EMTALA Analysis Scenario Assignment

Scenario: You are the administrator on call for a local hospital and you receive a call at 2:00 a.m. from another local hospital regarding a patient with a broken upper arm. The ED physician’s assistant is calling to arrange an EMTALA transfer from his hospital to yours, but the orthopedic physician on call at your hospital is refusing to accept the transfer, stating that the patient doesn’t need a higher level of care. When you ask him about that, he tells you the fracture is not displaced, and can be splinted and seen in the office. The ED physician at your hospital is very nervous about the possibility of an EMTALA violation.

1) Write an analysis (1,000-1,500 words) of the situation, how it is impacted by EMTALA, and what decision you will make as the administrator, along with your rationale and thought process.

2) Prepare this assignment according to the APA guidelines found in the APA Style Guide, located in the Student Success Center. An abstract is not required.

Emtala scenario analysis

Scenario Analysis: The Emergency Medical Treatment and the EMTALA Rule

Ethical challenges are among some of the strongest and most consistent trends in modern-day medicine. Ethical problems arise in the daily practice of medicine, educational practices, and in the conducting of research. As a result, it is dire that physicians to understand the role of relevance ethics in their professional lives (Bitterman, 2006). One particular area of ethics that continues to upset doctors is the ethical delivery of hospital-based emergency services primarily through the close inspection of the Emergency Medical Treatment and Labor Act (EMTALA). It is a federal law that dictates that any patients brought to an emergency department to be accepted and treated regardless of their insurance status, health conditions, or the ability to pay (American College of Emergency Physicians, 2016). The EMTALA places three core mandates on physicians. These include the duty to accept patients in transfer from less capable facilities, the obligation to perform medical screening examination, and the requirement that a hospital provides on-call physician services to the emergency department to help in stabilizing patients with emergencies or help accept patients in a transfer. In any way, refusing to receive in-patients with emergencies in a transfer, devising ways to avoid on-call duties, and avoiding the application of EMTALA all comprise violations of the law, and can attract adverse consequences (Peth, 2004). The central objective of this paper is to address a situation that entails EMTALA and the ethical delivery of hospital emergency services. It will analyze the situation, discuss how it is impacted by the EMTALA, and the best decisions that can be made from an administrator’s capacity.

EMTALA Analysis Scenario Assignment

In the given scenario, an emergency department physician’s assistant has called a hospital in which I am the administrator on call to arrange an EMTALA transfer of a patient in need of urgent medical attention following a broken arm. The orthopedic physician on-call at my hospital has refused to accept the transfer stating that the patient does not require specialized care. He says the fracture is not displaced and can thus be splinted, seen, and addressed by the local hospital making the call. Following this situation, the emergency physician at my hospital is nervous about the possibility of an EMTALA violation. The concern is whether an EMTALA violation occurred or not.

As a matter of fact, the EMTALA provisions were violated in the scenario presented. In its broadest sense, the EMTALA requires physicians of a higher level hospital to help in emergency situations by ethically administering care upon receiving a request from a lower level hospital. The EMTALA defines an emergency as a medication condition that manifests itself by acute symptoms of sufficient severity. These include severe pain, and where an absence of immediate medical attention could result in placing an individual’s health in danger, serious dysfunction of bodily organs, or impairment in bodily functions (American College of Emergency Physicians, 2016). In the scenario presented, the local hospital calling to arrange for EMTALA transfer had already assessed the patient and declared his condition as an emergency and requiring immediate attention from a higher level hospital. According to the law, the EMTALA applies when an individual comes to the emergency department, which has been defined as a specially equipped and staffed area of the hospital used especially during the initial assessment, medication, treatment of outpatients for emergency medical conditions (Bitterman, 2006). Since my hospital is well equipped to handle medical emergencies, it is obligated under the EMTALA and has a duty to receive and attend to patients from lower-level hospital-based facilities. As such, there was no reason for the orthopedic physicians at my hospital to reject the transfer and justifying with inappropriate reasons. The scenario was overall unethical and could result in various consequences.

The situation is impacted by law, EMTALA, in different ways, but primarily because various adverse effects are likely to arise. The law states that where an emergency department has violated the EMTALA, penalties may occur in different forms. These are termination, fines, and litigations (Bitterman, 2006). Firstly is termination in which a hospital’s or physician’s Medicare provider agreement may be terminated such that the hospital or physicians are no longer in a capacity to provide health care services (Bitterman, 2006). Secondly are fines, which can be either hospital fines or physician penalties. Hospital fines may be up to $50,000 per violation for a hospital with more than 100 beds and up to $25,000 for a hospital with fewer than 100 beds. Similarly, physician fines for physicians including on-call physicians may be up to $50,000 per violation (American College of Emergency Physicians, 2016). Finally are litigations. The violating hospital may be sued for personal injury in a civil court under the private cause of action.

EMTALA Analysis Scenario Assignment

In the scenario presented, whether a violation has occurred or is presumed to have been transpired, various decisions can be made in a bid to avoid any penalties. Firstly, as the administrator, I would report the scenario to the state surveyors and the Center for Medicare and Medicaid Services (CMS). I would file a report within 72 hours to say that my hospital received a call from a local hospital requesting to make an EMTALA transfer. I would state that my hospital did not accept the transfer because it found it inappropriate or did not have necessary facilities to handle an emergency of that nature. Even though this is self-reporting, it would be an easy way to avoid penalties for violating EMTALA (Peth, 2004). Secondly, I would train and retrain my hospital’s physicians so as to reduce the chances of the incident recurring. From time to time, I would train my staff to help them know to whom, when, and where the EMTALA applies. Training would be useful in helping the employees stay complaint (Bitterman, 2008). Even if staff fails to comply, the documented training will help insulate me from the actions of a rogue physician who negligently and knowingly violates the policies after being trained.

Thirdly, I would decide to post the required EMTALA signs in the dedicated emergency departments and the associated waiting areas. I would ensure that all physicians are familiar with the rights guaranteed in the signs (Bitterman, 2008). Fourthly, I would maintain written policies, which would be a way of encouraging staff to comply and establish the basis for correction when the staff fails to comply. With written policies, it would be easy to avoid penalties from regulators when a rogue employee makes a violation (Bitterman, 2008). Finally, I would decide to encourage physicians to do what is best for the patients. Ultimately, EMTALA is all about patients (Peth, 2004). If my hospital’s doctors do the best towards patients, it would be easy to avoid significant EMTALA liabilities even if there is a violation.

In conclusion, the paper discussed the application of the EMTALA rule in the administration of emergency medical services. The paper analyzed the scenario presented, and concluded that it violated the EMTALA rule. The reason for the stance is that despite being an equipped and staff hospital capable of handling emergency services to patients, it escape its role thereby placing the patient’s health in danger. Following the scenario, the hospital and its involved physician are subject to various adverse consequences…

References

American College of Emergency Physicians, (2016). EMTALA. American College of Emergency Physicians. Retrieved November 18, 2016 from https://www.acep.org/news-media-top-banner/emtala/

Bitterman, R. A. (2006). EMTALA and the ethical delivery of hospital emergency services. Emergency Medicine Clinics of North America, 24(3), 557-577.

Bitterman, R. A. (2008). Transferring patients: EMTALA rule to apply to those needing more care. ED Legal Letter, 19(6), 61-64.

Peth, H. A. (2004). The emergency medical treatment and active labor act (EMTALA): guidelines for compliance. Emergency Medicine Clinics, 22(1), 225-240.

ORDER NOW FOR AN ORIGINAL PAPER!!! EMTALA Analysis Scenario Assignment

ADDITIONAL INSTRUCTIONS FOR THE CLASS

Discussion Questions (DQ)

• Initial responses to the DQ should address all components of the questions asked, include a minimum of one scholarly source, and be at least 250 words.
• Successful responses are substantive (i.e., add something new to the discussion, engage others in the discussion, well-developed idea) and include at least one scholarly source.
• One or two sentence responses, simple statements of agreement or “good post,” and responses that are off-topic will not count as substantive. Substantive responses should be at least 150 words.
• I encourage you to incorporate the readings from the week (as applicable) into your responses.

Weekly Participation

• Your initial responses to the mandatory DQ do not count toward participation and are graded separately.
• In addition to the DQ responses, you must post at least one reply to peers (or me) on three separate days, for a total of three replies.
• Participation posts do not require a scholarly source/citation (unless you cite someone else’s work).
• Part of your weekly participation includes viewing the weekly announcement and attesting to watching it in the comments. These announcements are made to ensure you understand everything that is due during the week.

APA Format and Writing Quality

• Familiarize yourself with APA format and practice using it correctly. It is used for most writing assignments for your degree. Visit the Writing Center in the Student Success Center, under the Resources tab in LoudCloud for APA paper templates, citation examples, tips, etc. Points will be deducted for poor use of APA format or absence of APA format (if required).
• Cite all sources of information! When in doubt, cite the source. Paraphrasing also requires a citation.
• I highly recommend using the APA Publication Manual, 6th edition.

Use of Direct Quotes

• I discourage overutilization of direct quotes in DQs and assignments at the Masters’ level and deduct points accordingly.
• As Masters’ level students, it is important that you be able to critically analyze and interpret information from journal articles and other resources. Simply restating someone else’s words does not demonstrate an understanding of the content or critical analysis of the content.
• It is best to paraphrase content and cite your source.

 

LopesWrite Policy

• For assignments that need to be submitted to LopesWrite, please be sure you have received your report and Similarity Index (SI) percentage BEFORE you do a “final submit” to me.
• Once you have received your report, please review it. This report will show you grammatical, punctuation, and spelling errors that can easily be fixed. Take the extra few minutes to review instead of getting counted off for these mistakes.
• Review your similarities. Did you forget to cite something? Did you not paraphrase well enough? Is your paper made up of someone else’s thoughts more than your own?
• Visit the Writing Center in the Student Success Center, under the Resources tab in LoudCloud for tips on improving your paper and SI score.

Late Policy

• The university’s policy on late assignments is 10% penalty PER DAY LATE. This also applies to late DQ replies.
• Please communicate with me if you anticipate having to submit an assignment late. I am happy to be flexible, with advance notice. We may be able to work out an extension based on extenuating circumstances.
• If you do not communicate with me before submitting an assignment late, the GCU late policy will be in effect.
• I do not accept assignments that are two or more weeks late unless we have worked out an extension.
• As per policy, no assignments are accepted after the last day of class. Any assignment submitted after midnight on the last day of class will not be accepted for grading.

Communication

• Communication is so very important. There are multiple ways to communicate with me: 
  • Questions to Instructor Forum: This is a great place to ask course content or assignment questions. If you have a question, there is a good chance one of your peers does as well. This is a public forum for the class.
  • Individual Forum: This is a private forum to ask me questions or send me messages. This will be checked at least once every 24 hours.