Patient 6 months pregnant presented to ED with right back pain radiating down right leg such that she claims she was barely able to walk. The PA on duty evaluated the patient, contacted the patient’s PCP office, sent patient to the PCP’s office without evaluation of elements of pain, treatment of pain, or OB exam as required by hospital policies. The PA records are characterized as “very limited review” of the patient’s condition.
In CMS interviews, the investigator indicates that the PA reported the patient requested to go to her PCP, while the patient indicates that she was sent to the PCP without requesting it. The patient also indicated that she was briefly examined by an RN who reported her condition to the PA and that the PA never saw her. The PA reportedly stated that he contacted the PCP, but the PCP denies being contacted according to the CMS investigator.
According to reports, the PA did not consider the patient’s condition emergent and stabilizing care was not deemed necessary. The PA is reported to have stated that he deemed the referral to be a discharge, but later completed a transfer form as an “afterthought”.
The hospital was cited for failure to provide a Medical Screening Examination. Tag C2406.
Comments:
If we afford the PA the benefit of the doubt on all issues (which CMS seldom does), it appears that at the very least, the PA failed to involve an OB as required by hospital protocols. That alone is sufficient to get cited for an EMTALA violation. It also appears that his documentation was minimal per the CMS report. The subsequent completion of the transfer form is inexplicable given his version of the visit.
If the patient’s version is believed – as CMS almost always will do unless there is clear documentation to support the provider’s version – this is a more direct substantive violation of EMTALA by:
- failing to actually examine the patient,
- failure to understand that the MSE must prove that no legally defined emergency medical condition exists (substantially different than whether the patient is “emergent”),
- failure to address pain as an emergency medical condition,
- and improper transfer of a patient prior to completion of MSE and stabilization.
If the PA billed for an MSE without personally examining the patient … well, let’s not step into that quagmire.