Legalities of practice- Urgent Care

[Annika]

A patient comes into your UC center with a head wound that seems to your front desk staff to be disoriented.  You are in with patients, and have 5+ waiting. Your front office staff says that they think they might be better served by going to the ED which is less than a mile away.  

 

This is a new patient, and clearly has a bleeding head wound and cannot answer if they had any LOC or not.  Your office staff is NOT medical.  You have not seen the patient.

 

Pt calls a week later and is angry because "you should have seen me. They did a terrible job sewing my head up at the hospital"

 

There was some talk in our office about having a legal obligation to see the patient as they "walked thru our door" but my thought is that as an UC, with NO CT here, and no actual physician here ( they are available by phone, but not usually in house), it was totally appropriate that the patient was advised to move on to the ED.

 

Thoughts??

[EMEDPA]

just as a cya you should do a medical screening exam first before sending someone elsewhere.

[cupojava]

Agree with above. My clinic does both walk-inand appt and as the sole provider majority of the time, I still have to at least do an assessment on the patient before telling him to the ER ad make sure someone else is driving. We have a triage form where we still have to document that pt was triaged and report given to ER. Your triage form should have basic info- patient demographics, vital signs, condition at discharge, accompanied by whom and relationship and their phone number, how pt left- POV or ambulance and your physical exam. This is most important if you are the only licensed personnel. You can't rely on unlicensed folks to do your triaging, IMHO.

[LKPAC]

I agree with previous responses.  And by the way, your remark about "no actual physician here" is completely off base.  When PAs provide medical services we are expected and capable of providing those services at the same level of quality and competence as a physician (within our scope.)

[True Anomaly]

From a completely legal liability standpoint...since I'm assuming you don't accept Medicare at your urgent care and aren't classified as an "emergency room", then you don't fall under EMTALA and all it entails from a medical stabilization standpoint.  So there's no actual "legal obligation"- ie, you'll get in trouble with some government entity if you don't provide a medical screening exam.  

 

There is, however, as others have pointed out, an ETHICAL responsibility to make sure the patient safely gets to a place that can actually stabilize them- if this means dropping what you're doing, making a very quick assessment and calling 911 and observing him until they get there, you do it.  

 

He can always enter into a civil suit against you/your urgent care facility, but that's another matter entirely.  

[ToppDog]

Agree with the above, but would take it a step further to call 911 & have them taken to the ER by ambulance instead of by POV, even if someone else is driving.  The problem is, once they show up at your door (even if they shouldn't have), you are going to be held responsible for anything that happens to them until their care is transfered to another provider.  Too many things can go wrong if the pt. drives themselves or has a friend or family member take them to the ER, or they may blow it off entirely.

 

I've even worked with providers who made it policy that even if a patient "called" asking for advice regarding a condition or injury that required an ER visit, & it seemed like the patient was being hesitant, we would call 911 & have an ambulance dispached to their location, with or without their permission.

 

In either scenario (in clinic/over phone), the patient will be evaluated by first responders, & if the patient refuses to go, then you have covered yourself by transferring their care to EMS.

[True Anomaly]

I've even worked with providers who made it policy that even if a patient "called" asking for advice regarding a condition or injury that required an ER visit, & it seemed like the patient was being hesitant, we would call 911 & have an ambulance dispached to their location, with or without their permission.

So just out of curiosity....was there something bad that happened to lead to a policy like that?

[ToppDog]

So just out of curiosity....was there something bad that happened to lead to a policy like that?

 

Not that I am aware of.  I think part of it was what you referred to earlier, where even though they may not be legally liable, they were trying to avoid any ethical issues.  I think the other part was that a lot of the providers that made this their policy also worked as ER docs & also had EMT's as well as MA's on staff, so I think it was more bleedover from their other working environments, as I never saw the same extremes to cya coming from the moonlighting internists, etc.

[True Anomaly]

Not that I am aware of.  I think part of it was what you referred to earlier, where even though they may not be legally liable, they were trying to avoid any ethical issues.  I think the other part was that a lot of the providers that made this their policy also worked as ER docs & also had EMT's as well as MA's on staff, so I think it was more bleedover from their other working environments, as I never saw the same extremes to cya coming from the moonlighting internists, etc.

 

I guess I was reading it as "there was a blanket policy that required people to call 911 for those who even called for advice" as opposed to each provider taking what may have sounded like a scary case (80-year-old called about her having some chest pain and she was alone). The former would be a very dangerous policy to EMS workers....the latter would at least allow providers to use their own judgement.