H E A L T H L A W EMTALA and Transferring Patients to the Emergency Department ■ JOHN SHUFELDT, MD, JD, MBA, FACEP I was an emergency medicine resident on the south side of Chicago in the mid-1980s and, truth be known, I sometimes played inappropriate practical jokes on residents at other area trauma centers. One of my favorites was calling over the “patch phone” with a report that a patient whose penis was “Lorena Bob- bitted” by a pit bull was en route; the paramedics were bringing in both the patient and the dog so that a “reimplantation” could be attempted post vivisection of the dog. My other favorite was the one where multiple severely hand- icapped children were coming in post minor bus accident for eval- uation, with their parents not readily available. Anyway, usually the calls concluded with the recipient resident saying things like, “Oh yeah, why don’t you bite me?” Calling emergency departments from an urgent care is some- times a traumatic experience made worse by some ED physician giving you the third degree about “what you are dumping on us?” and muttering something about EMTALA (the Emergency Med- ical Treatment and Active Labor Act) and hanging up phone while saying “bite me!” Urgent Care Obligations Do urgent care centers have any obligation under EMTALA? The answer is: it depends. If the urgent care center is owned and operated by the hos- pital and is under the same Medicare provider number and meets the Centers for Medicare & Medicaid Services’ definition of a “dedicated emergency department” by meeting one of the following criteria: 1) is licensed by the state as an emergency de- partment; 2) holds itself out to the public as providing emergency care; or, 3) during the preceding calendar year, provided at least one-third of its visits for the treatment of emergency conditions, John Shufeldt is the founder of the Shufeldt Law Firm, as well as the chief executive officer of NextCare, Inc., and sits on the Editorial Board of JUCM. He may be contacted at JJS@shufeldtlaw.com. w w w. j u c m . c o m then the answer is yes. However, does EMTALA apply if the urgent care center operates independently from the hospital (different provider number) and sees less than 33% walk-in patients with emergency conditions? Or, what if an urgent care advertises that it only treats urgent conditions and not emergent conditions; is that center exempt from EMTALA? The answer to both these scenarios is (I hate to answer like a lawyer) more likely than not, EMTALA does not apply. CMS does retain the right to review claims on a case-by-case basis. In other words, they can use the dreaded “retrospectoscope” to evaluate the relationship and then pass judgment. The take-home point is this: If you are working at a hospital- owned urgent care center which makes no distinction on the types of patients treated and sees patients who may qualify as an “emergency,” you have some EMTALA exposure. Therefore, the same EMTALA policies used in the emergency department should be in place at the hospital urgent care center. For exam- ple, not taking insurance information until an appropriate screen- ing exam is completed, stabilizing prior to appropriate transfers, and providing an appropriate screening exam for all comers. Occasionally, urgent care physicians tell me that when they do call to alert an emergency physician, they are given the third de- gree by the recipient and are often told that the ED won’t accept the patient. Do you need to call an emergency department from a physi- cian-owned urgent care prior to transfer? Absolutely not! In a perfect world, communicating with a receiving provider should be commonplace; this direct communication facilities the continuum of care and allows the sending provider to alert the receiving provider about what has already transpired and what the concerns or issues are regarding the patient. What should not occur, however, is the sending provider re- ceiving the third degree by some overworked, burned out EM physician. At the end of the day, the emergency department cannot re- fuse the patient no matter how inappropriate they believe the JUCM T h e J o u r n a l o f U r g e n t C a r e M e d i c i n e | J a n u a r y 2 0 0 9 43