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Emergency Medical Treatment and Active Labor Act (EMTALA)

The Emergency Medical Treatment and Active Labor Act (EMTALA), is legislation enacted by Congress that ensures patients have the right to receive emergency services despite their ability to pay. Code 1395dd, is the U.S. code for EMTALA. The code protects the examination and treatment of women in labor and experiencing an emergency medical condition. EMTALA is a federal law. The law prohibits the financial discrimination of patients who are unable to pay for emergency health services including the obstetrics population. Women’s rights particularly those affecting pregnant women needing emergency services fall under the protection of EMTALA.

Following the recent overturning of Roe v Wade led to the U.S. Department of Health and Human Services (HHS) bringing forth new guidance that will guarantee pregnant women or those who have lost a pregnancy recently, have full legal rights as well as safeguards for emergency medical services (hhs, 2022). President Biden soon after signed an executive order protecting access to reproductive health care services. One place to find changes in laws and regulations is the electronic code of federal regulations e-CFR website.

Despite regulations, hospitals continue to be cited for EMTALA violations particularly related to labor and obstetrical care. Violators of EMTALA can face civil monetary penalties up to $103,139, a sufficient increase from the previous $50,000 penalty (Terp, et al., 2020). Hospitals with fewer than 100 beds would expect to pay no more than $25,000 per violation. Paying penalties and fines not only affects the financial stability of the organization but also can play a negative effect on the reputation of the healthcare system as well. Hospitals rely on funding from government programs and insurance reimbursements to provide the necessary services to patients. Having these funds decreased or even eliminated can prove detrimental to the safety net of hospitals and other healthcare systems (Lagasse, 2020). Being educated on the importance and ramifications of EMTALA is important. Ensuring each patient is properly evaluated, stabilized, and if necessary, the appropriate arrangements for transferring have occurred.

The role of the healthcare administrator is important in preventing litigation because healthcare organizations stand to lose more than just money when filed cases led to paying out losses. These judgments also affect the reputation of the organization and provider practices. Administrators work to prevent misunderstanding, improve and track communications, and recognize and correct errors if they are to remain aligned with legal compliance.  There are several managerial compliance tools that can assist administrators as they navigate the legal aspect of healthcare. From various checklists, templates, and forms for corporate management, guidelines and protocols, training materials, policies, and procedures, as well as risk management and assessment tools, this is a great place to browse for guidance on an array of issues.

The EMTALA compliance checklist falls under the compliance and risk management tools. If followed correctly the checklist will eliminate the possible violation of EMTALA by ensuring the patient has been properly evaluated and treated regardless of the inability to pay. It will also ensure that if the patient requires transferring to another facility that the patient is stabilized, and it is medically necessary and not due to the chance of financial discrimination.

Part 2

When an organization is issued a letter of litigation hold it becomes important that documents are preserved. Documents may contain information that is relevant to a dispute. The primary purpose of a litigation hold is to preserve evidence that can be used in helping to make a fully informed and just decision (litigation holds-the, 2018). Three important steps to take in ensuring the preservation of documents is to first create a document retention policy. This policy will outline what documents need to be kept and for how long. Generally, federal and state laws require certain records are kept, including financial and employee records. Secondly, develop a policy for how documents are stored versus destroyed. Finally, develop a plan for implementation of the policy and assigning role responsibility to ensure these policies are being followed.

In this pending case involving potential negligence, certain documents will be of the utmost importance to review and preserve. Nursing documentation, surgery and procedure notes, and time-out records detailing who was present during the case and what instruments were counted in and out. The time-out documentation will list everyone who was present at the beginning time of the procedure. It will not speak to who was left at the end so this is where the surgeon’s note and procedure note will become important. The surgeon will be required to document the case and it should detail if he was there at the end of the case. Nursing documentation will capture the instrument count at both the beginning and end of the case which is performed by a circulating nurse and scrub nurse, however, it is everyone’s responsibility in the surgical room to ensure the count is accurate (Perry, 2018). Medical records and documentation contain important information pertaining to a patient’s medical history and hospital stay.

As nurses, we are taught to document events by being subjective and non-bias. Documentation should state true and accurate accounts of an event. Documentation is a vital tool that can increase liability, such as in a situation where the documentation substantiates the negligence. Recently I encountered a situation where a nurse had two patients with the same first name and she subsequently mixed the patients up leading to inaccurate lab results and causing one to receive the medication they did not need and causing a delay to the one that needed the medication. In this case, documentation will show that the nurse caused potential harm.

Time-outs have been proved to increase patient safety when it comes to performing surgical procedures. Therefore, I would initiate a policy mandate of instrument counting where the responsibility is not just on the two designated nurses but everyone in the room. The time out will require everyone to pause, eliminate distractions, and perform the count. I would also implement a mandatory visual wound sweep performed by the surgeon and the assisting surgeon in the room that will require them to sign off on stating that no visual foreign objects are left in the patient prior to the closing of the surgical site. Lastly, a required count of every instrument/sponge handed off, how many, and to who. During a cardiac arrest, there is so much recall of actions that are documented and the same should go for surgeries.

References

HHS (2022, July 11). Following President Biden’s Executive Order to Protect Access to Reproductive Health Care, HHS Announces Guidance to Clarify that Emergency Medical Care Includes Abortion Services, https://www.hhs.gov/about/news/2022/07/11/followin…

Lagasse, J. (2020, July 10). Value-Based Payment Penalties Disproportionately Impact Safety Net Hospitals. Healthcare Finance, https://healthcarefinancenews.com/news/value-based…

Litigation Holds- The Triggers and Consequences for Failing to Preserve Evidence (2018, July 11). https://www.tandllaw.com/blog/litigation-holds-the…

Perry, M. (2018, May 4). Surgical Counts – Accuracy Keeps Everyone Safe. The Circulating Life: OR Nursing with a Dose of Reality, https://thecirculatinglife.com/2018/05/04/surgical…

Terp, S., Wang, B., Burner, E., Arora, S., and Mecnhine, M. (2020). Penalties for Emergency Medical Treatment and Labor Act Violations Involving Obstetrical Emergencies. The Western Journal of Emergency Medicine, 21(2), 235-243. https://doi.org/10.5811/westjem.2019.10.40892

 

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