"Parking" Of EMS Patients In Hospitals

[Guest]

Department of Health & Human Services

Centers for Medicare & Medicaid Services

7500 Security Boulevard, Mail Stop S2-12-25

Baltimore, Maryland 21244-1850

Center for Medicaid and State Operations/Survey and Certification Group

Ref: S&C-06-21

DATE: July 13, 2006

TO: State Survey Agency Directors

FROM: Director

Survey and Certification Group

SUBJECT: EMTALA - "Parking" of Emergency Medical Service Patients in

Hospitals

The Centers for Medicare & Medicaid Services (CMS) has learned that

several hospitals routinely prevent Emergency Medical Service (EMS)

staff from transferring patients from their ambulance stretchers to a

hospital bed or gurney. Reports include patients being left on an EMS

stretcher (with EMS staff in attendance) for extended periods of time.

Many of the hospital staff engaged in such practice believe that unless

the hospital “takes responsibility†for the patient, the hospital is

not

obligated to provide care or accommodate the patient. Therefore, they

will refuse EMS requests to transfer the patient to hospital units.

This practice may result in a violation of the Emergency Medical

Treatment and Labor Act (EMTALA) and raises serious concerns for

patient

care and the provision of emergency services in a community.

Additionally, this practice may also result in a violation of 42 CFR

482.55, the Conditions of Participation for Hospitals for Emergency

Services, which requires that a hospital meet the emergency needs of

patients in accordance with acceptable standards of practice.

Page 2 – State Survey Agency Directors

A hospital has an EMTALA obligation as soon as a patient "presents" at

a

hospital's dedicated emergency department, or on hospital property (as

defined at 42 CFR 489.24() other than the dedicated emergency

department, and a request is made on the individual’s behalf for

examination or treatment of an emergency medical condition. A patient

who arrives via EMS

meets this requirement when EMS personnel request treatment from

hospital staff. Therefore, the hospital must provide a screening

examination to determine if an emergency medical condition exists and,

if so, provide stabilizing treatment to resolve the patient’s emergency

medical condition. Once a patient presents to the dedicated emergency

department of the hospital, whether by EMS or otherwise, the hospital

has an obligation to see the patient, as determined by the hospital

under the circumstances and in accordance with acceptable standards of

care.

EMTALA obligations would also apply to a hospital that has accepted

transfer of a patient from another facility, as long as it is an

"appropriate transfer" under EMTALA. An appropriate transfer is one in

which the transferring hospital provides medical treatment that

minimizes risks to an individual's health and the receiving hospital

has

the capability and capacity to provide appropriate medical treatment

and

has agreed to accept transfer (42 CFR 489.24(e)(2)). Therefore, the

expectation is that the receiving facility has the capacity to accept

the patient at the time the transfer is effectuated. A hospital that

delays the medical screening examination or stabilizing treatment of a

patient who arrives via transfer from another facility, by not allowing

EMS to leave the patient, could also be in violation of EMTALA.

CMS recognizes the enormous strain and crowding many hospital emergency

departments face every day. However, this practice is not a solution.

“Parking†patients in hospitals and refusing to release EMS equipment

or

personnel jeopardizes patient health and impacts the ability of the EMS

personnel to provide emergency services to the rest of the community.

For questions on this memo, please contact Donna Smith at (410)

786-3255

or by email at Donna.Smith@cms.hhs.gov.

Effective Date: Immediately. The State agencies should disseminate this

information within 30 days of the date of this memorandum.

Training: The information contained in this announcement should be

shared with all survey and certification staff, surveyors, their

managers, and with managers who have responsibility for processing

EMTALA complaints.

/s/

Thomas E. Hamilton

cc: Survey and Certification Regional Office Management (G-5)

[Jybehofd 85]

Thank the Lord

Now I can report some facilities when doing interfaciltity tranport. Watch out New York Presby Phyic in White Plains I am not waiting for 4 hours anymore!!!

DAM I just saw the top of the email its for Delaware...... When is New York going to do something like this does anyone know?

Edited July 17, 2006 by Jybehofd

[ny10570 745]

Thank the Lord

Now I can report some facilities when doing interfaciltity tranport.  Watch out New York Presby Phyic in White Plains I am not waiting for 4 hours anymore!!!

←

Quick solution for Presby...just let 'em off the stretcher. If the pt is calm and reasonable, let 'em off and sit em down on the chairs.

[Jybehofd 85]

Quick solution for Presby...just let 'em off the stretcher.  If the pt is calm and reasonable, let 'em off and sit em down on the chairs.

←

Its kinda hard sometimes but i found once that if the pt is in full restrants and needs to pee. (pt also knows ems is not bad guys) and Preby refused to let him off to use the head.... Well lets say he didn't get anything on the strecher but the wall was going to look intresting.... lets just say they let him off REALLY fast that time.

[Guest]

DAM I just saw the top of the email its for Delaware...... When is New York going to do something like this  does anyone know?

←

This notice is from the federal government, the dept of health and human services centers for medicare and medicaid, they just happen to be located in Delaware.

http://www.cms.hhs.gov/SurveyCertification...Letter06-21.pdf

[Guest paramedico987]

Keep in mind folks that this law takes effect when we "request treatment for the pt."

Now, upon walking into 814 & 815 (the 2 biggest offenders I encounter with any regularity) I immidiately walk to the nurses station and announce "I am requesting evaluation and treatment in accordance with EMTALA for my patient, [pt's name here]"

I've been getting a pretty good response from the staff after being able to identify the law that makes them responsible to handle the patient's care.

[Guest paramedico987]

Edited August 10, 2006 by paramedico987