The Chicago Tribune carried the headline “Stroke Victim: Hospital Didn’t Help” on a half-page story that raises questions of a possible EMTALA violation in one of the scenarios that hospitals seem to have forgotten.
According to the Tribune, the stroke victim was driving his sister to the airport on August 20, 2012, when he became “woozy” and pulled the car off the road. His sister, worried about his condition, looked around and spotted a hospital entrance within view. She drove her brother to the hospital entrance and ran inside and allegedly told the receptionist that her brother was ill and needed immediate help, the Tribute reports.
According to the sister, the receptionist asked if the brother could come into the hospital on his own. When the sister advised that he could not, the receptionist reportedly told her to call 911. The sister indicated that she repeatedly told the receptionist that this was an emergency and that she believe her brother had suffered a stroke and was in the car right outside the door. The receptionist reportedly called 911 on the sister’s cell phone. The ambulance arrived and transported the patient less than 1/10th of a mile and charged $901.
In November, the patient received a bill for the transport after insurance refused the bill as an unnecessary charge, and the patient contacted the hospital with his complaint and heard nothing in response. When the bill went to collections in July 2013, the patient contacted the Tribune for help in dealing with the lack of response from the hospital.
After the newspaper got involved, the hospital vowed that it would investigate and assured the paper that it had policies that should have resulted in prompt medical assistance by the hospital staff. Conspicuously missing is any mention of CMS, but after a story of this prominence, I would expect a CMS visit will follow soon.
250 Yard Rule
Here’s the rule — hospital personnel must respond to any individual that they become aware of who may be in need of emergency assessment or care if that person is on hospital property and within 250 yards of the main facility including access walks, drives, and parking areas. Just calling 911 is not considered an adequate response from the hospital.
That rule was the result of another Chicago case where a wounded young man was left bleeding out 25 feet from the emergency department door. That case was the object of a Presidential press conference announcing the EMTALA citation and cost more than $12 million in a civil settlement.
Hospitals recently have seemed to have forgotten the 250-yard rule because it is not included in the EMTALA site review guidelines. The rule, however, is found in a different regulation, 42 CFR 413.65 where it defines the word campus:
“Campus mans the physical area immediately adjacent to the provider’s main buildings, other areas and structures that are not strictly contiguous to the main buildings but are located within 250 yards of the main buildings, and any other areas determined on an individual case basis, by the HCFA regional office, to be part of the provider’s campus.”
As such, any patient that makes it onto the defined campus has “come to the hospital” and has triggered EMTALA.
Was Anyone Paying Attention?
I am willing to assume that the hospital did have a policy, but obviously it was not one on which they spent much training time for employees — maybe it was just this employee who missed the message. But, you may say, this person was not on the ED staff. It doesn’t matter. Any hospital employee can violate EMTALA and put the hospital at risk. EMTALA does not require that anyone commit a violation intentionally — well meaning folks trying to “help” have gotten as many hospitals cited as evil-doers.
What makes this case worthy of this much mention is how poorly the hospital handled the situation once it became aware of it. Risk management should have been all over the case the minute the hospital got the initial complaint about the unnecessary ambulance bill from their front door to their back door. I am surmising here, however, that whatever department got the complaint did not deem it important enough to pass along to risk management. Someone buried this or someone higher up ignored it, either way, it was a bad move.
The thing that escalated this to a major public relations bomb was the bill collection notice from the EMS system. The image of the hospital — its name appears repeatedly in the Tribune story — has taken a big hit so far, and you can bet the Tribune will have several follow-up stories as the dispute evolves. In the mean time, CMS will undoubtedly get wind of this and be forced to launch its own investigation with the high probability of a site visit, full scale EMTALA case files review, and ultimately several citations requiring an extensive plan of correction. Obviously, training of all hospital personnel will be a big element in the plan of correction. For a hospital of this size, plans of correction often involve $175,000 – $350,000 in preparation and implementation expense, and the threat of at least a $50,000 OIG fine.
My Real Concern
You will note that I am assuming that the violation occurred — otherwise, I would not expect that there would be an ambulance bill in dispute for transport from the front door to the back door of the hospital. If CMS gets involved, the hospital better hope that they don’t find any similar calls on the logs of the local EMS system, or the price tag would be pretty staggering.
Screw ups like this happen and one of my risk management sayings for EMTALA is “God save us from helpful employees..” The thing that is really frightening is the hospital apparently was blissfully unconcerned and failed to take action when it learned of the incident. Working out the bill with the local EMS system or paying it would have been a lot cheaper and prudent than letting the dirty laundry become a major story in the Chicago Tribune. They could have also done an in-house correction plan that would be much less expensive and would not have involved the press or CMS.
Now, I don’t know what happened internally, and that might make the hospital actions seem more reasonable, but the news version makes a well-known hospital with a good reputation look really bad. And CMS doesn’t really care why it happened. They just cite violations and demand that it gets fixed.
A word to the wise…
our hospital lost $14 million some years back; a man who had just left the ED after workup collapsed in the parking lot. security guard did not call ED but told wife she had to call 911. finally someone notified ED, patient was in remote parking lot, got to ED and was resuscitated left with severe cognitive and functional deficits. plaintiff’s lawyer sent 15 minute docudrama that rivaled any network production, asked for settlement and received it. this was before the Chicago incident; no EMTALA proceedings occurred but it flows nicely with your article. common sense is not natural to everyone.