$1.3 Million EMTALA Settlement Should Have Hospitals Re-Evaluating Emergency Department Care Protocols for Behavioral Health Patients

AnMed Health in South Carolina has agreed to pay the largest-ever settlement in a case brought under the Emergency Medical Treatment and Labor Act (“EMTALA”), a Federal law requiring hospitals to stabilize and treat patients in emergency situations. The three-hospital system will pay nearly $1.3 million to settle federal allegations that in 2012 and 2013 the hospital involuntarily held behavioral health patients in its emergency department for multiple days instead of admitting them to the hospital’s inpatient behavioral health unit.

Medicare-participating hospitals with an emergency department are required by EMTALA to provide proper screening of patients who present for treatment. If the screening reveals that the patient has an emergency medical condition, the hospital must either (a) provide appropriate stabilizing treatment before discharging or transferring the patient, or (b) determine that the benefits of transfer outweigh the risks of transfer. Penalties for an EMTALA violation come in the form of monetary fines, at a maximum of $103,139 per violation, and exclusion from Medicare and Medicaid.

In this case, the U.S. Department of Health & Human Services Office of Inspector General (OIG) considered the patients’ unstable psychiatric conditions to be emergency medical conditions triggering EMTALA obligations and alleged that AnMed did not properly stabilize the patients. Specifically, the OIG alleged that AnMed failed to have its on-call psychiatrists examine and treat the patients, and refused to admit patients to the hospital’s inpatient behavioral health unit, instead holding them until they could be transported to another facility specializing in behavioral health.

This settlement indicates a twofold position from the U.S. Department of Health & Human Services: that (1) behavioral health patients should be seen by an on-call psychiatrist in order to satisfy EMTALA requirements, and (2) acute care hospitals with behavioral health units that have open beds cannot discriminate between voluntary commitments and involuntary commitments. This position should trigger hospitals to re-evaluate current emergency department policies, procedures, and practices for all behavioral health patients to ensure that they are in compliance with EMTALA requirements. With the recent increase in penalties for EMTALA violations, the cost of noncompliance is steep.
Link to settlement: http://src.bna.com/qyD