Re: American hospital procedure- early labour

From: Garry E. Siegel, M.D. (garrys@mindspring.com)
Mon Jul 8 21:07:33 2002

Freda:

Thanks to Ashley for his excellent discourse.

In very real terms, even when an insured patient comes to my hospital and I am the on call doc, and even if in early labor, the incentive to allow her to transfer is zero, and the peril potentially great. Life is too short, so she stays.

If she wants to go to her "chosen" hospital and doctor, I have been known to discharge her (just like I might do to my patients not in active labor) after she is stable, etc., and then she drives where she wants.

Garry

At Mon, 8 Jul 2002, D. Ashley Hill, MD wrote: >
>At Mon, 8 Jul 2002, freda wrote:
>
>>If she was in early labour could you send her to another hospital?
>
>Yes, assuming the patient was stable (not in active labor, normotensive,
>etc). EMTALA (emergency medical treatment and active labor act)
>regulations apply to all hospitals that accept Medicare funds, which
>essentially means all US hospitals. EMTALA laws apply to all patients
>presenting to that hosptial, not just Medicare patients. EMTALA
>specifically discusses pregnant patients, and prohibits transfer of
>those patients in "active labor." It even specifies that the placenta
>must be delivered at that facility. However, since a pregnant woman can
>go from 2cm to 10cm in a fairly short amount of time, and since the law
>does not specify what "active labor" means, ER and labor unit physicians
>and nurses often prefer not to transfer pregnant patients who arrive at
>their hospital. Plus, they are afraid of liability in case something
>happens in the ambulance. Under our insurance system, unfortunately,
>some HMOs might refuse to pay if a patient comes to the wrong hospital
>to deliver. So, hospitals might want to transfer stable patients to a
>facility that accepts their insurance (and, in fact, most patients want
>this, too, since they don't want to receive a bill).
>
>Note that medically-indicated transfers are a completely different
>ballgame, because one facility may not have a neonatal ICU or a trauma
>unit or specialized facilities to care for the patient's specific
>medical problem.
>
>If you look up EMTALA on a search engine you will find information about
>this law.
>
>Ashley
>
>--
>D. Ashley Hill, MD
>Associate Director
>Department of Obstetrics and Gynecology
>Florida Hospital Family Practice Residency
>Orlando, Florida
>

--
Garry E. Siegel, M.D.
Private Practice
Roswell, GA


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