EMTALA and bypassing a hospital

[u/Dowcastle-medic]

So I had a pt today totally stable but she has an injury I know the local type 4 community hospital (20min) is not going to be able to fix. It was suggested by the clinic staff where I picked her up to go to the type 3, 1.5 hours away. But one of the ER drs for the community hospital happened to be there and looked at the injury and said no just take her to our hospital.

She said the type 3 couldn’t deal with that either and she would need to go to One 3.5 hours away so go and get her c spine cleared…

So we did and then I get chewed out by the ER drs on call saying I can NEVER bypass them based on EMTALA. I always have to stop and let them stabilize the pt and cat scan and such…

That’s not true is it?

[u/Anonymous_Chipmunk]

This is not an EMTALA issue, it's a protocol issue. Only you can look at your protocols and find the answer. But no, this isn't an EMTALA issue.

[u/Advanced-Day-9856 → u/Anonymous_Chipmunk]

If your service is not owned by a hospital, EMTALA doesn’t apply to you at all. It regulates hospitals, not ambulances (so long as they’re not owned by the hospital). You are bound by your protocols so if your protocols don’t allow bypass, that’s another issue. If this was a 911 call pretty substantial distance versus going to the closest hospital. It’s hard to believe that any ER would be unable to run routine CT scans — fixing the issue that they may find is another story. Then again in rural areas, they might not be 24-7 CT coverage.

There could also be reimbursement issues, insurance wants to pay to get to the closest hospital, and after that they may not pay for additional mileage. Anytime a hospital complains about receiving a patient. It’s because they’re just being lazy and don’t want to deal with it. THEIR EMTALA obligation is to take care of patients when you bring them.