OIG Enters into $1.295 Million Settlement Agreement to Resolve EMTALA Violations Related to Patients Presenting to a Hospital’s Emergency Department with Unstable Psychiatric Conditions

 

On June 23, 2017, the OIG entered into a $1,295,000 settlement agreement with AnMed Health (South Carolina) to resolve 36 incidents involving alleged violations of the Emergency Medical Treatment and Active Labor Act (EMTALA) related to a hospital Emergency Department’s (ED) handling of patients presenting to the ED with unstable psychiatric conditions. The OIG’s investigation found that (i) the hospital involuntarily committed these patients instead of utilizing an on-call psychiatrist to conduct a psychiatric examination and treat them, and (ii) the hospital’s ED failed to admit these patients for stabilizing treatment to psychiatric beds that were available in the hospital’s psychiatric unit, and instead held such patients in the hospital’s ED between 6 and 38 days. The civil money penalties levied in this case to resolve these alleged violations are the largest ever imposed by the OIG for EMTALA violations.

 

Although the facts in this case are distinguishable from many of the situations facing our hospital clients—where small and rural hospitals do not always have an on-call psychiatrist available, and psychiatric hospitals frequently do not have psychiatric beds available to which a community hospital’s ED can transfer involuntarily committed psychiatric patients—this case is a stark reminder for our hospital clients to revisit the way they handle patients presenting to their EDs with unstable psychiatric conditions.  Some take-home points from this case:

 

  • Hospital EDs should utilize available mental health professionals to conduct psychiatric evaluations of patients presenting with potential emergency psychiatric conditions as part of EMTALA’s required medical screening examination.
  • EMTALA medical screening examinations and stabilizing treatment must be provided to patients even if they are going to be involuntarily committed. Hospital EDs have EMTALA obligations to patients presenting to hospital EDs with potential emergency psychiatric conditions even if such patients meet criteria for involuntary commitment under state law.
  • After a patient has been involuntarily committed, the hospital ED should continue to diligently search for an available psychiatric bed at a psychiatric unit or hospital where the involuntarily hospitalized patient can be transferred and admitted for stabilizing treatment.  It is critical that a hospital ED document its efforts to locate an available bed at regular intervals, especially as such efforts may be required under emergency involuntary commitment statutes.

 

If you have any questions related to this Client Alert, or if we can be of assistance to you in reviewing and updating your hospital’s EMTALA and involuntary commitment policies, procedures and processes, contact Steven L. Johnson, Esq. (sjohnson@kozakgayer.com), Benjamin P. Townsend, Esq. (btownsend@kozakgayer.com), or another K&G attorney, at (207) 621-4390.