"Emergency rooms refused to treat pregnant women, leaving one to miscarry in a lobby restroom"

[wamcp]

Are these all EMTALA violations? Or more to the story here to make these scenarios 'defensible'?

Emergency rooms refused to treat pregnant women, leaving one to miscarry in a lobby restroom

Complaints about pregnant women being turned away from emergency rooms spiked in the months after states began enacting strict abortion laws following the 2022 U.S.

apnews.com

Pregnant patients have “become radioactive to emergency departments” in states with extreme abortion restrictions, said Sara Rosenbaum, a George Washington University health law and policy professor.

“They are so scared of a pregnant patient, that the emergency medicine staff won’t even look. They just want these people gone,” Rosenbaum said.

Consider what happened to a woman who was nine months pregnant and having contractions when she arrived at the Falls Community Hospital in Marlin, Texas, in July 2022, a week after the Supreme Court’s ruling on abortion. The doctor on duty refused to see her.

“The physician came to the triage desk and told the patient that we did not have obstetric services or capabilities,” hospital staff told federal investigators during interviews, according to documents. “The nursing staff informed the physician that we could test her for the presence of amniotic fluid. However, the physician adamantly recommended the patient drive to a Waco hospital.”

Investigators with the Centers for Medicare and Medicaid Services concluded Falls Community Hospital broke the law.
----
At Sacred Heart Emergency Center in Houston, front desk staff refused to check in one woman after her husband asked for help delivering her baby that September. She miscarried in a restroom toilet in the emergency room lobby while her husband called 911 for help.

“She is bleeding a lot and had a miscarriage,” the husband told first responders in his call, which was transcribed from Spanish in federal documents. “I’m here at the hospital but they told us they can’t help us because we are not their client.”

Emergency crews, who arrived 20 minutes later and transferred the woman to a hospital, appeared confused over the staff’s refusal to help the woman, according to 911 call transcripts.

One first responder told federal investigators that when a Sacred Heart Emergency Center staffer was asked about the gestational age of the fetus, the staffer replied: “No, we can’t tell you, she is not our patient. That’s why you are here.”

A manager for Sacred Heart Emergency Center declined to comment. The facility is licensed in Texas as a freestanding emergency room, which means it is not physically connected to a hospital. State law requires those facilities to treat or stabilize patients, a spokeswoman for the Texas Health and Human Services agency said in an email to AP.
----
Meanwhile, the staff at Person Memorial Hospital in Roxboro, North Carolina, told a pregnant woman, who was complaining of stomach pain, that they would not be able to provide her with an ultrasound. The staff failed to tell her how risky it could be for her to depart without being stabilized, according to federal investigators. While en route to another hospital 45 minutes away, the woman gave birth in a car to a baby who did not survive.

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[Dr Mantis Toboggan]

Are these all EMTALA violations? Or more to the story here to make these scenarios 'defensible'?

Emergency rooms refused to treat pregnant women, leaving one to miscarry in a lobby restroom

Complaints about pregnant women being turned away from emergency rooms spiked in the months after states began enacting strict abortion laws following the 2022 U.S.

apnews.com

Pregnant patients have “become radioactive to emergency departments” in states with extreme abortion restrictions, said Sara Rosenbaum, a George Washington University health law and policy professor.

“They are so scared of a pregnant patient, that the emergency medicine staff won’t even look. They just want these people gone,” Rosenbaum said.

Consider what happened to a woman who was nine months pregnant and having contractions when she arrived at the Falls Community Hospital in Marlin, Texas, in July 2022, a week after the Supreme Court’s ruling on abortion. The doctor on duty refused to see her.

“The physician came to the triage desk and told the patient that we did not have obstetric services or capabilities,” hospital staff told federal investigators during interviews, according to documents. “The nursing staff informed the physician that we could test her for the presence of amniotic fluid. However, the physician adamantly recommended the patient drive to a Waco hospital.”

Investigators with the Centers for Medicare and Medicaid Services concluded Falls Community Hospital broke the law.
----
At Sacred Heart Emergency Center in Houston, front desk staff refused to check in one woman after her husband asked for help delivering her baby that September. She miscarried in a restroom toilet in the emergency room lobby while her husband called 911 for help.

“She is bleeding a lot and had a miscarriage,” the husband told first responders in his call, which was transcribed from Spanish in federal documents. “I’m here at the hospital but they told us they can’t help us because we are not their client.”

Emergency crews, who arrived 20 minutes later and transferred the woman to a hospital, appeared confused over the staff’s refusal to help the woman, according to 911 call transcripts.

One first responder told federal investigators that when a Sacred Heart Emergency Center staffer was asked about the gestational age of the fetus, the staffer replied: “No, we can’t tell you, she is not our patient. That’s why you are here.”

A manager for Sacred Heart Emergency Center declined to comment. The facility is licensed in Texas as a freestanding emergency room, which means it is not physically connected to a hospital. State law requires those facilities to treat or stabilize patients, a spokeswoman for the Texas Health and Human Services agency said in an email to AP.
----
Meanwhile, the staff at Person Memorial Hospital in Roxboro, North Carolina, told a pregnant woman, who was complaining of stomach pain, that they would not be able to provide her with an ultrasound. The staff failed to tell her how risky it could be for her to depart without being stabilized, according to federal investigators. While en route to another hospital 45 minutes away, the woman gave birth in a car to a baby who did not survive.

I mean those seem to have nothing to do with abortion laws and more just places that have no Ob services trying to not to deal with pregnant patients.

 

[Dral]

The supreme court is hearing a case on the role of EMTALA related to abortions today (link below). I believe physicians in a state with strict laws (Idaho) were actually relying on EMTALA for pregnant patients. The ED physician sees the patient and decides based on law (state's abortion law) that they can't be seen there for treatment. So the patient is then entitled to transport to an out of state hospital for care (abortion if needed).

 

[BoardingDoc]

Are these all EMTALA violations? Or more to the story here to make these scenarios 'defensible'?

Emergency rooms refused to treat pregnant women, leaving one to miscarry in a lobby restroom

Complaints about pregnant women being turned away from emergency rooms spiked in the months after states began enacting strict abortion laws following the 2022 U.S.

apnews.com

Pregnant patients have “become radioactive to emergency departments” in states with extreme abortion restrictions, said Sara Rosenbaum, a George Washington University health law and policy professor.

“They are so scared of a pregnant patient, that the emergency medicine staff won’t even look. They just want these people gone,” Rosenbaum said.

Consider what happened to a woman who was nine months pregnant and having contractions when she arrived at the Falls Community Hospital in Marlin, Texas, in July 2022, a week after the Supreme Court’s ruling on abortion. The doctor on duty refused to see her.

“The physician came to the triage desk and told the patient that we did not have obstetric services or capabilities,” hospital staff told federal investigators during interviews, according to documents. “The nursing staff informed the physician that we could test her for the presence of amniotic fluid. However, the physician adamantly recommended the patient drive to a Waco hospital.”

Investigators with the Centers for Medicare and Medicaid Services concluded Falls Community Hospital broke the law.
----
At Sacred Heart Emergency Center in Houston, front desk staff refused to check in one woman after her husband asked for help delivering her baby that September. She miscarried in a restroom toilet in the emergency room lobby while her husband called 911 for help.

“She is bleeding a lot and had a miscarriage,” the husband told first responders in his call, which was transcribed from Spanish in federal documents. “I’m here at the hospital but they told us they can’t help us because we are not their client.”

Emergency crews, who arrived 20 minutes later and transferred the woman to a hospital, appeared confused over the staff’s refusal to help the woman, according to 911 call transcripts.

One first responder told federal investigators that when a Sacred Heart Emergency Center staffer was asked about the gestational age of the fetus, the staffer replied: “No, we can’t tell you, she is not our patient. That’s why you are here.”

A manager for Sacred Heart Emergency Center declined to comment. The facility is licensed in Texas as a freestanding emergency room, which means it is not physically connected to a hospital. State law requires those facilities to treat or stabilize patients, a spokeswoman for the Texas Health and Human Services agency said in an email to AP.
----
Meanwhile, the staff at Person Memorial Hospital in Roxboro, North Carolina, told a pregnant woman, who was complaining of stomach pain, that they would not be able to provide her with an ultrasound. The staff failed to tell her how risky it could be for her to depart without being stabilized, according to federal investigators. While en route to another hospital 45 minutes away, the woman gave birth in a car to a baby who did not survive.

As was already mentioned, I don't see how any of these are related to abortion laws except for maybe number 2.

1: Pregnant patient having contractions is refused care in the ED. Obvious EMTALA violation.

2: FSED refuses to see a patient having a miscarriage. Also obvious EMTALA violation (assuming FSEDs are beholden to EMTALA, I don't know). Unclear if she was turned away because "we don't have OB" or because "miscarriage = hot potato and I don't want to go to jail for murder for treating a miscarriage because Texas"

3: This sounds like a carefully crafted story. I can very easily see what happened as being: pregnant patient shows up at 1am with vague abd pain. Denies anything that sounds like contractions. Pelvic exam normal. US not available overnight. Labs all benign. Patient asks to be discharged. She doesn't leave AMA since everything seems fine and she isn't in labor. Patient goes into labor after leaving, has bad outcome, sues because "something bad happened to me and there was a doctor within 25 miles. I'm owed millions of dollars."

That said I don't make any claims to know what actually happened, and perhaps the docs there were in fact guilty of gross negligence.

 

[DrDrummer]

As was already mentioned, I don't see how any of these are related to abortion laws except for maybe number 2.

I read the same article and thought the same thing -- but another angle (not really taken in the article) is that many of the states that are passing these laws are having a difficult time retaining OB/GYN providers, which will lead to even more drying up of the L&D services landscape. I think that cost of keeping an L&D open (nursing, etc) is probably more of a driver than MD cost, but as someone who works at a critical access hospital that had and then closed their L&D services who now sees a lot of late-term pregnant multiparous women showing up at the ER where they delivered their other 7 kids, this is a real issue and will just get worse as a function of time especially in these states.

I feel for the people working at these places, and I imagine it's often it's a triage nurse saying "There's no OB here -- you *could* drive yourself 30 minutes down the highway, or...." and then they leave, have a bad outcome, and now it's a purported EMTALA violation, sometimes even before they register.

Scary stuff. 2/3rds of the hospitals I work in don't have L&D and that is one of my least favorite things about my work setup, even if it rarely comes up.

 

[AlvinKamara]

If things transpire a certain way, we could see an EM landscape without both noncompetes and EMTALA.

Good for the individual doc honestly. Social effects are a whole different story.

 

[Tiger26]

Depends on what the real story is but I think there's a big difference between refusing to treat and letting someone know that there's no OB at the hospital and they would just be immediately transferred.

 

[pkwraith]

Depends on what the real story is but I think there's a big difference between refusing to treat and letting someone know that there's no OB at the hospital and they would just be immediately transferred.

Yeah, too bad EMTALA as it is implemented and enforced has nothing to do with nuance, reality of clinical practice, common sense, or what is actually patient centered.

 

[Tiger26]

Yeah, too bad EMTALA as it is implemented and enforced has nothing to do with nuance, reality of clinical practice, common sense, or what is actually patient centered.

You can't tell someone we're happy (and obligated) to see them if they so desire but we don't have that specialty at our hospital?

 

[Apollyon]

You can't tell someone we're happy (and obligated) to see them if they so desire but we don't have that specialty at our hospital?

That's EXACTLY what UPMC said. "We are more than happy to see you and treat you". And we couldn't say any more (until they were actual patients), like "although we don't have psych or OB here".

 

[TrailRun]

Our triage nurses 'hint' at it all the time. Where EMTALA hurts patients is when they come to a little ER with no OB, peds, etc, and the closest big hospital is "at capacity." Then they end up transferred much further, often out of state. A theoretical example would be a 3 week old just discharged from the NICU, presenting for g-tube dislodgment. Or a complex facial lac requesting plastics. If they check in I'm glad to see them (but don't have any of the necessary equipment or specialists) and there is a good chance level 1 super hospital nearby is going to refuse transfer and then they're stuck going wherever I can find an accepting. If the big hospitals had some sort of auto accept it would be a different story.

 

[southerndoc]

2: FSED refuses to see a patient having a miscarriage. Also obvious EMTALA violation (assuming FSEDs are beholden to EMTALA, I don't know). Unclear if she was turned away because "we don't have OB" or because "miscarriage = hot potato and I don't want to go to jail for murder for treating a miscarriage because Texas"

FSEDs are bound to EMTALA if they accept Medicare or Medicaid. Urgent cares that accept Medicaid/Medicare have sometimes in the past been bound by EMTALA.

 

[pkwraith]

You can't tell someone we're happy (and obligated) to see them if they so desire but we don't have that specialty at our hospital?

You just said something that could be construed as discouraging a patient from receiving their MSE. EMTALA is bull ****. Almost every ED in the US can probably be dinged on something every day. Results in healthcare providers have to talk code/hints (that will still go over a patient's head and the wrong wording can still be dinged as EMTALA voilations) instead of providing accurate appropriate information that can actual provide guidance before they get a very expensive bill.

 

[southerndoc]

You just said something that could be construed as discouraging a patient from receiving their MSE. EMTALA is bull ****. Almost every ED in the US can probably be dinged on something every day. Results in healthcare providers have to talk code/hints (that will still go over a patient's head and the wrong wording can still be dinged as EMTALA voilations) instead of providing accurate appropriate information that can actual provide guidance before they get a very expensive bill.

You have to arrange for formal transfer.

 

[CoolDoc1729]

You just said something that could be construed as discouraging a patient from receiving their MSE. EMTALA is bull ****. Almost every ED in the US can probably be dinged on something every day. Results in healthcare providers have to talk code/hints (that will still go over a patient's head and the wrong wording can still be dinged as EMTALA voilations) instead of providing accurate appropriate information that can actual provide guidance before they get a very expensive bill.

This comes up at my hospital related to venous Doppler - not available at night. I will most nights have people sign in for unilateral leg swelling, obviously their main concern is r/o DVT, I go see them and explain Doppler left 3 hours ago and they can wait 5 more hours or come back in am -

“Then why didn’t they tell me that before i signed in?!?!?!!” They usually don’t like my layman’s crash course explanation of EMTALA but that is why no one told them.

“Will I have to pay another ER copay!?!?!?” For those coming in on the weekend where I can’t refer them to outpatient Doppler in am - I tell them if they are charged twice they should contest it… idk what actually happens though

I would definitely want to know, if I was in labor, that the hospital I was checking into did not have OB services available so I could make my informed decision where to go. Ideally people would self triage to somewhere that can adequately address their issue, but it’s not like any of this is transparent .. it has gotten difficult with nearby places being at capacity … what is the small place supposed to do? What is the big place supposed to do if they truly have every space full already, or not enough staff for everyone who is already there?

At my main ER, the main thing we can’t keep is kids (no inpatient peds at all) - maybe a year ago I signed out a very sick 2 year old asthmatic to my Director as nowhere in state was open to PICU XF’s and mother was refusing xf out of state … what do you know later that day we have an auto accept agreement to the peds hospital 2 miles down the road 🤣

 

[Tiger26]

Is there something specifically in EMTALA that forbids you from telling patients what hospital services are offered at your facility upon arrival? It's public information that easily findable online.

 

[gruemd]

Or what about legitimately telling patients "We do not have that specialty at our facility and recommend that you transfer to another facility. That hospital does not have capacity right now to accept you. We are obligated to and happy to transfer you by ambulance when they do have capacity, and that is what I would recommend. Some patients choose to leave anyway and seek treatment elsewhere or drive themselves to that facility's ED, I do not recommend that you do that as you could get worse/suffer increased morbidity or mortality."

 

[CoolDoc1729]

Is there something specifically in EMTALA that forbids you from telling patients what hospital services are offered at your facility upon arrival? It's public information that easily findable online.

The way it has been explained to me is that staff cannot do anything to discourage a patient from being seen and getting a MSE prior to the MSE. I’ve specifically asked about the Doppler thing and been told that we cannot tell people prior to MSE that we do not have Doppler at night.

The way our legal team has interpreted is that we cannot even post a sign behind the desk at our main ER noting that we have a FSED about 10 miles away - cannot post or tell anyone if we have plastic surgery, ob, peds, Doppler, US, etc until they have had vitals and been “screened.”

 

[TrailRun]

The way it has been explained to me is that staff cannot do anything to discourage a patient from being seen and getting a MSE prior to the MSE. I’ve specifically asked about the Doppler thing and been told that we cannot tell people prior to MSE that we do not have Doppler at night.

The way our legal team has interpreted is that we cannot even post a sign behind the desk at our main ER noting that we have a FSED about 10 miles away - cannot post or tell anyone if we have plastic surgery, ob, peds, Doppler, US, etc until they have had vitals and been “screened.”

I’m surprised that those ER’s that post the wait times hasn’t been interpreted as a discouragement. The DVT thing is a little tricky because I feel like half the time those are cellulitis so it is reasonable for them to be seen. Most docs where I work either just give a dose of eliquis and have them come back or wait till AM, or do a dimer then decide empiric anticoag if positive while waiting for US. For the OB or peds (stable) it’s in their best interest to avoid two ER bills (and whatever the transfer cost is) but very tricky to do with EMTALA

 

[Janders]

Is there something specifically in EMTALA that forbids you from telling patients what hospital services are offered at your facility upon arrival? It's public information that easily findable online.

One of the issues with emtala is there is less of a defined rule book and more a set of prior decisions (which aren’t published in a comprehensive single source…) which we read like tea leaves. The general concept is that saying / doing things that may encourage a patient to walk out prior to MSE IS risky, as multiple hospitals have been found to have violated emtala for that.

Some examples I’ve heard of include posting an aggressive we don’t refill opiates statement in the lobby (prior to mse / vitals) or a patient calling on the phone while they were driving in contracting and being told said ED doesn’t have L&D and they should reconsider their options (they should have really included the “we’d be happy to see you!!” Part..)

 

[comp1]

Okay, I don't ever trust public patient reports and they certainly can't ever be verified due to "privacy," but regardless of what random rare horror the patient shows up with...you triage and then transfer them if you don't have the service they need, right? It seems really dangerous to be telling patients what services you have and don't have ahead of time before they even are assessed by the MD. That WOULD seem to be at least vaguely obstructing or delaying care (to a lay jury). The patient has the choice to decline the transfer if they wish, of course. Now again, grain of salt, I don't believe patient reports to the media by default and I'm sure what they're saying isn't entirely accurately. I'm also honestly a little surprised EDs don't all have immediate access to L&D since it's one of a rare few things very concretely laid out in EMTALA. It's literally the fifth letter in the acronym.

 

[Apollyon]

I'm also honestly a little surprised EDs don't all have immediate access to L&D since it's one of a rare few things very concretely laid out in EMTALA. It's literally the fifth letter in the acronym.

Seriously? What if your hospital delivered one baby (in the ED, at that) in the past 10 years?

Hell, there was a hospital in my county at my last job that had an active labor deck - and still stopped doing deliveries.

 

[DocEspana]

Is there something specifically in EMTALA that forbids you from telling patients what hospital services are offered at your facility upon arrival? It's public information that easily findable online.

The consensus I've seen (because no one is putting it formally into writing) is that you can put up signs in triage that are phrased in a neutral way that list what services you have. You can not put up signs that specifically say what you do not have, and you can't tell someone registering "we don't have this service" because those would both be considered discouraging the MSE.

 

[DocEspana]

Seriously? What if your hospital delivered one baby (in the ED, at that) in the past 10 years?

Hell, there was a hospital in my county at my last job that had an active labor deck - and still stopped doing deliveries.

You're totally right.

Two different hospitals I work(ed) at had L&D and just decided delivering babies wasn't profitable enough so they just closed L&D. Theyre actually both in the same larger hospital group and they just downsized all their L&D to one single site in the group. The pregnant ladies still show up to the ER as if we were still delivering a few babies per day on the third floor, when we are now just transferring them all out or making some really uncomfortable discharge decisions.

 

[Janders]

Seriously? What if your hospital delivered one baby (in the ED, at that) in the past 10 years?

Hell, there was a hospital in my county at my last job that had an active labor deck - and still stopped doing deliveries.

Exactly. I work in an ED that sees around 40k/yr. L&D isn’t here, Ob/gyn doesn’t do ED consults, and is a 20min ambulance ride (at best) in any direction to get to an L&D. This is after you get an accepting MD (can take 1-2hr of calls and pulling teeth) and an ambulance (lolz).

So if a lady calls that lives midway between us and one of the multiple hospitals that DO deliver babies, CLEARLY the right thing is to send her to one of them. But… can’t be violating emtala.

 

[WhatJobDoIPick]

The large fake news academic hospital systems looooove EMTALA.

It enables their predatory patient capture model.

Open one "academic" mother ship, then buy up a bunch of failing community hospitals for the real estate and beds, give them phony trauma / stroke designations, but market them as "we are all one hospital!". Then let your spoke and wheel spider web of malicious intent spin.

You catch unsuspecting patients who come to your "stroke center" with whatever and then it's all "aw shucks we don't have neuro here, we gotta transfer you to our center of academic excellence for an unnecessary MRI. Sure we can transfer you outside the system, but it will take much longer and more difficult for you!"

 

[NYEMMED]

Are these all EMTALA violations? Or more to the story here to make these scenarios 'defensible'?

Emergency rooms refused to treat pregnant women, leaving one to miscarry in a lobby restroom

Complaints about pregnant women being turned away from emergency rooms spiked in the months after states began enacting strict abortion laws following the 2022 U.S.

apnews.com

Pregnant patients have “become radioactive to emergency departments” in states with extreme abortion restrictions, said Sara Rosenbaum, a George Washington University health law and policy professor.

“They are so scared of a pregnant patient, that the emergency medicine staff won’t even look. They just want these people gone,” Rosenbaum said.

Consider what happened to a woman who was nine months pregnant and having contractions when she arrived at the Falls Community Hospital in Marlin, Texas, in July 2022, a week after the Supreme Court’s ruling on abortion. The doctor on duty refused to see her.

“The physician came to the triage desk and told the patient that we did not have obstetric services or capabilities,” hospital staff told federal investigators during interviews, according to documents. “The nursing staff informed the physician that we could test her for the presence of amniotic fluid. However, the physician adamantly recommended the patient drive to a Waco hospital.”

Investigators with the Centers for Medicare and Medicaid Services concluded Falls Community Hospital broke the law.
----
At Sacred Heart Emergency Center in Houston, front desk staff refused to check in one woman after her husband asked for help delivering her baby that September. She miscarried in a restroom toilet in the emergency room lobby while her husband called 911 for help.

“She is bleeding a lot and had a miscarriage,” the husband told first responders in his call, which was transcribed from Spanish in federal documents. “I’m here at the hospital but they told us they can’t help us because we are not their client.”

Emergency crews, who arrived 20 minutes later and transferred the woman to a hospital, appeared confused over the staff’s refusal to help the woman, according to 911 call transcripts.

One first responder told federal investigators that when a Sacred Heart Emergency Center staffer was asked about the gestational age of the fetus, the staffer replied: “No, we can’t tell you, she is not our patient. That’s why you are here.”

A manager for Sacred Heart Emergency Center declined to comment. The facility is licensed in Texas as a freestanding emergency room, which means it is not physically connected to a hospital. State law requires those facilities to treat or stabilize patients, a spokeswoman for the Texas Health and Human Services agency said in an email to AP.
----
Meanwhile, the staff at Person Memorial Hospital in Roxboro, North Carolina, told a pregnant woman, who was complaining of stomach pain, that they would not be able to provide her with an ultrasound. The staff failed to tell her how risky it could be for her to depart without being stabilized, according to federal investigators. While en route to another hospital 45 minutes away, the woman gave birth in a car to a baby who did not survive.

Reporter does not know much about the topic.

The last example in Roxboro NC, is not even a hospital or freestanding ED, it’s a medical clinic….

 

[sloh]

The large fake news academic hospital systems looooove EMTALA.

It enables their predatory patient capture model.

Open one "academic" mother ship, then buy up a bunch of failing community hospitals for the real estate and beds, give them phony trauma / stroke designations, but market them as "we are all one hospital!". Then let your spoke and wheel spider web of malicious intent spin.

You catch unsuspecting patients who come to your "stroke center" with whatever and then it's all "aw shucks we don't have neuro here, we gotta transfer you to our center of academic excellence for an unnecessary MRI. Sure we can transfer you outside the system, but it will take much longer and more difficult for you!"

Would the patient still get charged twice in this case?

 

[CoolDoc1729]

Would the patient still get charged twice in this case?

They 100% do at my place. Two ER visits requiring being registered again, two doctor notes and two facility fees 🤦🏻‍♀️ even if they are coming from our FSED with a clear diagnosis they have them come to the main ER for “specialty consultations” unless they are med surg admissions with no consults

 

[sloh]

They 100% do at my place. Two ER visits requiring being registered again, two doctor notes and two facility fees even if they are coming from our FSED with a clear diagnosis they have them come to the main ER for “specialty consultations” unless they are med surg admissions with no consults

Wow sucks, any way to help patients get a med surg admission with no consults?

 

[Mount Asclepius]

The same emergency physician group can’t bill for two ED visits in the same 24 hour period when transferring between facilities.

 

[Janders]

The same emergency physician group can’t bill for two ED visits in the same 24 hour period when transferring between facilities.

But sometimes the community and academic groups are separate entities…

 

[CoolDoc1729]

Wow sucks, any way to help patients get a med surg admission with no consults?

I mean, when I work at the FSED no one goes to the main ER except complicated ortho stuff .. I just admit them to the floor …but then I get yelled at and they don’t schedule me there for a bit .. which is ok by me but the system the way it is sucks and I can’t believe they don’t get a ton of complaints doing it that way. We are not supposed to contact resident services from the FSED but sometimes I do anyway to facilitate a direct admission. Idk if this is solely a cash grab or if they are also concerned the patients will not be placed in the right level of care but again, same ED attending group at both hospitals, and I think if we have to defer to a surgery pgy2 or a Neurosurg PA re: level of care then we should just be able to reach out to them …