There is no EMTALA issue in emergency medicine more difficult, more confusing, or more risk-prone than managing psychiatric patients in the emergency department. The AnMed Health case is the quintessential example and should greatly concern emergency physicians.
AnMed Health, a hospital system based in Anderson, South Carolina, recently settled with the Office of Inspector General (OIG) for $1.295 million for allegedly failing to appropriately screen and stabilize psychiatric patients presenting to the hospital’s emergency department.
The Centers for Medicare and Medicaid Services (CMS) and the OIG, the agencies within the Department of Health and Human Services (HHS) charged with enforcing EMTALA, claimed that AnMed Health:
- Should have required its on-call psychiatrist to come to the emergency department to personally examine all patients with psychiatric symptoms and participate in the screening and stabilizing of each patient, irrespective of whether the emergency physician needed or requested the services of the on-call psychiatrist—asserting in effect that emergency physicians are incapable of screening or stabilizing psychiatric patients under EMTALA;
- Should have admitted involuntary committed (IVC) patients to its inpatient psychiatric unit instead of boarding them in its emergency department for many days until they could be transferred to the nearby state psychiatric hospital, despite the fact that for more than 30 years by written policy and actual practice the hospital only admitted “voluntary” patients to its psychiatric unit; and
- Emergency physicians inappropriately transferred the patients in an unstable condition when patients were transported in the back of a locked secure police car for approximately 11–12 minutes to the nearby state psychiatric hospital.1,2
Who Can Screen and Stabilize Psychiatric Patients?
The sole purpose of EMTALA’s mandated medical screening exam (MSE) is to determine whether or not an emergency medical condition exists, and the hospital must designate who is “qualified” to perform the MSE on its behalf (emphasis added).3,4 Virtually all hospitals designate their emergency physicians, as did AnMed Health.
Accordingly, if the emergency physician determines the patient has an emergency medical condition (EMC), such as acute psychosis or suicidal intent, the MSE is finished, and there is no legal requirement that the hospital’s on-call psychiatrist be summoned to the emergency department to confirm that the patient has an EMC.
The psychiatrists who serve on the hospital’s on-call list are available to the emergency department to assist in screening patients for psychiatric emergency conditions when necessary to determine whether or not an emergency medical condition exists.3,5