discussion response HMGT 372

Sam

Respond to the discussion

Emergency Medical Treatment and Active Labor Act

A legal right that is present within all healthcare organizations and is presented by law is one called the Emergency Medical Treatment and Labor Act (EMTALA) which was created in 1986. EMTALA requires all hospital emergency departments to treat and provide medical screening to anyone suffering or believed to be suffering a medical emergency despite insurance status. According to Levy (2018), this act was initiated and concluded that all hospitals must provide free treatment to non-Medicare patients suffering emergency medical conditions, this reports that they cannot transfer them to other hospitals without good cause or send them away. There are three main components to EMTALA; 1. An individual who comes and requests a medical screening has the right to receive to determine if a medical condition exists, 2. if there is an emergency medical condition present it must be treated until resolved or stabilized, 3. hospitals with specialized capacities are obligated to accept transfers from those who lack these capabilities (ACEP, 2022). Therefore, the patient has a legal right to receive screening and treatment in an emergency department at any given time for any reason, this includes testing, imaging, treatments and a diagnosis, in which they are entitled to receive copies of their medical records if they wish along with consultations to specialty providers if the case warrants. The health care organization is obligated to provide these services to every client despite financial status or insurance availability. 

Case A - EMTALA #2

The law of EMTALA was presented in this case as a claim against a hospital in which the plaintiff argues this law was breeched. Ms. Power’s presented to the emergency department complaining of back pain that radiates to her hip and down into her leg, she was seen by a nurse and evaluated by a doctor, she had x-rays performed and a urinalysis in which the doctor concluded this was likely related to musculoskeletal issues, she was given medication and discharged home with follow up with an orthopedic specialist. Ms. Powers returned to the hospital the following evening with the same complaint and it was reported that she was critically unstable, she was found to have septic shock and was ultimately transferred to Central Middlesex Hospital in London, England where she spent 4 months in recovery. Ms. Powers files claims against Arlington Hospital Association for medical malpractice and EMTALA violation. 

This case was presented against Arlington Hospital Association in 1994. 

Ultimately the plaintiff was awarded $5 million dollars for compensation for the count I of medical malpractice, although, this in this case, the jury did not affirm the plaintiffs claim of EMTALA violation against Arlington Hospital Association.

The healthcare organizations role in this case was justified according to the jury. The plaintiff was not denied care or treatment, although the physician failed to collect blood work or record the plaintiffs x-ray reports in her chart which could have ultimately detected her sepsis prior to the condition worsening this was a case of misdiagnosis. The hospital provided the plaintiff with a medical screening, stabilized her and later transferred her to an appropriate facility for further care. Therefore it was proven that this was more of a case of misdiagnosis than an EMTALA violation as the plaintiff initially filed claim against. 

Case B - EMTALA #2

Correa v. Hospital San Francisco 

The law of EMTALA (Emergency Medical Treatment and Active Labor Act) relates to this case. A 65 year old woman went to the HSF ER for feeling unwell, having dizziness, nausea and chest pain. She checked in, waited and subsequently went to a clinic that was accepted by her insurance after having a long wait period and was told to “bide time” by hospital staff. The claim was made that the hospital “scrutinized” her insurance and informed the clinic that the patient would be coming to their facility for treatment. When the woman arrived at the clinic the doctor determined that the patient was unstable and shortly after ended up going unconscious and ultimately succumbed to her condition at the clinic. The family filed a lawsuit seeking compensation for their damages.

This case took place at Hospital San Francisco

A $700,000 jury verdict was issued in favor of the heirs and survivors of Carmen Gloria Gonzalez against defendant-appellant Hospital San Francisco.

The jury concluded that HSF violated EMTALA because they failed to provide Ms. Gonzalez the appropriate medical screening based upon her request to be evaluated by a provider as evidence by coming to the hospital along with improperly transferring Ms. Gonzalez before her condition worsened. The medical malpractice claim was initially dismissed by the district court. 

References: Correa v. Hospital San Francisco, 69 F. 3d 1184 - Court of Appeals, 1st Circuit 1995 - Google Scholar. (1995). Google Scholar. https://scholar.google.com/scholar_case?case=7271661395954895649&q=emtala+violation&hl=en&as_sdt=20000006

EMTALA Fact Sheet. (2022). American College of Emergency Physicians. https://www.acep.org/life-as-a-physician/ethics--legal/emtala/emtala-fact-sheet/

Levy, N. (2018, April 27). Legal Issues. . .Emergency Medical Treatment and Active Labor Act. UMGC Library. https://learn.umgc.edu/content/enforced/686368-027419-01-2225-OL1-6380/UMGC%20Library%20Article%20Legal%20Issues%20EMTALA%20PDF.pdf?_&d2lSessionVal=apmB9S6734Ac0KfOSbj2uogdP

Power v. Arlington Hosp. Ass’n, 42 F. 3d 851 - Court of Appeals, 4th Circuit 1994 - Google Scholar. (1994). Google Scholar. https://scholar.google.com/scholar_case?case=3905343900940379530&q=EMTALA+violation&hl=en&as_sdt=20000006

Ashley

Respond to the discussion

1. The Patient Right #1 from the readings (start with the title of the law and the proper legal citation);          

Emergency Medical Treatment and Labor Act (EMTALA) was passed in 1986 as part of the “Consolidated Omnibus Budget Reconciliation Act of 1985 (COBRA), Public Law 99–272” (CMS, n.d.). Congress incorporated these act’s provisions within the Social Security Act to ensure that any individual with an emergency medical condition (EMC), regardless of the individual’s insurance coverage, is not denied essential lifesaving services.

1. In your own words, produce a statement as to how this law applies to this case;

Before the enactment of EMTALA, patients with low-income or with no health insurance have been discriminated for years from receiving emergency care services due to the possibility of being unable to pay for their emergency medical services. In addition, governmental hospitals emergency departments were experiencing crisis of patient overcrowding the wards due to other private hospital rejecting uninsured patients seeking emergency medical treatments. Thereby, resulting to delay of treatment, worsening of patients’ medical conditions, and over whelming workload for fewer hospitals that eventually accept those patients. Therefore, to fix the problem, congress passes the EMTALA to prevent hospitals from denying patients of emergency medical treatments. This law obligates all healthcare providers and facilities that provide emergency healthcare services to treat and stabilize any patient seeking treatment for emergency health conditions regardless of whether they are insured or not, or able to pay for the services.

3. The HCO setting in which the violation of the Patient’s Legal Right #1 occurred (Examples: assisted living facilities for the disabled patients, long term care facility, a home care nursing association, a small physician practice, a hospital, a rehabilitation center, or a first responder/ambulance);

 An example of the significance of this act is seen in the case of a 15-year-old boy who was shot outside the Ravenswood Hospital Medical Center in 1998. However, despite the patient’s friends’ effort to bring him to the emergency entrance, the emergency department staff refused to help him in when je collapsed outside the emergency entrance. The patient died few hours later. According to the employees interviewed, they claim according to the hospital policies and procedure, they are not allowed to treat or attend to patient outside until they are registered inside. go outside and help him in for treatment. The hospital was fined forty thousand dollars for delay of emergency care, and approved the hospital to revised its policy on treating victims outside hospital buildings. The patient’s family also filed a lawsuit and the hospital settled for twelve million dollars.

 4. The penalty for the violation in Case A

 “Under section 1866(a)(1)(I)(i) of the Act, a hospital that fails to fulfill its EMTALA obligations under these provisions may be subject to termination of its Medicare provider agreement which would result in the loss of Medicare and Medicaid payments. In addition, section 1867(d) of the Act provides for the imposition of civil monetary penalties on a hospital or physician who negligently violates a requirement of EMTALA under section 1867 of the Act” (CMS, n.d.)

3. The health care organization’s responsibility.

 The emergence service providers must provide medical screening examinations for individuals who come to the emergency department of a hospital and request examination or treatment for a medical condition (CMS, n.d.). The statute further provides that, if a hospital finds that such an individual has an emergence medical condition, it is obligated to provide that individual with either necessary stabilizing treatment or an appropriate transfer to another medical facility where stabilization can occur (Zibulewsky, 2001). In addition, the EMTALA statute also separately outlines the obligation of hospitals to receive appropriate transfers from other hospitals. Section 1867(g) of the Act states that ‘‘A participating hospital that has specialized capabilities or facilities (such as burn units, shock-trauma units, neonatal intensive care units, or (with respect to rural areas) regional referral centers as identified by the Secretary in regulation) shall not refuse to accept an appropriate transfer of an individual who requires such specialized capabilities or facilities if the hospital has the capacity to treat the individual” (CMS, n.d.)

 Structure of your post for Case B -Patient’s Legal Right #2:

1. The Patient Right #2 from the readings (with the title of the law and the proper legal citation);

Health insurance Portability and Accountability Act (HIPAA)was passed on August 21, 1996, and was intended to make health care delivery more efficient and to increase the number of individuals health insurance coverage. These objectives were pursued through three main provisions of the Act: “the portability provisions, the tax provisions, and the administrative simplification provisions” (CDC, 2015).

2. In your own words, a statement of the “Right” and how the law applies to this case;

Under HIPPA, patients have the right to access their information, and also the right to choose who can access their information. This facilitate autonomy and delivery of quality care because since healthcare has emerge to an interdisciplinary profession with technology advancement, patient’s information has to be shared safely among those engaging in the care of the patient. The patient also has the right to be notified of interventions and have access to her information to stay in tuned with his or her health.

3. The HCO setting in which the violation of Patient’s Legal Right #2 occurred;

 Discussing patient’s personal information in public or open area, or with someone without the need-to-know basis is a violation of the patient’ right to privacy. Also leaving patient’s information expose in an open area is a violation of HIPAA, and liable to penalty.

4. The penalty for the violation in Case B;

 The penalties for noncompliance of HIPAA regulation care based on the level of negligence and can range from one hundred dollar to fifty thousand dollars per violation with a substantial maximum amount of one million five hundred thousand dollars per violation over a year for similar provision (CDC, 2015). Penalties can also include jail time for criminal offense such as obtaining PHI under false pretenses, for personal gain, or to cause harm.

3. The health care organization’s responsibility.

The HCO have legal obligation under the Privacy Rule to take reasonable steps to limit the use or disclosure of, and requests for patient PHI to the minimum necessary to accomplish the intended purpose (CDC, 2015). However, there are situation were in content/authorization is not needed from the patient to share her PHI. For instance, reporting possible abuse to law enforcement, proceedings and for public health and safety. HIPAA allows reporting of communicable diseases, child abuse, violent injuries, and other mandatory public health reports, as well as to prevent crimes by the patient. The HIPAA Privacy Rule permits covered entities to use and disclose health information without individual authorization. Other instances include, purposes such as quality assurance, utilization review, credentialing, and other activities that are part of ensuring appropriate treatment and payment (CDC, 2015).

Centers for Disease Control and Prevention. (2015, January 27). Hipaa Privacy Rule. Centers for Disease Control and Prevention.  https://www.cdc.gov/nhsn/hipaa/index.html .

Emergency medical Treatment & Labor act (emtala). CMS. (n.d.).  https://www.cms.gov/Regulations-and-Guidance/Legislation/EMTALA .

Zibulewsky, J. (2001, October). The emergency medical treatment and Active Labor Act (EMTALA): What it is and what it means for physicians. Proceedings (Baylor University. Medical Center). https://www.ncbi.nlm.nih.gov/pmc/articles/PMC1305897/.