New Guam hospital faces EMTALA complaint before it is even JC accredited.

The new 135 bed private facility on Guam opened in July and was awaiting it JC accreditation in December when it drew its first EMTALA complaint for allegedly transferring an OB patient for financial reasons.

According to reports on Kuam.com, a young woman was brought into the hospital by ambulance complaining of labor pains at 9 months. She reportedly was a high-risk pregnancy with low amniotic fluid. Initial exam by a nurse found she was discharging amniotic fluid, with possible rupture of the bag of waters, and the presence of meconium staining, following an ultra-sound.

The patient reportedly stated that two hours into her admission, she was transferred without her consent to another hospital on the island because “they don’t accept Medicaid.” The hospital was not yet approved for Medicare or Medicaid, but was surveyed by Joint Commission for accreditation and Medicare/Medicaid acceptance and was awaiting the outcome of that survey.

Kaum.com quoted the physician’s statement as the patient was “not an emergency case” because a nurse evaluation “found she was not in critical condition or unstable condition.” He said “she was not in labor, and could have been sent home, but instead was sent via ambulance to GMH because it was unclear whether her water broke.”

Unfortunately, this physician was under the same misunderstanding that keeps coming up — not knowing that legal definitions, not medical definitions, control under EMTALA. In essence, his belief was apparently that if the mom is not at risk to life or limb, there is no emergency — strike 1. Then he apparently believed that if you are not sure of the patient’s progress in labor, you can send them home — strike 2. And apparently he believed that he did not have to care for a patient with the wrong kind of insurance — strike 3.

For a quick review of why these assumptions or beliefs are incorrect:
• By definition under EMTALA, pregnancy with contractions present is an emergency medical condition.
• By definition under EMTALA, a pregnant woman with contractions present is legally unstable until delivery of baby and placenta
• By definition under EMTALA, a woman is in active labor from the early incipient stages through delivery of baby and placenta
• The presumption is that an emergency medical condition continues until it is ruled out. Uncertainty is the hallmark of the on-going EMTALA duty to rule out or stabilize
• Per EMTALA, the fetus is a separate patient, and the meconium staining would be an indicator of possible fetal distress which would be an emergency medical condition
• EMTALA expressly requires care to be rendered without regard to the means or ability to pay or source of payment.
• EMTALA requires a signed patient consent to transfer, among other documentation requirements
• EMTALA applies to the US, its territories, and administrated regions — which includes Guam

Undoubtedly, this facility and its staff are going through a baptism of regulatory fire as a result of this incident. Hopefully the lessons learned will ultimately result in a high-quality addition resource on Guam.