Addressing ED call in your bylaws

Q: Should we specify in our bylaws that only active staff members will take call?

Michael R. Callahan, JD, senior partner in the Health Care Practice Group Katten Muchin Rosenman LLP, Chicago, Illinois: EMTALA requires that hospitals provide ED services in all areas and services for which they provide patient services. If you provide neurosurgery, you have to have neurosurgeons on call. You have to match up your call schedule with the services that you provide.

How you do that, and whether you have the right numbers to provide call so it is not so burdensome on any individual, will depend on how many physicians you have.

If you can meet the coverage requirement with just your active staff and people are not going to complain they are taking call too often because you have enough physicians at the active staff level to make it fair and equitable and not burdensome, that is great. But if you can’t and since most hospitals want to provide 24/7 ED coverage, you either pay for ED call or dip down into associate staff and maybe courtesy staff.

You have to have adequate numbers—what it takes to get there is going to vary from hospital to hospital. Where you have coverage gaps, if payment is not an option, you then have to make other arrangements. You can’t say, “Sorry, we only provide psych services on Mondays, Wednesdays, and Fridays. If you show up on Tuesday, you are out of luck.” Even though the ambulance companies should know that you don’t have coverage on Tuesday, if they show up, then you have to have an advance arrangement with Academic Center X that if someone shows up on a Tuesday, you are going to screen, stabilize, and transfer if stabilized to Academic Center X. Setting up a shared schedule with other hospitals in the community is another option.

Source: News & Analysis