EMTALA and patients in labor

Pro Publica reported at least 20 rural hospitals in the United States have been found in violation of EMTALA in the past five years based upon federal investigation data. In several instances, women in labor faced serious complications after being denied care or were misdiagnosed at facilities that lacked obstetrics specialists (The Advisory Board Co., 2017).

In 2011, Harlan County Health in Alma, Nebraska faced an EMTALA citation after an ED staff member told the boyfriend of a woman in labor that the hospital did not perform deliveries, which prompted the couple to leave. The good news is the hospital reported the problem and hired a consultant to update its policies (Lasson, 2017).

In 2012, federal investigators found a Texas-based hospital turned away emergency deliveries more than once, even though staff members were aware of EMTALA requirements (Lasson, 2017).

The gravity of the regulatory compliance issues related to EMTALA are magnified when patients suffer poor outcomes. In 2013, a hospital in Willows, California was cited and fined for not recognizing that 29-year-old Martha Guzman had preeclampsia, a dangerous pregnancy complication. Guzman suffered seizures later that night and was rushed to a different hospital, where she delivered a stillborn boy. She died the next day (Lasson, 2017).

In 2014, a woman in labor was rushed to the ED at Jewish Hospital Shelbyville by her mother. Upon arriving at the ED, the patient signed a slip at the front desk, listing her chief complaint as “labor.” Although the hospital had closed its obstetrics department eight years earlier, they were still required under EMTALA to treat a patient in labor. The patient was told over the phone, “We don’t deliver babies here,” by a nurse who did not realize that she was calling from inside the ED, a government inspection found. With no help offered, the woman and her mother went to a nearby gas station and called 911. An ambulance took her to a hospital 24 miles away, where she delivered a baby girl via C-section (Lasson, 2017).

Under EMTALA, every U.S. hospital with an ED has a duty to treat patients who arrive in labor, caring for them at least until the delivery of the placenta after a baby is born (Lasson, 2017).

An appropriate transfer, under EMTALA, 42 U.S.C. § 1395dd(c)(2), has five elements that must be accomplished and documented:

1. Pending a transfer, the hospital must provide medical treatment within its capability (including on-call specialists) to minimize the health risks to the patient. For a woman in active labor, the treatment must address both the health of the woman and her unborn child.
2. The hospital receiving the transfer must have available space and qualified personnel to accept the transfer.
3. The hospital receiving the transfer must have agreed to accept the transfer and to provide appropriate medical treatment.
4. The transfer is accomplished with qualified personnel and transportation equipment, including appropriate life support measures during the transfer.
5. The transferring hospital must send to the receiving hospital all relevant medical records, radiographs, etc. (ACEP, 2011).

A hospital that has the capability and capacity to accept the transfer of an unstable patient must do so. Violations will be cited for the refusal of an on-call specialist to be available to treat a transfer patient, and for the hospital’s failure to accept for unacceptable reasons. This practice is commonly referred to as “reverse dumping” and occurs most frequently in connection with the attempted transfers of behavioral health patients.

Source: CRC News & Analysis