EMTALA Violation

[BirdDogPA]

Would like you guys option on a situation I recently encountered. 
 

Doing solo coverage at a small ED and get a call from the floor to see a patient that has a new onset GI bleed ( was admitted for respiratory complaint). I refused to go to the floor because my protocol does not cover hospitalist work and it’s questionable if my malpractice insurance would cover it. The attending physician for the patient refused to come in “because it’s the ER responsibility for emergencies”. The hospital DON gets involved and her solution is to discharge the patient from the floor and have them brought to the ER for the new GO bleed complaint. 
 

messed up in my mind on many levels. 

[DiggySRNA]

Yikes.

Whose responsibility is it when a rapid response is called?

They could've just RRT that patient and get them off the floor to the ER for workup. You did the right thing by not going to the floor to evaluate a patient that is under the care of a Hospitalist. 

Malpractice would definitely not cover you because that is NOT YOUR PATIENT to treat. Sounds like patient abandonment on the Attending Physician's part. 

Edited September 27, 2020 by Diggy

[ohiovolffemtp]

 I would check with your employer.  For example, I do solo overnight coverage at a CAH. Our contract specifically covers responding to the floor and we bill for it.  It's also covered by our med mal.  On a practical basis, there is overlap between our responsibilities and the admitting physicians.   For the most part, after 22:00, they don't want to be called, so it's us.  Fortunately, the focus is to make sure that the patients' needs are met.

Do you work for the hospital or a staffing co?  If the latter, I'd have your boss (e.g. ED medical director) meet with the hospital admin to determine how these situations should be handled.  If you work for the hospital, have them make a determination and then make sure your protocols and med mal coverage reflects that.

Especially in a small facility, making things difficult is not a good plan.

[LT_Oneal_PAC]

What the hell? I’m confused. Does your contract or job description state you will cover the floor at night? This is just blowing my mind.

I work both as a solo ED/Hospitalist where I cover the floor. During the week we just cover the ED, but respond to pretty much everything over night. I also work as PRN solo Hospitalist and the ED doesn’t cover me at all. I cannot imagine the the storm that would come down if I sent a patient to the ED for GI bleed as the Hospitalist.

Now you’re taking call from home and patient is having emergent respiratory failure needing tube or is coding, cool, I got your back until you get here. Anything else, I’ll discuss the case and see if it’s truly emergent, as in this guy is exsanguinating, and I’ll still help out if it is an emergency because I know I’ll do a better job. But a GI bleed often is not an emergency.
 

I would not work there again if they were dumping non-emergent problems in my lap. No way. 

[MediMike]

7 hours ago, BirdDogPA said:

Would like you guys option on a situation I recently encountered. 
 

Doing solo coverage at a small ED and get a call from the floor to see a patient that has a new onset GI bleed ( was admitted for respiratory complaint). I refused to go to the floor because my protocol does not cover hospitalist work and it’s questionable if my malpractice insurance would cover it. The attending physician for the patient refused to come in “because it’s the ER responsibility for emergencies”. The hospital DON gets involved and her solution is to discharge the patient from the floor and have them brought to the ER for the new GO bleed complaint. 
 

messed up in my mind on many levels. 

Yeah this all comes down to what your contract says.  I cover 4 hospital ICUs overnight, if someone crashes and burns before I get to come see them the ED will pop up and throw a line or tube in, start the code etc. then I tag them out. 

The last bit about discharging the patient and having them come to the ED is a mind%$@ on a couple different levels.  Pretty sure it's not legal. Unless the patient went AMA and then represented? I can't believe (ok I can) that the attending wouldn't come in to manage the patient, on the same hand it would also be strange (from my experience) for the ED not to have some kind of ability to do a RR or something.

As Lt. said above, a lot also depends on how critical the patient was, we talking a ruptured can of Hawaiian Punch or a leaky cranberry mold?

[dphy83]

I don't see how the DON and hospitalist keep their jobs in this situation if you are not required to see floor patients. Did they even consult GI? If GIB are out of the scope of your hospital they should have just been transferred from the floor to another facility. This blows my mind.

[Mayamom]

All I can say is wow.  Lots of blurred lines that needs to be clarified.  The patient is the one who suffers in all of this.  And makes your shift hell.  

[EMEDPA]

Like others above, I cover a critical access hospital and am responsible for floor emergencies at night. The hospitalist is 30+ min away, so the afterhours chf that needs bipap, etc is mine.