0071643192.pdf

LEGAL ISSUES

apparently required by law, you must decide how comfortable you are pro-

ceeding without a specific court order. Arrestees and incarcerated prisoners

have not automatically lost the right to refuse medical care.

Patients Who Refuse Treatment or Leave Against Medical Advice Should

Have the Following Documented in the Medical Record

■ Mental capacity to refuse treatment

■ Understanding of the risks of refusing treatment and explanation of alter-

native treatment, if any

■ Discharge instructions if appropriate

■ Follow-up care options if appropriate

EMERGENCY MEDICAL TREATMENT AND ACTIVE LABOR ACT (EMTALA)

At its most basic, EMTALA mandates that unstable patients cannot be dis-

charged or transferred except for medical necessity.

The Emergency Medical Treatment and Active Labor Act:

■ First appeared in the 1986 Consolidated Omnibus Budget Reconciliation

Act (COBRA)

■ Discourages poor and high-risk patients from being transferred from one

ED to another for financial advantage

■ Encourages“equal” treatment for patients, not necessarily appropriate

treatment

■ Isnot malpractice law

■ Mandates that hospitals keep on-call listsof specialty physicians

EMTALA Basics

■ Any patient presenting to an emergency department has the right to a med-

ical screening exam (MSE)to determine if an emergency medical condi-

tion (EMC) exists without regard to the patient’s ability or willingness to pay

for any services rendered.

■ If an EMC exists, the hospital must, given its resources including staff and

facilities, stabilize the condition.The term “stabilize” means to assure

that no material deterioration of the condition is likely to result from or

occur during the transfer, or to deliver the baby and placenta.

■ If the hospital cannot stabilize the condition, the staff are further obligated

totransfer the patientto a facility that can.

An EMC Is One Where:

■ Any delay in treatment would cause loss of body functions or impairment

to organs or limbs. The regulation offered examples of such symptoms:

severe pain, psychic disturbances, and/or symptoms of substance abuse.

■ A pregnant woman is contracting and there isn’t time to transfer her before

she delivers, or the transfer may pose a threat to mother or child. In reality,

if a woman is in active labor in the emergency department, she should

deliver in that hospital.

An MSE:

■ Is not triage!MSE requires the usual workup including ancillary tests and

consultations as necessary to determine if an EMC exists.

EMTALA focuses on medical

screening and stability, not

simply financial motivations

for transfers.

Patients must have screening

and stabilization before

discharge from the ED.