he or she is in an emergency medical condition, the hospital must provide further medical examination and treatment to stabilize the medical condition. Restricting Transfers Until Stabilization:  Restricting Transfers Until Stabilization Restricting Transfers Until Stabilization:  Restricting Transfers Until Stabilization A hospital may not transfer an individual unless: The individual requests transfer having been informed of the hospital's obligation to provide further examination and treatment and of the risks of transfer, ... Restricting Transfers Until Stabilization:  Restricting Transfers Until Stabilization A hospital may not transfer an individual unless: ...or a physician certifies in writing that the benefits reasonably expected from treatment at another facility outweigh the increased risks to the individual and/or the unborn child from effecting the transfer... Restricting Transfers Until Stabilization:  Restricting Transfers Until Stabilization A hospital may not transfer an individual unless: ...(if the physician is not present in the emergency department, a "qualified medical person" may sign the certification if a physician consulting with that person has made the determination that the benefits of transfer outweigh the risks, and subsequently countersigns the certification); and... Restricting Transfers Until Stabilization:  Restricting Transfers Until Stabilization A hospital may not transfer an individual unless: ...and... The transfer is an appropriate transfer. Patient Decisions:  Patient Decisions The patient's decisions during the emergency department visit are also addressed in EMTALA. Documentation is required in each of the following instances. Patient Decisions:  Patient Decisions Refusal to Consent to Treatment The record must reflect the examination and/or treatment refused by the patient. Patient Decisions:  Patient Decisions Refusal to Consent to Transfer Documentation must reflect if the patient refuses a transfer recommended by the physician after being informed of the risks and benefits of that transfer. The medical record must include notation of that refusal, details of the proposed transfer and the risk/benefit ratio as described to the patient. Patient Decisions:  Patient Decisions Request for Transfer If the patient or their delegate requests a transfer the record is to include that request, its rationale and the fact that the individual had been made aware of the risks and benefits of the transfer. Appropriate Transfer:  Appropriate Transfer Appropriate Transfer:  Appropriate Transfer Transferring hospital provides medical treatment to minimize risks to the individual and/or unborn child. Receiving facility has available space and qualified personnel to treat the individual and has agreed to accept transfer of the individual, and…. Appropriate Transfer:  Appropriate Transfer Transferring hospital sends all medical records related to the emergency condition, including emergency medical records, observations of signs and symptoms, preliminary diagnosis, treatment provided, results of any tests, the informed consent and/or certification provided under EMTALA and the name and address of any on-call physician who has refused or failed to appear within a reasonable time to provide necessary stabilizing treatment, and... Appropriate Transfer:  Appropriate Transfer Transfer is effected through qualified personnel and transportation equipment as required, including the use of necessary medically appropriate life support measures during transfer. Meet other requirements imposed by the Secretary. Appropriate Transfer:  Appropriate Transfer The hospital is obligated to assure (and document) that The patient has been provided information regarding the hospital's obligation for examination and treatment, and The risk/benefit ratio of the proposed transfer has been explained. Appropriate Transfer:  Appropriate Transfer The transfer is only deemed appropriate if qualified staff possessing adequate equipment provide "necessary life support measures" en route to the receiving facility, and That facility has agreed to accept the patient. Appropriate Transfer:  Appropriate Transfer Complete documentation, including consent forms and records of the medical examination and treatment of the patient, must be delivered to the receiving facility. Violation of the Emergency Medical Treatment and Active Labor Act can yield significant penalties. :  Violation of the Emergency Medical Treatment and Active Labor Act can yield significant penalties. A hospital knowingly, willingly or negligently violating EMTALA is subject to termination of its provider agreement.:  A hospital knowingly, willingly or negligently violating EMTALA is subject to termination of its provider agreement. A hospital may be fined between $25,000-$50,000 per violation.:  A hospital may be fined between $25,000-$50,000 per violation. The physician responsible for examination, treatment or transfer can be fined $50,000 per violation for knowingly and/or willfully violating EMTALA. This provision applies to on-call physician violations as well. :  The physician responsible for examination, treatment or transfer can be fined $50,000 per violation for knowingly and/or willfully violating EMTALA. This provision applies to on-call physician violations as well. The physician involved can be excluded from Medicare and Medicaid programs. :  The physician involved can be excluded from Medicare and Medicaid programs. A patient can sue the hospital for personal injury in civil court. :  A patient can sue the hospital for personal injury in civil court. A receiving facility, having suffered financial loss as a result of another hospital's violation of EMTALA, can bring suit to recover those damages. :  A receiving facility, having suffered financial loss as a result of another hospital's violation of EMTALA, can bring suit to recover those damages. Summary:  Summary EMTALA Summary:  Summary The Emergency Medical Treatment and Active Labor Act serves to provide structure to the proper examination, treatment and transfer of Emergency Department patients. Summary:  Summary Adherence to the law is dependent upon attendance to those who present for care on hospital property, life-sustaining care, and informed patient transfer. Summary:  Summary Documentation of each aspect of care and communication is central to compliance with the law. Ready for the Post Test?:  Ready for the Post Test? Click this link!

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