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THE
"20 Commandments" OF COBRA/EMTALA
1.
THOU SHALL: Log in every patient who presents, together with
complaint/diagnosis and disposition. A patient has
"presented" when they enter onto the premises, campus
(and 250 yard zone around the hospital), "provider
based" remote sites and ambulances owned by the hospital
without regard to means or ability to pay.
2. THOU SHALL: Provide a medical screening examination
[by physician, preferably], beyond triage, to all patients
regardless of acuity who present in the hospital and/or
"provider-based" locations (including movement to the
main hospital ED as necessary to complete the MSE);
3. THOU SHALT NOT: delay the Medical Screening
Examination or attempt to secure verification or authorization
from third party payor, nor attempt to influence the patient by
drawing payor status issues to the patient's attention prior to
completion of Medical Screening Exam and initiation of
stabilizing care;
4. THOU SHALL: Provide necessary testing, including
on-call services, as needed to exclude the presence of an
legally defined emergency medical condition (does NOT equate to
emergent patient);
5. THOU SHALL: To the extent of the capabilities of the
hospital and/or "provider-based" location, provide
stabilization, such that the patient is not likely to
deteriorate from or during transport or discharge -- in the case
of OB patients with contractions present, until stabilized by
delivery of baby and placenta -- and make a medically
appropriate transfer if the patient exceeds hospital or
"provider-based" location capabilities. ;
6. THOU SHALL: Provide on-call coverage schedule listing
on-call physicians by individual name for all medical
specialties represented on the medical staff, provider policies
and procedures for occasions where the on-physician is not
available, and maintain the list of the individuals on-call for
five years. On-call physicians are not at liberty to decline
patients;
7. THOU SHALL: Require on-call specialists respond to the
hospital to attend the patient (including transfer patients and
in-house emergencies), in timely manner and provide legally
defined stabilizing care and/or definitive treatment in the
hospital without regard to means or ability to pay;
8. THOU SHALL: Transfer COBRA/EMTALA patients for only
for services or care not available at your facility or upon
patient request documented to EMTALA requirements and accept
transfers for all those patients where the intended receiving
hospital is better able to care for the patient than the
hospital requesting transfer;
9. THOU SHALL: Provider MSE to OB patients and treat
patients with contractions as unstable emergency patients per
the law;
10. THOU SHALL: Obtain and document advance acceptance
from the receiving hospital;
11. THOU SHALL: Provide medically appropriate vehicles,
personnel, and life support equipment for all COBRA/EMTALA
transfers. Private vehicles are not appropriate transfer
vehicles and may not be used without written refusal of
ambulance;
12. THOU SHALL: Provide a physician certification with
clearly stated risks and benefits of transfer for all COBRA/EMTALA
transfers;
13. THOU SHALL: Provide medical records, labs, reports
and consultation records to accompany the patient on all COBRA/EMTALA
transfers;
14. THOU SHALL: Include the name of any on-call physician
who refused to respond or failed to make a timely response in
the transfer records of any COBRA/EMTALA patient transferred as
a result of that refusal or lack of timely response;
15. THOU SHALL: Obtain written refusal of services by a
patient or responsible party that refuses exam, treatment, or
transfer that documents the specific risks of refusal associated
with the individual case, or document the reasonable efforts by
the hospital to obtain written refusal;
16. THOU SHALL: Obtain written consent to transfer from
the patient or responsible party, or document the reasonable
justification for not obtaining the written consent;
17. THOU SHALL: Document in the medical record sufficient
specific data and information to substantiate the appropriate
nature of the actions taken in the individual case. Failure to
document is a potential violation, even without adverse outcome;
18. THOU SHALL: Obtain full vitals on all presenting
patients and maintain documented vitals at appropriate frequency
during the stay, and in ALL CASES obtain discharge vitals or
vitals at the time of discharge or transfer, and document such
in the record.
19. THOU SHALL: Post COBRA/EMTALA signs in all public
entrances, waiting areas, registration and care areas. Signs
that conflict with the intent and purpose of COBRA/EMTALA shall
not be posted. Signs must be easily visible and readable from a
distance of 20 feet or the position of the patient and must
appear in non-english languages common to the patient
population.
20. THOU SHALL: Report any possible violations of COBRA/EMTALA
by another facility within 72 hours of receipt of the patient.
For informational and educational purposes only. Be certain to
consult your hospital counsel for legal advice regarding
policies, procedures, and legal obligations under this and other
laws. Copyright 1996-2002--Frew Consulting Group, Ltd. Loves
Park, IL. Reprinted with permission of the author, Stephen A.
Frew, J.D., Frew Consulting Group. For more valuable articles
and information about COBRA or other issues please visit Frew
Consulting.
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NURSING LEGAL ISSUES
