University of Chicago Medical Center agreed to pay $50,000 to settle a civil money penalty case for allegedly violating the Emergency Medical Treatment and Labor Act by failing to screen or stabilize a 78-year-old man, who died while waiting in the emergency room, according to the HHS Office of Inspector General.
EMTALA requires hospitals with emergency rooms to conduct medical screening exams and stabilize patients with emergency medical conditions regardless of their ability to pay. Patients can be transferred only if the hospital lacks the staff or equipment to treat them.
According to OIG, the elderly man arrived at the University of Chicago Medical Center emergency department (ED) in an ambulance in 2009. He was complaining of severe jaw pain because of a physical assault. “His information was not entered into the ED log. He did not receive an appropriate medical screening or stabilizing treatment and died in the waiting room,” the settlement says. The civil monetary penalty law that bans patient dumping under EMTALA allows for a maximum $50,000 penalty per violation, “so the amount of the fine suggests that OIG was not in any mood to settle,” says Los Angeles attorney Lowell Brown, with Arent Fox.
He notes that EMTALA has stringent requirements, making compliance more challenging at a time that EDs have a shortage of beds, especially in large cities. His compliance tip: routinely educate ED staff on EMTALA obligations. For example, all patients must be logged in. “If a patient isn’t logged in, that is the most basic and potentially worst mistake you can make because you can lose track of the patient,” Brown says. Either the patient could die, unattended, in the waiting room, or head to another hospital and complain about the neglect at your hospital, which would be reported by the second hospital, and sometimes by the patient. “You have no record of the patient being at your facility…and you have yourself a violation, because CMS and OIG always accept the patient’s version of events,” he says.
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In a statement about the man’s 2009 death, University of Chicago Medical Center said “the hospital conducted an investigation immediately afterward to determine whether every aspect of the care and coordination in the emergency department was appropriate. Our investigation at that time found that proper policies and procedures were in place but staff members may not have followed the protocol. Appropriate disciplinary actions were taken.” Since then, the University of Chicago Medical Center worked closely with CMS and the state of Illinois to advance its compliance with regulatory and patient care standards. “The hospital also submitted a performance improvement plan to government regulators. The plan, which was accepted in 2010, included greater emphasis on monitoring patients in the waiting room and established a quality committee to make certain that the emergency care meets the highest standards.”