In my community we have had a County owned hospital bought out by a privately owned "for profit" company. They are now stating that we should bring pt.s that are out of their level of care to their facility for assesment before being transported to a higher level of care. Its because they feel they are losing money since these pt.s never come through their doors. Anyone have any feed back as to the legality of this.
Private Hospital dictating Pt care
- Thread starter swmedic
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Are they your medical director? if so, you may not have much choice; as long as it doesn't put the patient at risk.
If the new hospital company is not your medical director; talk to your medical director and let him handle the issues.
The hospital may be losing money, but it is NOT fair to the patient that they are getting billed for 2 hospital visits for the same thing, especially since alot of insurance companies will not pay for the extra hospital.
If the new hospital company is not your medical director; talk to your medical director and let him handle the issues.
The hospital may be losing money, but it is NOT fair to the patient that they are getting billed for 2 hospital visits for the same thing, especially since alot of insurance companies will not pay for the extra hospital.
firecoins
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well how far is the other hospial?
emtfarva
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It all depends on what your state protocols state. And, if you drive the Pt onto the hospital grounds, they have to have an exam by the ER. This is a federal law. (Cobra)
firecoins
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So let me understand this. The closest hospital is a community hospital now run for profit. The ER doctor at this facility is your medical doctor. He wants you to bring patients in to him before deciding to fly them out to the more appropriate facility directly. Is this the issue?
emtfarva
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I miss read... I am with firecoins on this, what is the problem with that?
VFFforpeople
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I agree with coins and farva on this. We do the same thing our hospitals are spread out in rural areas, min. time travel by freeway is an hour, with one being 45min. My hospital is the only level 2 trauma center for 1hour+ around (freeway). So, in some cases it is best to get the to a hospital (regardless of level), let them handle what they can and ship them to another hospital to deal with the rest. It may not be perfect, but it is our world haha.
JPINFV
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That's not 100% true. There's an exception for EMS providers using a helipad at an outlying hospital to airlift patients to a higher level hospital. If you're just going to the hospital to use the helipad then you don't fall under EMTALA and the ER doesn't have to examine the patient.
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Good catch!!
Epi-do
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I think what the OP is saying is that regardless of if they are going to do a ground transport or fly the patient, they are supposed to stop their first.
Sort of like, if the first hospital doesn't have an interventional cath lab and they want to go past it to get to the ER that does, but the doc is saying they still have to stop there with the patient regardless of the fact that the first facility is unable to provide the proper intervention.
I would have a problem with being told I have to stop at hospital A with every patient I have just so they can pad their bottom line. If hospital B is more approriate, and I can safely get the patient there, why delay transport to that care just so the doc at hospital A can say, "Yes, you are right, they should go to hospital B."
Also it can be a major financial issue to the patient; if their insurance does not cover the new hospital; and you take them there with out a valid medical reason, the insurance may charge the patient 50% of the bill instead of 10-20% or even just a deductible. (my insurance charges a $50 deductible for an ED visit in network, and 25% and $250 deductible for out of network, unless there is a valid reason {life or death}).
not a good thing to do to the patients unless absolutely neccessary.
a few patients sueing the hospital for the extra expense it cost them will end up costing the hospital more than they make.
not a good thing to do to the patients unless absolutely neccessary.
a few patients sueing the hospital for the extra expense it cost them will end up costing the hospital more than they make.
emtfarva
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JP, I have been told, even if you drive on to hospital grounds, find out you are on the wrong campus, and then drive off the grounds to the right one, you have broken EMTALA laws. A good example of this is would be the Boston Medical Center. You have the Boston City (Harrison Ave) and the BU campuses (East Newton). I was told that if they are going to the ER of one of the campuses, and you drive to the wrong one, and then drive to the right one, you have broken EMTALA. And, When talking about MedFlight, I would be calling for Medflight and the closest LZ is on hospital grounds, I would be calling CMED and letting the hospital know what was going on. Most ER doc's would still want to see the Pt even if it is for 2 minutes. Seen it done at the Jordan Hospital in Plymouth.
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JPINFV
Gadfly
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"If as part of the EMS protocol, EMS activates helicopter evacuation of an individual with a potential EMC, the hospital that has the helipad does not have an EMTALA obligation if they are not the recipient hospital, unless a request is made by EMS personnel, the individual or a legally responsible person acting on the individual’s behalf for the examination or treatment of an EMC."
http://www.medlaw.com/healthlaw/News/emtala-and-helicopters-wh.shtml
Additionally, I'd argue that if you find yourself at the wrong hospital and it is either not an emergency or an emergency that requires a speciality hospital, then EMTALA doesn't apply since you are not seeking care at that specific hospital.
http://www.medlaw.com/healthlaw/News/emtala-and-helicopters-wh.shtml
Additionally, I'd argue that if you find yourself at the wrong hospital and it is either not an emergency or an emergency that requires a speciality hospital, then EMTALA doesn't apply since you are not seeking care at that specific hospital.
firetender
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Being a medic is a juggling act. In order to get to do everything you get to do to save lives you have to accept that you are part of a system. It's called the capitalist system.
That's why God made Code 1's (you recumbent taxi hack, you!), to support the companies as they take care of the needs of the institutions that provide them somewhere to take the bodies they pick up from the street.
The important thing to look at is will a two-tiered system now compromise the safety of patients more than if it remained a one-tier system? If it really will, then let your voice be heard. If not, Chill! Look at it like an imposed triage that keeps everybody alive.
In some cases the patient needs to go directly to the 2nd tier hospital. The "rules" should be written so you have the leeway to get permission from tier 1 Doc to do so. Other than that, and even if it means two ambulance rides for the patient, your psychic energy is better spent elsewhere.
Mountain Res-Q
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Here is an extreme example. Several years ago I was on duty when this call came in.
Elderly man and woman go to hopital and learn that they both have advanced cancer and there is no hope... just a slow decline and death. Man and woman leave hospital, go to the car (on hospital property), and while in the car, man takes a gun, kills his wife, kills his dog, and shoots himself. However, these circumstances are unknown a the time. All that is known is that two people were shot right outside the hospital. SWAT is there with their assault rifles and Hospital gets put on lockdown (is not recieving patients).
But wait... man is still alive and breathing... OMG... ambulance (run by the private hospital district) responds and works on the man. QUESTION? If you are on that ambo do you...
a. Transport to the closest hospital not on lockdown, which is 10 miles away? or...
b. Say, "It is an EMTALA violation for this hospital not to see this patient since I we are on the grounds" and demand that this patient be seen by this hospital?
If you said B, then you would be waiting in that parking lot for the next 3 hours while the Investigators hashed this out...
JP quoted it... EMTALA only applies when talking about the intended recieving hospital. If your patient need to be flown out (and it is in keeping with local protocol - as in the OPs issue) and you need to use a hospital's helipad to fly the pt. out... then that hopital does not have a reposibility to see that patient since the reason the patient is being flown out is because that hospital is incapable of treating the patient to the degree needed... hence, they are not the intended recieving hospital.
In the case of the OP... local protocol trumps you in this case. If you are being given an order by someone with the authority to do so then you have to follow it. MD Medical Dirrector outranks EMT or Medic. They set policy and have to answer for that, just as you have to answer for a violation of that policy, despite the fact that you may not agree with it. If you violate that policy, you had better be able to justify it and stand by your desision... You can try to fight it, but in the end, it is what it is as long as it does not violate any superceding laws...
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reaper
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EMTALA only states that the hospital must assess the pt with an emergency, when they are "presented to the facilities Emergency Dept." It does not mean, when you are on hospital grounds.
I have ran several shootings on hospital property. The ED's were always placed on lock down, during the event. I have taken every single pt to that hospitals ED without problems. You should have an LEO present with pt and be allowed access into ED. I have never seen an ED refuse to allow access in said event!
I have ran several shootings on hospital property. The ED's were always placed on lock down, during the event. I have taken every single pt to that hospitals ED without problems. You should have an LEO present with pt and be allowed access into ED. I have never seen an ED refuse to allow access in said event!