EMTALA: Legal, Ethical and Regulatory Issues

[Music] you [Music] hello welcome back to our 2017 educational webinar series I am dr. Jill Brooke senior director of education for first Healthcare Compliance at first healthcare compliance we help you with a comprehensive compliance management solution tailored to your business a hospital a hospital network healthcare practice of any size billing company or skilled nursing facility as part of our complimentary educational webinar series we bring you experts from around the country discuss relevant topics in the healthcare industry we are wrapping up our January theme of access with the topic of MTEL we are so pleased to have ila Rothschild discussing the legal regulatory and ethical issues related to EMTALA miss Rothschild is an accomplished healthcare attorney with a diverse experience serving both as in-house and private practice counsel to physicians hospitals health care and Accreditation associations her areas of expertise include drafting and negotiating of health care and commercial contracts HIPAA hi-tech and tala compliance monitoring stark fraud and abuse regulations credentialing of physicians and allied health care professionals medical staff and peer review as well as risk management disruptive behavior and conflict management miss Rothschild is certified in mediation arbitration and healthcare risk management she earned her BA in psychology from the University of Wisconsin a Master of Arts from the School of Social Service administration at the University of Chicago and Juris Doctor from the chicago-kent College of Law Misurata child is a noted speaker at state and national health care meetings a co-author of multiple multiple articles on topics such as mediation and conflict management as well as participating as special counsel to the Joint Commission and several educational videos by emerging healthcare communities addressing topics such as addressing disruptive behavior and unprofessional conduct a copy of the handout is available for download and a handout section on the control panel feel free to submit questions into the question box on your control panel we will address questions at the end of the presentation PACOM see yous difficut will be emailed to you directly from PACOM within a few days following the live broadcast there is no need to request your certificate additional CEU opportunities will be available to BC advantage members following the live broadcast see their website for details ila go ahead hi thank you so much Jill it's a delight to be here with you today let's get started on the very first page you will see my email and you have any questions after after the session you're concerned you know so let's start originally with EMTALA it was enacted by Congress and signed into law by President Reagan in 1986 I show where the ranks can be found at 42 USC and you know Tyler eggs at 42 CFR section 489 and then I refer all of you to the CMS state operations manual it has all the information you need with respect to EMTALA surveys the kinds of information you need and also more recent issues relating to EMTALA and guys this is all available on the internet so I highly recommend this information and again if you have any questions you can always email me and I can get you to the right proper place so I'm gonna talk a little bit about the origins and other Matala provisions and throughout my talks on demand management takeaways violation of them talent it can be pretty extreme the surveys are complaint driven excuse me for writing just complain complain driven by state agencies acting on behalf of CMS non-compliance is often not the result of a lack of policies and procedures or not having appropriate we are on call schedules and stamping unfamiliar with them tala policies and create procedures that's why all this information not only must be in writing but it must also your staff must be very familiar with it and the violations can be severe the penalties can include termination of the hospital where the physicians make your provider agreements and hospital fines convene up to believe this $50,000 for violations $25,000 for your hospitals - fewer than 100 beds and your even your position fines can make $50,000 per violation which would also include the on composition so pretty pretty hefty stuff origins of EFT Allah I think in the seventies and certainly prior to that a lot of patients in what I would call an emergency situation whether they have gunshot wounds what women in the active labor were being rerouted from your community hospitals and what the term that was originally used was dumped at academic centers and County and public hospitals and oftentimes probably aware that these patients were unable to pay for their medical care as a result of these actions and taua was enacted and referred to as the federal anti-dumping laws it ensures access to emergency wing Lua services regardless of one's ability to pay diagnosis race color national origin or disability but have been individuals must have an emergency medical condition the emergency room visit if the patient comes to an emergency room department the hospital or the critical access hospital with an emergency room must provide and perform a medical screening examination an MSc to determine if an emergency medical exam or condition exists the definition has expanded over the years so if we define an emergency department the Center for Medicare and Medicaid Services defines an emergency department as a specially equipped and staffed area of your hospital it's used a significant portion of the time for neutral evaluation and treatment of outpatients for emergency medical conditions there may be occasions when a patient is brought to another part of the hospital that is not considered an emergency room the patient should be screened there and if necessary moved to the emergency room further screening and stabilization now how do we define the hospital property the Medicare interpretive guide guidelines determine the hospital property and that's as opposed to your dedicated emergency department as a parking lot the sidewalk driveway or hospital departments including any buildings owned by the hospital there are within 250 yards of the hospital the two hundred fifty yard rule is found in regulations that discuss campus which means that the physical area immediately adjacent to the hospital's main building and other areas instructions that are not strictly continuous to the main building but are located within 250 yards of the building and the 250 yard reference arose here actually in Chicago in 1998 a young woman had been shot and his friends took him to the alley Ravenswood hospital grounds here in Chicago the hospital staff did not leave the hospital to help a young boy and he died of his wounds and even though the 250 yards rule did not apply at that time the OIG imposed a $40,000 fine on the hospital so again the fines are serious but hopefully these regs help a little bit in terms of defining those 250 years there's an interesting case that I wanted to bring up Fryderyk versus south county hospital it's a rhode island case from last year and the decision was was the question was whether an urgent walk-in facility and I'm sure all your states have them was required to perform an appropriate screening and stabilization on the plaintiff since the season pursuant to EMTALA guidelines the facility claimed that it was not the dedicated emergency department the CMA CMS definitions define the dedicated emergency department has meaning one of these three requirements so one facility has to be licensed by the state as an emergency going with Department or to the facility is has held out to the public and that is by way of its name it's posted signs are advertised as a place that provides care for emergency medical conditions on an urgent basis not requiring an appointment and the third option is that during the previous year based on a sample of at least one third of all patient outpatient visits the treatments at the outpatient emergency medical that the epicenter medical conditions were seen without an appointment and in this case the facility said that its website claimed that it did not offer emergency care I'm sure a lot of you have websites that would be very it would be very wise for you to look at your website if you talk about emergency care but yet your signs outside it can be a problem if your signs outside they say emergency tears the court found that the clinic met the second requirement that it held itself out is a place it provides care for mergency medical conditions on an urgent basis without requiring and though the clinic's web website was clear and that it did not provide emergency care anyone who drove by this particular urgent center would not be able to make out a distinction between a center offering or not offering the emergency care so the risk management takeaway is that hospitals and clinics are advised to be very careful in place appropriate signage outside and learning wording on your science let people know that what the clinics provide and that may be something that you'd want to go back to and see what what your website's day but more importantly what your signage states now a medical extreme medical screening exam once a patient comes to the emergency room what's our medical screening museums well as you probably know a medical screening museum is an ongoing process it starts with a triage that is given to all patients presenting with the same signs and symptoms is non-discriminatory non-discriminatory so your patients are treated honors to determine whether they have emergency medical condition is it a stroke is it a heart attack and for pregnant women are they in active labor now the medical exclaiming act must be examination must be appropriate to the patient's presenting symptoms and the MSE can range anywhere from a brief history and physical to using ancillary equipment such as x-rays yes bands love work whatever is needed to determine what is going on with this particular patient another patient list need to be stabilized according to the EMTALA guidelines or transferred to another facility but with respect to an EMTALA and patient registration the hospital can request health insurance information but it cannot delay the implementation of the medical screening exam or stabilization or transfer of the patient and I want to give you an example this actually happened to me a couple years ago I fell it was late at night and I broke I severely broke my last left wrist somehow I was able to drive to a nearby hospital and it was kind of funny I was in a lot of pain but as I've walked and they were all watching Dancing with the Stars needless to say I wasn't too happy about this but I told them that I broke my wrist they immediately took me into a room they started examining it and they tried to stabilize the wrist which was actually a very painful procedure but while they were literally doing this procedure one of the clerks walked in and wanted to get my patient registration and I will tell you if the attending physician who was attending to me got a bit angry with this clerk and said please please get out we're performing a procedure at this time I mean obviously later when I was stabilized see the appropriate information but it was kind of a bit of a stressful time when all this was happening to me the patient and then someone came in and wanted to just see my registration needless to say within two days my actually I had AF surgery is fine the capacity and capability of the hospital this is also an important issue the medical screening is a must be provider based upon the capability and capacity of the hospital in other words the hospital must have the appropriate staff and equipment equipment capable of treating a particular emergent situation so if the hospital does not have the capacity or capability to treat a patient in an emergent situation the hospital must either must stabilize the patient and the word transfer the patient to a facility that has the appropriate staff and equipment an EMTALA decline stabilized to mean that there's been no material deterioration of the condition and within reasonable medical probability to resolve from or occur during the transfer of the individual from a facility or about the patient the woman has delivered and created if an emergency medical exam has taken place and it is determined that the patient has an emergency medical condition and the hospital does not have the appropriate appropriate capability or capacity the hospital must stabilize the patient within the vest with an expressed capability in the capacity the hospital must transfer the patient if the patient or legally responsible individual acting of the patient's behalf requests a transfer after being informed of the hospital's obligations and of the risks of the transfer the request must be in writing and indicate the reasons for the request and that the patient or a legally responsible individual is aware of the risks and benefits or the transfer now this can kind of be different what a patient's physician is on the staff of one hospital but yet the patient is taken to the closer Hospital the closer hospital may not have the patient's medical information or even the name or the name of the patient's physician what was helpful in my case is I went to a hospital that knew me to have my medical records my physician was on staff there and actually recommended that I go to a particular orthopedist so I think you mean we need to look not only on behalf of your patients but yourself if you are if you live closer to a hospital that if your patient is if your physician is on staff at another hospital and if you are an emergency in an emergent situation there can be problems in getting information so I think between what you had it your your physician's office versus the hospital you are going to now so I think this is something that you need to look to not only when patients come into the hospital but also for yourselves the transfer to another hospital and appropriate when the receiving hospital after being called by sending Hospital has available space and qualified personnel capable to treat the patient and the receiving hospital has agreed to the transfer now there's a lot of work that the transferring hospital must send with the patient must include all the medical records related to the emergency conditions so that bed includes your observation signs and symptoms preliminary diagnosis results of any diagnostic tests treatment provided results of any tests in the signature of the patient if the patient is requesting the transfer in addition a participating hospital that has specialized capabilities and facilities such as your burn units your nephews a psychiatric hospital may not refuse to accept a patient from a referring hospital if it's an appropriate training sir and if this individual requires specialized capabilities for facility and if the receiving hospital has the capacity to treat the individual this requirement applies to any participating hospital with specialized capabilities regardless of whether that hospital has a dedicated an emergency department for example if a patient has a psychiatric emergency and the patient is transferred to a psychiatric hospital the fact that the psychiatric hospital does not have a dedicated emergency department is open up no rapport with the psychiatric hospital he has the capacity and capability and refuses the patient the hospital can be found in violation of their table now psychiatric patients are considered to have an emergency medical condition but they are considered to if they're expressing suicidal or homicidal thoughts stabilizing these psychiatric patients means that they are preventive injuring or harming themselves or others so so this could also mean that during the transfer of a psychiatric patient you may need to use chemical or physical restraints and which may be required and awesomo also hospital should have policies and procedures regarding psychiatric patients who are in the custody of police hospitals mail must also have hospital logs and this is absolutely critical then those lines are the names of patients who have come to the emergency departments and indicate whether these patients refuse treatment we're determined we're denied treatment or retreated admitted stabilized and or transferred to other hospitals logs are critical if a hospital has been cited for an entire violation because one of the first items our survey will review will be the hospital's er laws in violation of intolerant intolerant is complaint driven a hospital is required to report to see a master of state surveying agency if it's the specs that may have received an improperly transfer of the patient and the state must be notified within 72 hours failure to report an improper transfer can result in the receiving hospital losing its provider agreement again services can not be denied on the basis of diagnosis financial status race color national origin or handicap and claimants who are stating that they were denied the diagnosis based on any of those issues plain mental before state survey agency and it will be shot up over up to the Office of Civil Rights and you should be aware of the violation of them talent is not a medical malpractice statute so I'd like to talk to you about some special issues on-call position that's an telemedicine as you're welling because you well aware telemedicine is being used in a lot of different areas now so if we look at hospitals in critical care hospitals they are required to maintain an on-call list of physicians on its medical staff these on-call physician is required to make an infinite person's appearance when requested to by the physician which is using the ER physician who is treating the patient there is no time for the prohibition against a treating physician to remotely consult with another petition layer name may not be on the on-call list this is particularly helpful now that hospitals especially remote hospitals are you utilizing telemedicine when specialists are needed to consult with the treating hospitals or with the treating physician CMS services in telemedicine CMS does not require physicians to appear on site when a patient comes to the emergency department so and then position the Doctor of Osteopathy a PA or nurse practitioner with experience and emergency care can be immediately available via clone and radio were available in person within 30 minutes an MD their GTL must be available B via phone or radio 24 hours a day to receive emergency clause and this requirement can be met by telling the telemedicine the physicians for now with respect to see a CH is in telemedicine the critical in the CA H is not required to include telemedicine positions on its MV on-call roster the CA h is required under empower to have an on-call list reasonably related to the services of officers it authors must be composed a physician to practice on-site at the caucus EAH this does not mean that the physicians the practice on-site must be on call and available to appear in person at all times nor does it mean that an on-call mg must be call to appear on site or in every case involving an emergency medical condition it should also be noted that hospitals may have a practice that allows senior medical staff those who have worked 20 years or over 60 years of age to be exempt from on-call responsibilities hospitals merely need to maintain an on-call list of physicians in a manner that best meets best meets the needs of the hospital's and its patients now there are some special situations that are a lot of times we'll have to deal with and one certainly higher disasters now in 2009 we were inundated with the h1n1 influenza and there was concern expressed by hospitals that they might not be able to provide adequate care when the emergency rooms were overwhelmed in comments later stated by CMS in stated that the medical screening exam did not need to be an extensive work up in every single case that the medical screening is a nomination for to take place outside the meeting or other slides on the hospital campus and then use of the medical transports emergency medical transportation there may be instances where hospitals here refused to accept the transfer of a patient an emergency medical and emergency medical condition because they said that the sending Hospital would not use the either there at air medical service for an ambulance that was owned by the receiving hospital it's been very it's been made very clear and my advice Center for Medicaid and Medicare services that it is an EMTALA violation for receiving hospital to condition its acceptance of a patient in an emergency medical condition upon ascending they're sending hospitals use of a particular emergency transport instead of an emergency transport arranged by the sending Hospital so there's no need in no requirement that you use the preceding hospital's equipment and CMS also made some comments regarding lost labor originally only only physicians could certify the pregnant woman was experiencing contractions or whether she was a lost labor prior regulations required that if a qualified medical practitioner other than a physician that is RNR PA determined the others that a woman was in cross labor a position you had to certify the diagnosis the rules were changed in 2006 to expand those professionals or put certified false labor fresh the professionals must be acting not only within the scope of their practices defined by your hospital bylaws but also by your state laws so I think you'll want to look at your state laws and see who are considered qualified medical practitioners and then you need to look at your hospital bylaws and you may want to change your bylaws so that other qualified medical practitioners can make these determinations and finally it's important to review your policies and procedures you need to bring in a variety of staff will participate in treating patients we have emergency medical treatment and at some point it's also reasonable staff of other hospitals for you to meet with staff of other hospitals in your catchment area to determine what their capabilities are and how you can coordinate care when a disaster strikes and finally you need to consider a time when you another facilities in your act in your area can act out an emergency scenario and I'll be talking about that a little later hospitals are doing this throughout the United States so that plans can go into practice as soon as disasters fit we've seen too many disasters with respect to hurricanes and tornadoes we've seen hospitals that were severely hit so we need to know what's available for communities when these disasters strike so what I thought I'd do now is take some questions do you have any for me Joe I do and we will see about anyone else at this moment wants to type in any questions any more questions first we have you mentioned telemedicine how can mobile devices help the flow of traffic in the emergency room this is sort of interesting I've always been interested in telemedicine in that building Joint Commission was very interested in in telemedicine and I think it's always helpful for you to go to the Joint Commission and ask any questions I've done certainly after you are you are accredited by them I've been meeting a couple of articles lately a number of hospitals are beginning to use they have their own apps they also have various cell phones that they use my mobile devices that assist them in knowing what is the coverage in the emergency room especially if there is a crisis what kinds of devices do you have and how can they utilize that how does it assist the flow of traffic in your emergency room some facilities have used these mobile devices it actually determined that it didn't really assist in the flow of traffic so I think what you need to do what you need to do because it is so early on is that clearly there is a need for the use for mobile devices especially with respect to disasters when you've got people who may be triaged all over a particular Hospital and you need to contact one another it would be helpful to have those mobile devices that has specific numbers related to them so then if you need to contact individuals and one part of a hospital you can notify them determine what their coverage is and what their needs are so I suggest you pretty much step outside of the box again you can do the search on the internet also talk to hospitals and again in your catchment or even talked with states facilities also talk to a lot of your your stay the organization's I worked before the American Hospital Association in your medical association but I often give talks yeah at the state societies in the state levels in various states so you might like water not only know that your state nursing associations of the Medical Association and ask them and I know that I know that everybody is very interested in telemedicine especially in your virile variants where physicians are specialists in that so available so again think outside of the box and start talking to your peers if you have state meetings it would be appropriate to bringing in personnel who know more about telemedicine and confused it so that everyone another question there's more and more violence in the hospitals especially the ER what can we do to protect our staff unfortunately we've been hearing a lot about violence for a long time it's a big issue it's certainly not going away the Joint Commission publishes Sentinel events a sentinel event alerts and they're available on the internet there was one published in June on June 3rd of 2010 actually it was issued 45 and it discussed high risk areas of a hospital where there's high strings and certainly the emergency is one of them and it recommended that obviously there we need to have controls throughout the hospital institutions are you insecurity are you securing the perimeter or the public property with appropriate lighting barriers fences if necessary are you controlling access through your entrances your exits can your stairwells certainly in your parking lots make sure that they're extremely well lit um you can look to the Joint Commission and also OSHA and your various professional site societies again like your nurses American Nurses Association but the the Sentinel event the alert talks about causes of violence is if you don't already know your stress and eat are yes there articular mental health beds there is a increase in patient acuity and increase of use of hospitals by your law enforcement so what you need to do I think all institutions need to do this if they haven't already you need to conduct a pretty comprehensive evaluation and you need to bring in a competent credential hospitals security professional who should leave these meetings and make sure that these are multi disciplinary chains so you'd bring in its multidisciplinary you'd want to bring in all your important staff from your emergency rooms even your cardiac care unit your labor rooms bring in you're always bringing in uart risk managers and directors of those various units nursing staff and also bring in the clerk's because the clerks are the ones who need these and individuals first time so they're the ones we meet the patients and the nurses and can pretty much evaluate if there are particular concerns and then they also need to plan for an active shooter and unfortunately we've seen too many of those so you need to one have a team that responds or active shooters as well you need to have communication during the active shooter situation you need to have a really good alert system what amazes me is when we hear unfortunately that they're driven shoot at hospitals and also in your colleges you have immediate notices going to everyone's emails and telling them where you're shooting worthy after shooting is whether a particular area has shut down and also telling people to stay where they are so I think these are some of the things that you need to look at you need to pre-ops identifying safe rooms in your institution where your staff are located and what's a state safe area for them and you need to train the personnel and you need to actually have drills where you have a mock setting of a an active shooter scenario so that your staff you know firsthand what you do one that sort of situation first other questions yes are there any regulations that may impact EMTALA in the area of disaster preparedness okay so this is sort of interesting I've always done a lot of listservs and last week I got a particular listserv the CMS emergency preparedness rule and that's the name of it this CMS emergency preparedness rule was published in September 16th of 2016 it must be implemented by November 15th of this particular year and what you need to do is go on the internet and literally type in CMS emergency preparedness rule you'll get a lot of information that CMS has already put out but it applies to 17 provider and supplier groups so it certainly applies to your hospitals your critical access hospitals and let's say you in your long-term care facilities each each of these groups must develop an emergency plan based on its own capacity and capabilities must have policies and procedures and they need to be reviewed and updated on an annual basis or hospitals or critical access hospitals in your long-term care facilities you must have policies that address the provision of sustenance of food excuse me a little water on medical medical supplies for your staff and residents because you may not be able to evacuate your hospitals it may be too extreme outside you may have severely ill patients who cannot be moved so you have to determine if you're going to shelter these patients how you're going to do so you always have these instruments again you need to have a very sophisticated communication plan this plan must comply with your federal state and local laws and so that patient care can be coordinated not only among the various players in your particular institution and but with your local state and federal agencies you need to develop training and testing initial training facility staff must be able to demonstrate knowledge emergency procedures and again train on an annual basis and the facility must be able to conduct exercises to test the emergency plan again it's really important and I think you've already seen it I know we've seen it a number of times in Chicago in other cities where they literally have mock emergencies they even tell me particular the city or the county or wherever these my disasters are taking place to let people know that these are only these are not for real instances but it's just a testing what what facilities and capabilities are and then what's neat about when if you have these not disaster drills and even when it's in your particular hospitals and then I'll meet together and determine what went right want Retton law how can we make changes and it's important I think to hold these mock disaster drills or crisis drills or active shooter drills because it dr. Goodwin these things really happen your staff feel much more comfortable in getting into that crisis mode so with respect to the CMS you can log in the CMS there is a medical Learning Network and it had an emergency preparedness and preparedness national alcohol I think it occurred last year but they have a website that has the slides audios he has a transcript of what occurred so again it would be the CMS Medical Learning Network emergency preparedness national fall so I highly recommend that you go to these particular websites and got some critical information about your disaster plan if you don't already have one any other questions there is one more question we're concerned about the repeal of the Affordable Care Act could this impact patients seeking medical care or emergency rooms are already crowded and patients who won't have their own internist may start coming to the emergency room making it even more difficult to see critical patients this is a tough one I wish I had an answer for you I think it's too early to tell what the impact will be whether it will be a full repeal of the Act and what will be replaced my concern though is certainly if patients lose insurance work parts of their insurance or if they're not able to buy insurance because of high premiums and high deductibles the patients will resort to go into emergency controls I think you know that if Obamacare wasn't perfect but you did see a lot of patients who started to go to interest to find physicians who could help them when they had chronic illnesses I'm certainly one of them being diagnosed he had chronic heart disease and the other important thing and that's why patients should no matter what happens make sure that you have insurance so that you can go in even for your annual exams I think this is so important but you get just a basic physical exam to know whether perhaps you have high blood pressure whether you have the beginning stages of diabetes or whatever but that you're being treated on the early end of a particular illness waiting until we're taking the chance that you're you're not going to get insurance yeah you're just going to go to an emergency in a critical situation it's not good for you certainly not good for the patient who may be a very oh it's going to put your money stress on a hospital and I also want to just mention that you know a lot of hospitals are beginning to buy up medical practices I was in a particular practice that he had four positions three of them wanted to go into a concierge practice so nursing physicians who don't want to deal with law I think all of the issues pertaining to Medicaid and Medicare want to close their parenthesis down the Nikol chairs practice you're paying a couple thousand dollars a year to be you're still having to pay insurance to your positions but he's available to see you or she's available to see you at whatever time whatever time whatever problem you can reach them and at any time but there are unfortunately very few patients who I think can afford a concierge practice and they are also saying physicians and your practices who are being bought out by hospitals so there's these are physicians who never had to deal with patients who were in an emergency situation that is an emergency rural situation so when you see all these new physicians coming on board it's critical for you to meet with them and for them to understand what the call situation is all about what the requirements are and that they have to be specifically change their child because these practitioners unless they were residents and dealt in the emergency room in the hospital some of these positions may not be familiar with them and may try to transfer a patient in toward not treat a patient or whatever in violation of the tower so it could put a patient at risk position at risk and the institution at risk so I think we all need to stay is up to date as we can on Obamacare the Affordable period if you have questions I think it's important for you as an institution to maybe look to your risk management also your legal counsel you may even want to close a couple of meetings for all your medical staff or even community means a lot of communities are now bringing everyone together and having conferences or evening coffee and donuts and kind of discussing the state of medical affairs not only in your hospital so I wish us all well but I think you need to urge everyone to get some vlog insurance if they can't afford it and hopefully that insurance will be available before for everyone those are my initials I want to say I wanna say one more thing Jill if you don't mind um so much has been happening with President Trump he recently as of the last few days put into place a travel ban encompassing seven Muslim countries and that's having a tremendous tremendous impact on our hospitals and I hadn't even thought of this the international medical staff that we have in our hospitals your physicians your nursing staff work in your hospitals and your clinics especially in your long-term care facilities you know individuals taking care of you the physician or nurse or any individual is out of the country and planning to return to the United States and is from one of those seven countries there can be problems and there can be disruptions in terms of returning to the United States even though we've had a number of various current court rulings and attorneys who are trying to assist his individuals returning to the United States and I was also reading an article that talked about the stress that this band can cause Nach Day which is coming up the third Friday I'm huge in March where medical students determine where they want to see the residency here in the United States so it can impact those individuals who are being matched and we're certainly seeing foreign staff in our ers all over our institutions so and how stressed they must be not only with respect to their being here in the United States even if they do give a green card but if they are traveling forth or if percent perchance they're out of the United States and trying to get that at this time so I was trying to figure out sort of a takeaway that I was there to new American cell then you may have already done this but I think since this is so new you may want to take this to heart and talk to individuals within your your facilities so these are my thoughts your facilities have to take a proactive stance you can't let this stuff happen to hearing nurses 300 doctors you need to make a statement you need to let your staff know that you are there for them and that we will assist them in any way you can so I would recommend and that the CEO of your facility meeting with all the staff involved not only those who may have green cards but I think everyone in the institution and tell them that he is standing behind them and that the institution won't help any of the practitioners if they need assistance I think you also need to to an actor and have an ad hoc meeting that includes HR which may have a list of individuals who are employees or it enacted your legal staff nursing medicine risk management your compliance and determine what the next steps are and what your approach will be and sort of write up something that you would like to see your CEO would then take this I think this is a critical issue that your hospital boards need to look at they need to make a present and then they need to make a present into the hospital the hospital employees and what steps will be taken to assist employees who are traveling so and then ultimately I think you need to get your PR people and you might even want to get a statement that appears in various local papers and let individuals know in your communities and that your hospitals are well aware situations and they're available to help staff work within these institutions so you know we start out with the talk on an Tala but you see how violence now disasters how even a travel ban by our president can impair emergency rooms so I hope I hope if anything I've tried to explain to you what I'm telling us all about what some of the more pressing issues or prices are from where you can go to receive additional information and then just some of the current issues I think no I think you covered it and I appreciate your comments thank you so much please use eyeless contact information on the stream for any additional questions if you send us questions we will forward them on to her your pay can see you to certificate which will also have the index number will be emailed directly to you from Paycom please join us again next week on February 8th at noon eastern standard time for the first of our February webinars focusing on equipment and services this will be Jill Longo of Bittinger law and addressing issues related to physician distribution of durable durable medical equipment this webinar is both CEU and CME accredited you can register for this webinar and also request demo of our compliance solution at our website at one st hcc comm or call us at 888 5 4 3 4 7 7 8 thank you very much and have a great day

Channel: First Healthcare Compliance

Views: 5,053

Rating: 4.7600002 out of 5

Keywords: EMTALA

Id: HowqMdhq7hw

Length: 52min 54sec (3174 seconds)

Published: Wed Feb 01 2017