May 15, 2009

Tales of EMTALA: I'm not the patient!

Emergency Medical Treatment and Labor Act (EMTALA)
In 1986, Congress enacted EMTALA to ensure public access to emergency services regardless of the ability to pay. All Medicare-participating hospitals with emergency services must provide an appropriate screening examination for any pregnant woman experiencing contractions who comes to the emergency department for evaluation. (Emphasis mine.)

The definition of an emergency condition makes specific reference to a pregnant woman who is having contractions. Labor is defined as "... the process of childbirth beginning with the latent phase of labor continuing through delivery of the placenta. A woman experiencing contractions is in true labor unless a physician certifies that after a reasonable time of observation the woman is in false labor." A woman in true labor is considered "unstable" for interhospital transfer purposes until the newborn and placenta are delivered. An unstable woman may, however, be transferred at the direction of the patient or when a physician certifies that the benefits of treatment at another facility outweigh the risks of transfer. Physicians and hospitals violating these federal requirements are subject to civil penalties of up to $50,000 and termination from the Medicare program.
Amusingly, I had a patient tell me that she accompanied her husband (she was 7 months pregnant at the time) to the ED for recurrent bowel obstruction. He'd gone in multiple times and he'd get better right before the surgeon decided to operate. This time, things felt different.

On at least three separate occasions, someone came up to her in a hurry to put her in a wheelchair and whisk her off to the Labor and Delivery unit. "I'm not the patient!" she'd exclaim amusedly.

"Too bad you couldn't harness that desperation to get them to see your husband sooner..." I remarked.

Reference:
Williams Obstetrics > Section IV. Labor and Delivery > Chapter 17. Normal Labor and Delivery

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