EMTALA indeed DOES apply to "inpatients" when that patient becomes a "transfer". There are specific "transfers" to which EMTALA does apply.
Which transfers are governed by EMTALA?
Movement away from a hospital may be deemed a transfer under EMTALA, but it does not necessarily mean that EMTALA governs the transfer. Only those transfers of patient who have Emergency Medical Conditions (EMC’s) that have not been stabilized are controlled by EMTALA. The transfer of patient who do not have an EMC or who have had an EMC stabilized are NOT controlled by this law.
Thus, taking a patient from another hospital where that patient was an “inpatient” to an ED may be an EMTALA violation.
Sandra Castro, MD
Niswonger Children’s Hospital
From: Pediatric Emergency Medicine Discussion List [mailto:[log in to unmask]] On Behalf Of Peter Auerbach
Sent: Monday, February 02, 2015 5:17 PM
To: [log in to unmask]
Subject: Re: Inpatient transfers
EMTALA does not apply to inpatients. Period (there are no exceptions).
So an inpatient to ED transfer is not an EMTALA violation.
There are many other reasons that an inpatient to ED transfer is undesirable and/or inappropriate ...
I'm just saying that EMTALA is not one of them.
Peter Auerbach, MD, FAAEM, FAAP
Pediatric Emergency Medicine
Randall Children's Hospital
On Mon, Feb 2, 2015 at 1:33 PM, Niel Miele <[log in to unmask]<mailto:[log in to unmask]>> wrote:
> On occasion, we do accept. The EMTALA usual rule of thumb is that a
> patient may not be transferred to a lower level of care (For this
> purpose, the ED is considered a lower level of care than an inpatient bed).
> However, it can be argued that a Pediatric ED may provide a higher
> level of care than an inpatient unit at a non-pediatric facility.
> If you truly have no inpatient beds available, it is not technically
> an EMTALA violation to accept the patient. Although you have to have
> capability AND capacity, if you are able to care for the patient
> safely in the ED, then you have the capacity.
> The big rub in all of this is patient satisfaction. Patient leaves a
> hospital's inpatient unit where they may have a private room and bed,
> are transferred via ambulance, and are placed on a stretcher in an
> Emergency Department for what may be hours, with the understanding
> that the reason for transfer is that you're going to fix everything
> that the other hospital didn't accomplish.
> Finally, if the hospitalist accepts the transfer, and you haven't
> established a mechanism whereby the hospitalist is communicating with
> the ED, then the hospitalist is technically responsible for that patient.
> Hopefully, improved communication will avoid this issue.
> Niel Miele, M.D.
> New Brunswick, NJ
> > Date: Mon, 2 Feb 2015 15:01:36 -0500
> > From: [log in to unmask]
> > Subject: Inpatient transfers
> > To: [log in to unmask]
> > Does your ED accept transfers of INPATIENTS from other hospitals?
> > If
> so, is the PEM attending a part of the decision to accept the patient
> or does the hospitalist accept them without PEM attending involvement?
> > Do you take inpatients from other hospitals when there are no floor
> > or
> PICU beds available in your hospital? Does it depend on whether there
> are already admitted patients boarding in the ED and whether the ED
> volume is high?
> > If the hospitalist accepts them without PEM attending involvement,
> shouldn't either the transferring MD or the hospitalist inform the PED
> of the transfer?
> > Thanks for your input.
> > For more information, send mail to [log in to unmask]<mailto:[log in to unmask]> with
> > the
> message: info PED-EM-L
> > The URL for the PED-EM-L Web Page is:
> > http://listserv.brown.edu/ped-em-l.html
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