Avoiding EMTALA (...and Crossposted)

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I had the in house acute care surgery and trauma call last  night.   Between 
responding to more than 15 code 2 & 3 trauma  activations, 5 operations, 
continuing my week long www research into cross  posting, I received more than half 
a dozen calls from area hospitals, some of  them quite large.    I had very 
pleasant discussions with the  emergency room physicians and we had both 
clinical and "their backup" type  discussions.    We talked about the management of 
the clinical  conditions.   And YES, I accepted all of the patients.   My  
first response was, "Yes, I am going to accept your referral, now let's talk  
about the patient and anything else you wish to talk about."   I did  this even 
though we were quite full, because both the patient and the calling  doctor was 
not the ones responsible for the predicament they found themselves  in.   
Each of the emergency doctors were surprised I just accepted the  patient up 
front so readily.    I did tell them, that if we found  that the condition was of 
a very minor nature, I would give them a call back and  we would discuss what 
they could have done at their local  ER.     
 
At issue here is an INCREASING practice of emergency departments and backup  
specialty call.    Apparently Texas hospitals have discovered  that there is a 
loophole in the EMTALA law which states that if a hospital has  specialists 
on the staff, but because of the number of specialist, it would be a  burden 
for them to be on excessive numbers of call nights, then the call roster  will 
just be empty or devoid of a name for that specialty for that  night.   The 
doctors last night told me that some nights they have NO  names on any of their 
call rosters and on NO night is there at least 1-3 empty  spaces.    EMTALA 
then stipulates that although the hospital has  a specialist on the medical 
staff, they do not have a duty to call in that  specialist unless her/his name is 
on a call roster.  
 
None of the cases last night were immediately life threatening.  The  patient 
conditions (among others) included:  corneal abrasion, fractured  pelvis, 
painful abdomen (LLQ) and WBC of 19,000 with suspected diverticulitis,  and 
multiple different hand trauma calls.    I have discovered  that for more than 70% 
of the time, the BTGH is the only hospital with a "hand  surgeon" on the call 
roster in a 9 county area, whether or not the patient has a  funding source.   
 I encountered for the first time a very  interesting mechanism for transfer. 
 The patient with the acute abdomen who  I readily accepted in transfer, was 
checked out by the sending doctor, and  then the registration area of the 
emergency room arranged the  transfer.   They gave him a printed copy of a 
MapQuest route to get to  our hospital.     
 
This is not a new problem and we have been addressing it in open and  
regulatory forums (we being the hospital administration and the regional trauma  
council, etc.).   Apparently, this is allowable  by EMTALA.    My reason for this 
post is to alert each of  you to this  practice and to ask about its 
prevalence.    
 
Ironically, it is used MORE in patients with no resources.   
 
I am crossposting because this issue has significant interest to both  groups 
and according to my research is totally within the etiquette of the  
Internet.   
 
k



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