Emergency Room
Joined: 06 Sep 2003
Posts: 1
Posted: Sat Sep 06, 2003 4:11 am Post subject: Er Rooms Get Eased Rules on Patient Care
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>Emergency Rooms Get Eased Rules on Patient Care<
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>September 3, 2003<
> By ROBERT PEAR <
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> <
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>WASHINGTON, Sept. 2 - The Bush administration is relaxing<
>rules that say hospitals have to examine and treat people<
>who require emergency medical care, regardless of their<
>ability to pay. <
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>Under the new rule, which takes effect on Nov. 10, patients<
>might find it more difficult to obtain certain types of<
>emergency care at some hospitals or clinics that hospitals<
>own and operate. <
><
>The new rule makes clear that hospitals need not have<
>specialists "on call" around the clock. Some patients might<
>have more difficulty winning damages in court for injuries<
>caused by violations of the federal standards. <
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>"The overall effect of this final rule will be to reduce<
>the compliance burden for hospitals and physicians," the<
>administration says in a preamble to the regulation, to be<
>published next Tuesday in The Federal Register. <
><
>The administration drafted the new rule after hearing<
>complaints from scores of hospitals and doctors who said<
>the old standards were onerous and confusing, exposed them<
>to suits and fines and encouraged people to seek free care<
>in emergency rooms. Courts have often ruled for patients,<
>and against hospitals. <
><
>In an interview, Thomas A. Scully, administrator of the<
>federal Centers for Medicare and Medicaid Services, said<
>tonight that the new standards would reduce the costs of<
>compliance for hospitals and doctors without weakening<
>patients' protection. <
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>The new rule limits the scope of a law from 1986 that<
>defines hospital obligations. It expands the situations in<
>which hospitals are exempt from the federal requirements. <
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>Mr. Scully said the 1986 law did "a lot of wonderful<
>things, but also does some perverse things that cause a lot<
>of heartburn for doctors and hospitals." <
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>For example, Mr. Scully said, if a hospital has a cancer<
>center or a dialysis center three blocks from its main<
>building, the employees of the center have to be trained to<
>deal with emergency cases, duplicating the work of the<
>emergency room. <
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>But Dr. Robert A. Bitterman, an emergency physician at the<
>Carolinas Medical Center in Charlotte, N.C., said: "The new<
>rule could aggravate an existing problem. Specialists are<
>not accepting on-call duties as frequently as we would<
>like. As a result, hospital emergency departments lack<
>coverage for various specialties like neurosurgery,<
>orthopedics and ophthalmology. The new rule could make it<
>more difficult for patients to get timely access to those<
>specialists." <
><
>Mr. Scully's deputy, Leslie V. Norwalk, said: "The old<
>rules contributed to the overcrowding of emergency rooms.<
>Hospitals were afraid to move patients out of the emergency<
>department for fear of violating the rules." <
><
>The new rule, while not a wholesale return to the situation<
>before 1986, scales back regulations that specify when and<
>where hospitals have to provide emergency services.<
>Patients turned away or refused emergency care can still<
>sue, but hospitals will, in many cases, have stronger<
>defenses. <
><
>Dr. Douglas L. Wood, a cardiologist at the Mayo Clinic in<
>Rochester, Minn., said hospital duties under the 1986 law<
>had grown because of court decisions and the "layering of<
>regulation on regulation." <
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>In the last five years, the government has collected more<
>than $4 million from 164 hospitals and doctors accused of<
>violating the law. <
><
>The new rule narrows the definition of "hospital property"<
>where patients are entitled to emergency care. In addition,<
>it says the 1986 law does not apply to emergency patients<
>after a hospital has admitted them. <
><
>The 1986 law, the Emergency Medical Treatment and Labor<
>Act, or Emtala, applies to all hospitals that participate<
>in Medicare and offer emergency services. <
><
>Under the law, if any person - not just a Medicare<
>beneficiary - goes to the emergency department of a<
>hospital for treatment, the hospital has to provide a<
>"medical screening examination." <
><
>If the examination shows an emergency medical condition,<
>the hospital has to provide treatment to stabilize the<
>patient's condition. Alternatively, the hospital can have<
>the patient transferred to another institution if the<
>expected benefits outweigh the risks. <
><
>Under the new rule, the administration says, "Emtala no<
>longer applies to any individual who is admitted as an<
>inpatient." <
><
>Hospitals and doctors who violate a requirement of the 1986<
>law can be fined $50,000 for each violation and can be<
>excluded from Medicare. In addition, patients have a right<
>to sue hospitals that violate the law. Some patients have<
>recovered hundreds of thousands of dollars. <
><
>The American Hospital Association and other industry groups<
>have long sought changes in the emergency room standards.<
>In 1999, when Mr. Scully was president of the Federation of<
>American Hospitals, he complained that the government was<
>using the 1986 law in ways never intended by Congress. <
><
>Maureen D. Mudron, Washington counsel for the American<
>Hospital Association, welcomed the new rule today, saying<
>that it provided "clear and practical guidance." <
><
>Under federal law, each hospital participating in Medicare<
>also has to keep a list of doctors who are available, on<
>call, to treat emergency room patients. <
><
>The new rule gives hospitals greater discretion in<
>arranging such coverage. A hospital can legally exempt<
>senior members of the medical staff from on-call duty, it<
>says. Moreover, the new rule says federal law does not<
>require all hospitals to have doctors on call 24 hours a<
>day seven days a week. <
><
>In addition, the rule says, doctors can have simultaneous<
>on-call duties at two or more hospitals and can schedule<
>elective surgery or other medical procedures when they are<
>on call. <
><
>The old rules applied to all hospital departments, even<
>those not at the main hospital site. The new rule applies<
>to an "off-campus" site only if it is specifically licensed<
>as an emergency room, if the site is held out to the public<
>as a place that provides emergency care or if emergency<
>cases accounted for at least one-third of all outpatient<
>visits in the prior year. <
><
>The old rules provided protection to anyone seeking care on<
>hospital property, meaning "the entire main hospital<
>campus." <
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>The new rule makes clear that the law does not apply to<
>doctors' offices, rural health clinics, nursing homes or<
>other "nonhospital entities," even if they are adjacent to<
>the main hospital building and are owned or operated by the<
>hospital. <
><
>www.nytimes.com/2003/09/0...a6053b90c2<
><
>
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RedheadedReptile
Joined: 09 Mar 2003
Posts: 69
Posted: Sat Sep 06, 2003 9:28 am Post subject: Does this mean...
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...that ERs can turn away chronic dialysis patients who have been booted from their units?
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ridgerunner
Joined: 11 Jan 2003
Posts: 101
Posted: Sun Sep 07, 2003 6:54 am Post subject: ER
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we are going to get more restrictions because patients abuse the health care system a lot of patients use the er as a primary care facility. colds sore throats ackes and pains minor problem that could be better handled in a primary care center not acute setting. they will wait to go after hours and clog the system until they cannot take care of the true emergencys the costs in a er is much higher because of the need to handle acute problems. the patients are going to have to accept that there problems are their own and do what they can for them selves. yes mistakes will be made but if the patients do not acceptthere problems and do their part the whole system will
eak down. just because you are sick or have a problem doesn,t mean the world should stop and focus on you. come on and give me some feed back. give me hell that is the only way we are going to solve the problem. this in no way should take away from the fight for patient rights and to be treated as humans. but responsibility come with fredom and rights.
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Lin
Joined: 28 Oct 2002
Posts: 337
Posted: Mon Sep 08, 2003 1:39 am Post subject: Hell, lol
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No, not going to do that Ridgerunner; you're absolutely right!!! I've seen it for years. In fact saw it firsthand. A fair amount of the pts. I had were Medicaid and didn't drive. Whenever they had a sniffle would call for an ambulance and go to the ER because as they told me "it's easier than waiting for a doctor's appt. and trying to get transportation". Medicaid would pay for it, and whatever drugs they needed were covered and they would get them at hospital pharmacy, without having to make a special trip to the drug store. It's a huge problem all over the country. Until Medicaid stops paying for non emergency services performed in er, it will continue! I'm sure the hospitals will not turn away emergency pts., just those who aren't trully emergencies. Something has to be done or it one day might be you or I being told "sorry we're full you'll have to wait to have a heart attack" Lin.
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patient
Joined: 29 Oct 2002
Posts: 137
Posted: Mon Sep 08, 2003 3:39 am Post subject: er's
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yes, on Friday nights it is truly a joke trying to get into a emergency room from people that have a cold because they know that their primary doctor is closed on the weekend. I had a stomach problem where I could not swallow any food, water, or medications without choking and had to wait for eight hrs before being checked into a ER and watched the cases of sniffles and skinned knees (haven't the parents heard of band-aids!). When I inquired about the wait the nurse advised that they take ambulance arrivals first, then cardiac arrivals by car then order of care needed.
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dialysis patient
Joined: 10 Feb 2003
Posts: 5
Posted: Mon Sep 08, 2003 6:24 am Post subject: My Experiennce
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I had major surgery and I had to go to the er after getting out of the hospital as I was backed up from the drugs that were in my body. With my surgery I was unable to sit in a chair and had to be lying down. I was very weak and told er I needed to lie down. But they just stuck me in a wheel chair and said they had no beds or cots. I was in so much discomfort and pain by the time they took me. It had been hrs. And then once I was on the er bed it was more hours. I think I got there about 7pm and wasn't seen until early am. There weren't alot of people to be seen in the er. They just worked slow and seemd to be short handed. Then the medical people who saw me were rude and crude acting. I wondered where did they ever get medical people like this! They were so obnoxious and didn't seem to have any idea what was wrong with me. When I finally got admitted and put in a room, the nursing staff there were equally unprofessional. I felt like my life was in danger the whole time I was there. Anyone else have any er and hospital experiences, because the same abusive things go on in hospitals that go on in dialysis. Is it possible to find good hospitals, because what I experienced was a nightmare!
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Worker Bee
Joined: 29 Oct 2002
Posts: 28
Posted: Mon Sep 08, 2003 6:35 am Post subject: Hospitals
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If you have a "Magnet" hospital in your area, then go to that one. Those hospitals have to pass very high standards to get that type of certification. Their staffing is better, they are able to retain better quality staff and your chances of surviving your hospitalization is much better. <
>Problem is that there are not many in the U.S. It takes a lot of hard work by the hospital and the staff to keep this special certification. I work at such a hospital. And do I ever see the difference! I have worked at others in my area and I would not want to be admitted to any of those.
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patient
Joined: 29 Oct 2002
Posts: 137
Posted: Mon Sep 08, 2003 6:55 am Post subject: Magnet hospitals
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how do we find out if a specific hospital has Magnet accreditation?
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plugger
Joined: 11 Jan 2003
Posts: 236
Posted: Mon Sep 08, 2003 12:33 pm Post subject: magnet hospital website
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Here you go!<
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>www.nursecredentialing.or...ies.html#C
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CA
Joined: 08 Sep 2003
Posts: 1
Posted: Mon Sep 08, 2003 11:26 pm Post subject: Cedars-Sinai Med. Cen.
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is on the list. Isn't that the hospital the movie stars go to? Or is it Cedars of Lebanan?
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Lin
Joined: 28 Oct 2002
Posts: 337
Posted: Wed Sep 10, 2003 6:57 am Post subject: ER
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Is it a JCAHO accredidation?
