The patient presented at 5 pm with chest pains and shortness of breath. EKG and a blood draw were initiated within 20 minutes. A chest x-ray was performed in another 30 minutes. After several hours, the patient was seen by the ED physician, and then a cardiologist examined the patient. He offered the patient a “clot buster” or stent. He went to surgery for the stent about 11:30 pm.
Later, the patient discovered that standards recommended that the process should be 90 minutes or less from time of presentation and sued the “name brand” clinic and hospital for an EMTALA violation for failure to promptly assess and stabilize his condition.
The US Court of Appeals for the Third Circuit ruled that the hospital had followed its applicable policies and procedures and that they did not discriminate against the patient, so EMTALA does not apply. The patient was not represented by counsel. The court noted that the patient’s complaint might state a cause of action for malpractice, but EMTALA lawsuits are not federal malpractice cases.
So, if your hospital would handle chest pains and shortness of breath in this time frame, would you get the same legal outcome? Probably not.
First of all, your policies and procedures probably are different. Secondly, if you handle even one similar patient differently, you are potentially providing “disparate care” and EMTALA would be violated.
More importantly, however, is the fact the CMS does not use the same approach as the Courts. CMS looks at quality and standards of care and has access to information the courts never see in your peer review and quality documents. My opinion is that that CMS would have cited this hospital had they received a complaint (and that in turn could have changed the court case dramatically).
The patient made two mistakes: going to this hospital and not getting a lawyer to file a complaint with CMS.
No one can say for sure from the information you provided. It could have been handled appropriately even with your listed symptoms or it could represent an EMTALA violation. The only way to actually determine whether EMTALA was complied with is discuss it with your attorney or to file a complaint with CMS to trigger an investigation.
If a patient presented in the ER with shortness of breath was treated and discharged and 1 hour later returns with the same issue. Can the ER charge nurse refuse to see patient or is this considered a Emtala violations?
Each and every presentation or request for evaluation or care triggers a new EMTALA obligation. If a patient walks out the door and turns around and comes back in, CMS will likely find that it is a new presentation or request. This exact situation occurred several years ago at Los Angeles’ King Harbor Hospital and was the catalyst for the hospital’s citation and closure for several years. The Triage Nurse would be putting the hospital in jeopardy by refusing to see repeat patients or “frequent flyers”.
I worked in a small ET that had general practitioners on call. My first episode was a pt that stated he was going to commit suicide. Wife was very concerned. Called Dr he wanted the pt MSE to his office 3 hours later when it opened. Both pt and wife not happy with this. The dr then requested to speak to the pt and wife. They reluctantly agreed to see the dr at 0800 am. I let them know that they could insist that the dr come in. Wife very unhappy but signs out. Husband signs stating he will not commit suicide before seeing Dr. I was very unhappy with this. THe dr is a great bully and I signed them out. The pt DID commit suicide 1-2 days later.
The second encounter with this Dr was when I called him in the night for a92 year old woman with abdominal vs chest pain with nausea and vomiting. He wanted me to MSE her as well. I told him I was not comfortable with that. This particular night I had a second nurse with me and I told the Dr that neither of us were comfortable with that. He became Quite angry and yelled at me and accused me of being rude and slamming cupboards. He did come in but took both nurses to another room and chewed us out. I stood my ground because I believed this lady needed to be seen. The woman’s troponin was elevated became sicker and was eventually transferred to another facility where she died. Are these EMTALA violations? By the way, I was fired.
The best way to ask questions like this is to use the Ask a Question button on the front of the medlaw.com site.