Ref: Jeff Avner's question:
I concur fully with Dr. Linzer' s comments about the definition of "stable"
patient, appropriate documentation and having an accepting physician under
the EMTALA law. I would also add two more points which may be especially
relevant in the current managed care networks that we are in.
1. The 1994 EMTALA has also included provisions against "reverse dumping".
This means that the receiving hospital which may be the site of potential
higher level of care ( Burns unit, NICU etc) cannot refuse a transfer if
they have the available resources and personnel.
2. The "whistle blower" provision which allows without any penalty, the
transfer of a patient by the ED provider to another hospital if the
consultant at that hospital is not available within a reasonable period of
time. Reasonable is again not defined but the specific hospital policies are
one of the governing guidelines. The name of the consultant is to be
documented in the chart.
3. The patient can be transfered to another institution (and not necessarily
a higher level) without EMTALA violation if deemed stable and the
patient/caretaker wishes to go elsewhere. (with appropriate informed
Jay Pershad, M.D.
"We care for wee folks"
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