Legal Ramifications of Emergency Care

Dr. Limkakeng provided me with some questions to answer throughout my experience, and today, I decided to look into when an emergency department can refuse to care for a patient, when an emergency physician can transfer care to another physician, and learn about how EMTALA and HIPPA laws impact the daily functions of the emergency department.

EMTALA is the Emergency Treatment and Labor Act passed by Congress in 1986. For hospitals participating in Medicare (most hospitals in the United States do), the law outlines a patient’s right to emergency care regardless of their ability to pay for it. Without asking about insurance or payment, hospitals are required to provide stabilizing care: screening, emergency care, and appropriate transfers. It also explains that an emergency physician can transfer care when a patient has become stabilized, either on their own or because of a medical treatment. This is also where protocols like I mentioned in my previous post come into play. Of course, to avoid loopholes, EMTALA defines an emergency:

“a condition manifesting itself by acute symptoms of sufficient severity (including severe pain) such that the absence of immediate medical attention could reasonably be expected to result in placing the individual’s health [or the health of an unborn child] in serious jeopardy, serious impairment to bodily functions, or serious dysfunction of bodily organs.”

This law has had a huge effect on the nation’s emergency care system, as direct costs for uncompensated care to physicians are in the billions of dollars. It has basically ended something commonly referred to as “patient dumping” where, for financial reasons, uninsured patients were transferred from private to public hospitals despite an unstable medical condition. It is important to note, however, that patients sometimes leave the ED against medical advice or refuse examination/treatment, in which case the medical record must contain a description of what was refused and secure the refusal in writing, including confirmation that the risks and benefits were explained.

Another important legislation is HIPPA: the Health Insurance Portability and Accountability Act of 1996. The HIPPA privacy rule establishes standards for protecting heath information, and the HIPPA security rule specifically addresses protecting health information held and transferred electronically. Obviously, technologies have vastly improved healthcare (more mobility, more efficiency, etc.), but they also cause more potential security risks. So, the electronic health records, radiology, pharmacy, laboratory systems, and more that I observed yesterday in the ED all fall under HIPPA laws. An example I observed last night: on two occasions, Dr. Limkakeng needed to take pictures of people’s feet/lower legs for electronic medical records so other doctors could view them, and he made sure to tell and show the patients how the images went straight to Haiku medical records (not saved on his phone).

Example of  Epic electronic patient file

https://www.researchgate.net/figure/Example-user-interface-for-a-patient-record-in-Epics-EHR_fig2_318865889