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/[deleted]]

It’s not. Neither is requesting an air ambulance and meeting them at the hospitals helipad. You aren’t feeling treatment at that hospital just using their real estate. I will say document the reasons why you bypassed a hospital/facility thoroughly not only for yourself but for any bill g questions for that patient down the line. “X services are not available at referring facility and only available at ____, which is one hour away”

[u/Difficult_Sweet_6904 → u/[deleted]]

This does get tricky though. Particularly when walking through the ER to get to the elevator at places with rooftop helipads. If a doc interacts with that patient it can become a EMTALA violation pretty quickly