HHS-OIG Settles Alleged EMTALA Violations with 3 Healthcare Providers
The Department of Health and Human Services Office of Inspector General (HHS-OIG) has entered into settlement agreements with three healthcare providers to resolve alleged violations of the Emergency Medical Treatment and Labor Act (EMTALA). Two of the settlements resolve alleged failures to provide an appropriate medical screening examination, and one resolves an alleged failure to accept appropriate transfers.
EMTALA, often referred to as the patient dumping statute, was enacted in 1986 to prevent hospitals from transferring uninsured or Medicaid patients to public hospitals without first conducting a medical screening examination to ensure they are stable for transfer. EMTALA requires hospitals that receive Medicare payments to provide a medical screening examination to any patient presenting at an emergency department who requests an examination, regardless of their insurance status, ability to pay, national origin, race, creed, or color.
If the patient is determined to have an emergency medical condition, stabilizing treatment must be provided before the patient can be discharged or transferred, unless the hospital does not have the capability to provide the required stabilizing treatment, in which case the patient can be transferred to another hospital where that treatment can be provided. Hospitals with specialized capabilities are obligated to accept transfers from hospitals that lack the capability to treat unstable emergency medical conditions.
HHS-OIG enforces EMTALA and can impose civil monetary penalties on hospitals and physicians for failing to provide an emergency medical screening, stabilizing treatment, or refusing to accept appropriate transfers. HHS-OIG can also exclude hospitals and physicians from participating in Medicare and state healthcare programs if they violate EMTALA. Individuals who are harmed as a result of EMTALA violations are entitled to file a civil suit to obtain damages under the personal injury laws in the state where the hospital is located.
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Pitt County Memorial Hospital (ECU Health Medical Center), North Carolina
Pitt County Memorial Hospital, doing business as ECU Health Medical Center (formerly Vidant Medical Center) in Greenville, North Carolina, was investigated by HHS-OIG over an alleged failure to provide an emergency medical screening examination to a patient in March 2022. The patient lived in an assisted living facility (ALF), which called the police due to a psychiatric incident involving the patient. The patient was taken by ambulance to the ECU Emergency Department (ED) for evaluation and treatment. The patient had a medical history that included dementia with behavioral disturbances, major depression, and manic episodes.
The patient was assigned an Emergency Severity Index of 3 and was asked to wait to be seen. After waiting for 106 minutes, the patient went to the hospitality desk and said he was going to leave and walk himself back. Since the patient did not have an IV or appear to be in distress, the patient was allowed to leave. No one at the ED determined whether he was competent to make the decision to leave and travel back to his residence alone, and no one at the ED notified a family member or anyone at the ALF that he was leaving the hospital. The patient did not return to his ALF and was later found dead on the property of a local rehabilitation facility, of which he was not a patient.
HHS-OIG determined that, given the recent actions of the patient and his medical history, the patient should have been assessed by a qualified medical provider to determine if he had the capacity to make decisions for himself, and could have been considered for an involuntary hold. Pitt County Memorial Hospital was determined to have violated EMTALA by not providing a medical screening and settled the alleged violation and paid a $119,942 financial penalty.
Parkwest Medical Center, Tennessee
Parkwest Medical Center in Knoxville, Tennessee, was investigated by HHS-OIG over an alleged failure to provide an emergency medical screening examination to a patient in February 2022. The patient presented at the ED with a suspected ectopic pregnancy. She reported 10/10 pain, left lower quadrant pain, extreme cramping, and bleeding, and had a positive pregnancy test with her OB/GYN earlier that day.
Diagnostic tests revealed a beta HCG of 4049, indicative of intrauterine or ectopic pregnancy. She had an ultrasound, which the radiologist interpreted as a left simple cyst with no uterine pregnancy, and concluded there were no definitive signs of an ectopic pregnancy. The ED physician discussed the findings with the on-call OB/GYN, who agreed to have the patient discharged. The on-call OB/GYN did not evaluate the patient in the ED. HHS-OIG agreed to settle the alleged EMTALA violation with Parkwest Medical Center, which paid an $80,000 financial penalty.
Brentwood Behavioral Healthcare of Mississippi
The third financial penalty was imposed on Brentwood Behavioral Healthcare of Mississippi to resolve alleged EMTALA violations due to failing to accept the appropriate transfer of patients on seven occasions in June 2021, when the hospital had the capability and capacity to accept all seven patients.
In all seven cases, another hospital made a request to transfer an individual with an unstable psychiatric emergency medical condition to receive stabilizing treatment at Brentwood, which had specialized capabilities for dealing with psychiatric medical emergencies. The Brentwood interim CEO directed staff to refuse the transfers, claiming there was insufficient capacity to treat each individual, when that was not the case. The transfers were refused because the patients were uninsured and being transferred from a significant distance. HHS-OIG agreed to settle the alleged EMTALA violations, and Brentwood Behavioral Healthcare of Mississippi paid a $350,000 financial penalty.
