OIG Clarifies Hospitals’ Obligations to Patients with Psychiatric Emergencies

August 9, 2017 | Benjamin P. Malerba | Ada Kozicz | Health Services

The U.S. Department of Health and Human Services, Office of Inspector General (“OIG”) recently entered into a settlement with AnMed Health (“AnMed”), a South Carolina hospital, for over $1.2 million for a violation of the Emergency Medical Treatment and Labor Act (“EMTALA”). The settlement serves as an important reminder and clarification on the obligations imposed on hospitals with emergency departments under EMTALA.

EMTALA was enacted in 1986 to prevent hospitals for “dumping” emergency room patients because of their insurance status or inability to pay. See 42 U.S.C. § 1395dd. The law requires hospitals to screen all patients who walk into their emergency departments to determine whether the patient has an emergency medical condition. The screening must be conducted by an appropriate medical professional, within the capabilities of the emergency department. If it is concluded that an emergency condition exists, the hospital must stabilize the condition before sending the patient home or transferring the patient to another facility. In certain circumstances, a patient may be transferred before his or her condition is stabilized if a physician determines that the benefits of treatment at another facility (for example, because the facility receiving the transfer has better-suited staff and equipment to treat the condition) outweigh the risks associated with the transfer.

OIG concluded that AnMed failed to satisfy its obligations under EMTALA with respect to patients that presented psychiatric emergency conditions. AnMed was required to screen and stabilize the patients, regardless of their ability to pay, in accordance with AnMed’s capability to conduct such screening and stabilization based on its available staff and facilities. OIG concluded that at the time the patients were in the emergency room, AnMed had psychiatrists on-call and open beds available in its psychiatric department. However, instead of ordering the patients to be screened by a psychiatrist and sent to the psychiatric department for treatment as necessary, AnMed had the patients involuntarily committed in the emergency room. The patients spent days and sometimes weeks in the emergency room and were treated by emergency room staff before being transferred to a mental health facility. AnMed had a policy that ordered physicians to transfer such patients under involuntary confinement and without the financial resources to pay for treatment to a local mental health facility. Because AnMed had the capability to treat the patients in its psychiatric department, such policy violated EMTALA.

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