911 from hospital ED room ?

[SMC]

Scenario.

911 Call comes in and the patient relays that he needs an ambulance. He is currently discharged from the ED but is still in the exam room. Patient was cleared medically and thinks something is wrong with him and he wants to go to a bigger hospital in a city 30 minutes away. patient relays he is vomiting and is in severe pain.

A call over to the hospital finds that the patient is cleared and is not a patient anymore. the staff told us that they were letting him stay in the room until he finished vomiting and he could leave when he wants.

Question is....
I'm under the impression that we can not go onto hospital property and into the ED and pick this patient up. EMTALA Violation?

This guy would need to walk out to the street before we could pick him up? What do you guys know?

Texas. Non hospital based ambulance.

Thanks.

 

[FiremanMike]

I can't say I've ever been called to the back, but a handful of times I've been called to the lobby. In those cases, the charge nurse has helped us out and worked with the patient.

Do you have the ability to refuse to transport people? Although I've almost never used it, that'd be a case where I probably would. To answer your question, I don't see any legal violations to what has happened in your scenario.

 

[Carlos Danger]

the staff told us that they were letting him stay in the room until he finished vomiting and he could leave when he wants.

I would want to go to a different hospital, too.

 

[Bullets]

Scenario.

911 Call comes in and the patient relays that he needs an ambulance. He is currently discharged from the ED but is still in the exam room. Patient was cleared medically and thinks something is wrong with him and he wants to go to a bigger hospital in a city 30 minutes away. patient relays he is vomiting and is in severe pain.

A call over to the hospital finds that the patient is cleared and is not a patient anymore. the staff told us that they were letting him stay in the room until he finished vomiting and he could leave when he wants.

Question is....
I'm under the impression that we can not go onto hospital property and into the ED and pick this patient up. EMTALA Violation?

This guy would need to walk out to the street before we could pick him up? What do you guys know?

Texas. Non hospital based ambulance.

Thanks.

Ive had people get discharged and call from the lobby. We tell them we arent transporting from one to another.

 

[JPINFV]

I'm under the impression that we can not go onto hospital property and into the ED and pick this patient up. EMTALA Violation?

He's been examined by a physician who has determined that the patient is neither in active labor nor suffering from a life threatening disease. Why would it be an EMTALA violation? Just because you're vomiting doesn't mean you're going to die.

This guy would need to walk out to the street before we could pick him up? What do you guys know?

Why would he need to walk to the street? The bigger question is going to be are your protocols loose enough to allow you to bypass the closest hospital?

 

[Medic Tim]

Where I work 911. I have been called to the hospital a few times. Once to the waiting room because they wanted to be seen faster. We did a basic assessment , I stepped into the triage station and told the nurse what happened and she have us waiting room for our pt destination. He hen wanted to be taken to another hospital. The next closest one was over an hour alway and had less resources. He was not happy with us refusing.

Another time were were called to the Er for a transfer. We get there and the nurses and docs have no idea. Ended up the pt felt he was not being treated fast enough so he called our dispatch , pretended to be a nurse calling in a transfer. We cancelled and the pt got a nice tongue lashing from the doc.

 

[SMC]

That is my Question. Would he need to walk off the hospital property? Are there any laws in place I need to be aware of. Or any laws the hospital needs to be aware of ?

The 911 caller never did call back and we did not run on him. But if we had walked into the ED room and picked him up. transported him to another hospital and gave report that he came from another hospital ED with no Transfer paperwork of the sort what do you think the receiving facility would have said if anything. Its really not a transfer at that point. Is that an EMTALA violation on the hospital we picked him up from ? I doubt it.... IDK

And If we would have walked out to the street I would have told him we are not going to any other hospital other than the one we are standing in front of.

 

[Clipper1]

That is my Question. Would he need to walk off the hospital property? Are there any laws in place I need to be aware of. Or any laws the hospital needs to be aware of ?

The 911 caller never did call back and we did not run on him. But if we had walked into the ED room and picked him up. transported him to another hospital and gave report that he came from another hospital ED with no Transfer paperwork of the sort what do you think the receiving facility would have said if anything. Its really not a transfer at that point. Is that an EMTALA violation on the hospital we picked him up from ? I doubt it.... IDK

And If we would have walked out to the street I would have told him we are not going to any other hospital other than the one we are standing in front of.

This question was answered by JPNIFV:

He's been examined by a physician who has determined that the patient is neither in active labor nor suffering from a life threatening disease. Why would it be an EMTALA violation? Just because you're vomiting doesn't mean you're going to die.

If the patient has been seen by a physician and DISCHARGED from the hospital, EMTALA has been satisfied.
This person should have his discharge instructions on him. Make a copy and take those with you. This is not a transfer so you will not be directly billing this hospital. The patient would also have to request the release of medical records just like anyone else and will probably not be given them when you pick him up. The hospital staff may give you a courtesy report but should not be giving you any medical records if the patient is discharged or leaving against medical advice. This is all on the patient. If the patient has not been discharged from the hospital and has not been seen by the doctor or the doctor wants more to be done but the patient still wants you to take him elsewhere, this hospital will have the patient sign an AMA (Against Medical Advice) form after explaining he will still be responsible for what has already been done to him and that he is on his own with you. If the patient has a medicated IV already established, you might also contact your med control as well the the ED hospital to make sure the proper level of care is being provided or what to expect. The hospital will discontinue that IV if the patient is insistent on an AMA.

 

[Akulahawk]

He's been examined by a physician who has determined that the patient is neither in active labor nor suffering from a life threatening disease. Why would it be an EMTALA violation? Just because you're vomiting doesn't mean you're going to die.



Why would he need to walk to the street? The bigger question is going to be are your protocols loose enough to allow you to bypass the closest hospital?

My local protocols essentially say that I should take the patient to the closest, most appropriate hospital. If he's actually in the closest, most appropriate hospital and has been discharged from there, as far as I'm concerned, he can take a cab. I'm pretty sure we also have a Paramedic initiated refusal of service... and he'd probably fit it.

 

[SMC]

Thanks Clipper1

EMTALA has been satisfied.

I like that answer. It makes sense. Thank you.

 

[Clipper1]

Thanks Clipper1

EMTALA has been satisfied.

I like that answer. It makes sense. Thank you.

However, ideally this call should have been treated as routine transport arrangement with the same info gathered as any other call with verification of insurance and payment. This person would then be put in rotation with other transfers which means he might be waiting on the curb for awhile.

On a few occasions we have had people check out AMA from the ICU or med-surg floors but required an ambulance to get out of the hospital. This gets tricky but if the patient or family does not want to reason with the physicians or understand the transfer process with another physician accepting at the other facility, then they may have to rely on an ambulance taking them to an ER in the other facility. Insurance probably won't touch this and the level of care may not be just BLS.

 

[TheLocalMedic]

Whenever I've dealt with someone dialing 911 from inside a hospital it has invariably been a transient who was trying to game the system. All they get from me is a big NOPE followed by calling security or the cops. If they've already been seen, then I'm not required to deal with their BS.