WASHINGTON — A receiving hospital with specialized capabilities, like a stroke center, has the responsibility to accept an unstable inpatient from a transferring hospital, but only if the patient had not been stabilized for the original condition requiring admittance, according to a recommendation by the Emergency Medical Treatment and Labor Act Technical Advisory Group.
The EMTALA Technical Advisory Group has met regularly over the last 30 months to advise the Secretary of the Department of Health and Human Services on improving the statute.
Dr. Ralph Sacco, professor and chairman of the department of neurology at the University of Miami, commented on the recommendations. “It does make sense that acute neurological issues are treated in hospitals that are prepared to deal with acute neurological issues.” However, he added “one way we try to avert [a transfer] from ever happening is by designating stroke centers in advance and by designating [emergency medical service workers] to only take stroke patients there in the first place.”
Dr. Sacco was not a member of the advisory group.
If the Centers for Medicare and Medicaid Services—which is charged with writing the rules for and enforcing EMTALA—follows the recommendation, it's likely the EMTALA interpretive guidelines would be altered, or a new regulation would be issued, said panel chairman Dr. David Siegel, an emergency physician and senior vice president at Meridian Health, in Neptune, N.J.
The recommended change came after heated debate over whether EMTALA should apply to any inpatient transfers to hospitals with specialized services, such as a stroke center or a catheterization lab. The four CMS officials on the panel all voted for the recommendation.
But other panelists had reservations. The change would “open up a whole new universe of potential issues,” said advisory group member Dr. John A. Kusske, chairman of the department of neurologic surgeons at University of California, Irvine, Medical Center. Dr. Kusske was concerned that if EMTALA was applied to these transfers, it might make it harder to find specialists to take on-call duty.
Dr. Sacco added, “We hope people don't abuse the system, by saying, 'this patient is unstable, let's invoke this urgent rule and move them somewhere else.'” Dr. Sacco previoulsy served as director of the Stroke and Critical Care Division at Columbia University, New York.
“The other thing that's happening that could improve the ability to stabilize cases elsewhere is telemedicine,” he added.
Dr. Charlotte S. Yeh, a panelist from the CMS, said the agency has lacked clarity on whether EMTALA applies to these circumstances, and thus has not actively enforced any complaints.
The clarification will help CMS shape its enforcement policy, said Dr. Yeh, who also is an emergency physician.
The advisory group also made a number of recommendations aimed at strengthening hospitals' ability to find and retain on-call physicians.
And it unanimously supported the recommendation that liability protection be provided to hospitals and physicians who provide EMTALA care.
The full accounting of the technical advisory group's final recommendations will be included in its final report to the HHS secretary, which should be published in the fall, Dr. Siegel said.
“Unfortunately, there are issues beyond the statute, such as reimbursement and liability, that must be addressed to ultimately solve the problem.”