EMTALA Cause for Concern with Psychiatric Patient Care

In a room in the Washington Convention Center Sunday, I spent almost two hours watching a blistering Q&A session between two government officials and group of emergency physicians.

At the end of the session, the doctors were deeply concerned.

“What are we going to do about this?” I overheard one of the audience members ask Robert A. Bitterman, an emergency physician and health lawyer from Sarasota, Fla., who had moderated the panel discussion about emergency psychiatric care at the American College of Emergency Physicians’ 2017 annual meeting.

Their concerns stemmed largely from panelist Mary Ellen Palowitch’s assertion earlier in the discussion that a suicidal patient who presented for treatment at a hospital’s emergency department wasn’t considered stabilized for under the Emergency Medical Treatment and Labor Act (EMTALA) unless he was treated for the underlying suicidal ideation.

The question of how far emergency doctors are required to go in treating psychiatric patients who present themselves for emergency care could have expensive repercussions for the doctors and their hospitals. Under new civil monetary penalty guidelines, the HHS could fine a hospital just over $100,000 per violation.

AnMed, a South Carolina hospital, agreed this year to a $1.3 million settlement with the HHS for allegedly refusing to admit involuntarily committed psychiatric patients to its inpatient psychiatric care ward.

More recently, a man in Fort Worth, Ind., successfully argued that a psychiatric hospital may have had a responsibility to stabilize his suicidal condition before sending him out to find an actual acute care hospital with an emergency department.

He didn’t go to the other hospital. Instead, he crashed his car into an apartment building in an effort to kill himself. I wrote about the Fort Wayne case here.

Palowitch and Sandra J. Sands, from the HHS Office of Inspector General, told the assembled doctors and hospital representatives in Washington D.C. on Sunday that the key to compliance with EMTALA was using all of the psychiatric resources available at the hospital to treat suicidal patients.

However, Bitterman told me later, the CMS and OIG officials seemed to be ignoring the statutory and regulatory requirements of EMTALA that allows a hospital to transfer a patient who is no longer a danger to himself or others and only requires the hospital to use all of the resources of the emergency department, not the entire hospital to care for patients.

For more on that discussion, read my story here.

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