[co-author: Charles Pobee-Mensah -  Legal Intern]

On June 2, 2017, AnMed Health and the Office of Inspector General (OIG) for the United States Department of Health and Human Services agreed to a $1.295 million settlement of allegations that AnMed had violated the Emergency Medical Treatment & Labor Act (EMTALA) (Section 1867 of the Social Security Act). The OIG alleged that AnMed failed to provide appropriate medical screening and stabilizing treatment to individuals presenting to the ED with unstable psychiatric emergency medical conditions.

EMTALA imposes an obligation on Medicare-participating hospitals with an emergency department (ED) to provide, upon request, a medical screening examination and stabilizing treatment to any person that presents to the hospital’s premises for an emergency medical condition or active labor. The screening examination and stabilizing treatment must be provided regardless of the individual’s ability to pay. EMTALA and its subsequent regulation provides, among other requirements:

• Any individual who comes to the ED must be provided an appropriate medical screening examination to determine whether or not an “emergency medical condition” exists. This screening must be made by a qualified individual and must be within the capability of the hospital’s ED.  (EMTALA also applies to patients presenting at other hospital campus locations if a request for emergency services is made or a reasonably prudent layperson would conclude the person needs emergency treatment).
• Where an “emergency medical condition” exists, the hospital must provide treatment to stabilize the medical condition, or stabilize the condition as much as possible and appropriately transfer the individual to another hospital.
• When transferring the individual, the hospital must abide by certain restrictions on transferring unstable individuals.

AnMed is a not-for-profit system that operates three hospitals. The OIG claimed that certain AnMed patients were not examined and/or treated by available psychiatrists, including on call psychiatrists, even though this was within the capabilities of the staff and facilities available within AnMed’s ED.  Instead, the OIG alleged, patients were involuntarily committed, treated by ED physicians, and kept in the ED for days or weeks rather than being admitted to the psychiatric unit for stabilizing treatment.  According to the OIG investigation, this included situations where beds were available during the relevant time periods. The OIG also alleged that it was AnMed’s policy at the time not to admit involuntary commitments to the behavioral health unit. For patients who were involuntarily committed and did not have financial resources, the attending physician could write an order referring the patient to a local mental health center to evaluate the patient for commitment to the state mental health system once the patient was medically stable.

The OIG’s investigation of AnMed and subsequent settlement illustrate that federal regulators continue to focus on the underlying goals of EMTALA when deciding to bring regulatory actions, and indicate a heightened concern about hospital policies and procedures that allow or require different handling of ED patients lacking financial resources.

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