According to the second primary requirement when the patient comes to the hospital for the medical screening examination, the hospital must provide necessary treatment and stabilize the medical condition of the patient or transfer the patient to another medical facility. (Jerome FX Naradzay, 2006). According to this law, if the emergency medical condition of the patient is not stabilized, the hospital should not transfer the patient unless it satisfies certain conditions. The conditions are-the patient may be transferred only when the individual requests for transfer to another hospital.
Even if the individual has requested, the hospital has to inform the patient about the risks of transfer. A physician should sign a certification stating that the medical facility outweighs the increased risks to the patient. As defined in the statute, the transfer must be appropriate under any circumstances. The court rulings and HCFA define the term ‘stabilize’ in such a narrow way that even a patient with pain on discharge from emergency department and for which the cause is not known by the medical screening examination, is considered to be medically unstable.
With the rulings on medical screening examination, the courts stated that the hospital should only stabilize the condition of the patient and not cure the patient completely. Any discharge home from the emergency department is considered as transfer and it is assumed that the emergency department’s physician has opined that the patient had no emergency medical condition or the condition is stabilized before discharging the patient.
Thus, patients who have been sent home after the treatment could seek legal recourse through the EMTALA statute if they can prove that they have been discharged in unstable medical condition. Even sending the patient to other facility to conduct tests also comes under transfer. For example, if the CT scanner is not working properly, the patient should be sent to other hospital for the scan. To transfer the patient in this condition, appropriate paper work must be done, notification should be made and the consent should be obtained.
Once, if the decision is made to transfer the patient, there are many EMTALA requirements to follow. First, the physician must explain risks, reasons and benefit of transfer and obtain the consent from the patient. If the patient refuses transfer in any case, the reason should be documented. Then, to transfer the patient receiving hospital must be found and physician should contact that hospital and need to get acceptance from that hospital. In some cases, this is easy if the two hospitals have prior transfer agreements. The medical records along with the tests, radiographs must be sent with the patient.
If some test results are pending, then it is permissible to send the patient without the test reports but the reports should be sent as soon as possible. Finally, the transfer team must be called to the hospital. In case of patients in reasonable stable condition, the transfer may consist of paramedics from commercial ambulance company. For patients who are exceptionally ill, it may require specialized transport teams like pediatric or neonatal team and if required a physician on board should be sent along with the patient.
The emergency department physician must take in to consideration about the serious illness of the patient and decide whether helicopter transport is necessary for the patient. It is necessary in some cases like sending patients with an acute myocardial infarction to cardiac catheterization in another hospital. All these steps should be followed correctly and promptly and any violation in these steps may lead to EMTALA liability.