Comments on: You Want Pain? Try Transferring a Patient.

By: Winningham

Winningham — Sun, 14 Jun 2009 22:09:08 +0000

Hello webmaster I like your post

By: ERP

ERP — Tue, 25 Nov 2008 20:54:18 +0000

Guy, our GYN on call is now paid a stipend by the hospital to cover the ER since most GYN patients we see seem to be uninsured or from the clinic. I think that is the way to go.

By: Guy

Guy — Tue, 25 Nov 2008 19:45:50 +0000

well i know this is mostly er guys but being a specialist on the other side i heard a story of our ophthalmologists and psychiatrist the other day, basically they were getting consulted left and right from the er from non paying patients and basically said we are done, so now don’t have ophthamology or psychiatry at all.

I’m an obgyn and i cover the er but in 6 years I have had 3 patients total with insurance and I am on 3 or 4 times a month for 6 years.

And our er group gets a stipend for covering the er, hmm where’s my stipend for being a consultant.

By: ERP

ERP — Tue, 26 Aug 2008 22:48:52 +0000

I have been very close to reporting a few of our consultants for such violations - but have stopped short to avoid a giant broughaha. A few of them are so powerful in our hospital that they can essentially do no wrong (I have alse entertained letting the air out of their tyres….) As for the signing out AMA - in some of these cases, the patients have signed out on their own after getting digusted with the difficulty in transfer and/or the MD’s dodging the case. I know that if you “force or coerce” a patient to sign out, it is technically an EMTALA violation so one has to be careful. But in some cases, I would rather risk that then having the patient crap out in my shop.

By: shadowfax

shadowfax — Tue, 26 Aug 2008 20:47:28 +0000

Just FYI, discharging a patient with instructions on the sly to go to another hospital’s ER is a clear violation of EMTALA. The risk of getting busted is quite low, but you should know that it’s as much of a “bright line” as putting them in an ambulance and sending them. Yeah, yeah, I know, nobody ever gets punished for violating EMTALA, but if you are going to violate the law, you should at least do it knowingly.

One thing you can do, if your administration is willing to back you up, is to have a house-wide policy that transfers due to consultant preference need a dictated consult note in the chart, and the consultant needs to see the patient on request. If you request the consultant to see the patient and they refuse, document that refusal, and file your own EMTALA complaint with the HHS OIG. That will get their attention real quick!

By: hannah

hannah — Tue, 26 Aug 2008 20:32:45 +0000

If you sign out AMA ‘tho, your insurance often won’t cover anything…

By: WhiteCoat

WhiteCoat — Tue, 26 Aug 2008 20:22:41 +0000

This post should be required reading for new ED residents … although now you’ve given all the specialists new ideas for how to refuse patients.
In all fairness, the on-call doc who wants to transfer the patient probably should be coming in to at least take a look at the patient before recommending transfer.
You can also try calling the administrator on call at Screw U., waking them up out of a sound sleep, and telling them what’s going on. Do that enough times and things will change.

By: Mike Yerardi

Mike Yerardi — Tue, 26 Aug 2008 16:23:25 +0000

here’s another side of this that makes you want to kill someone. After you talk with transfer centers, then the resident, then the on call attending to point you have this story in your memory forever, someone finally has a bed!! and accepts your patient!! you hang up and turn around and there’s the patient’s nurse waiting to talk with you. You KNOW what’s coming next!! Some A**Hole family memory has showed up or called at the last second to say ” we don’t want that hospital, we want to go to Mecca University Hospital”. Give me your drug seekers, any day, rather than deal with this crap everyday.

By: Kevin B. O'Reilly

Kevin B. O'Reilly — Tue, 26 Aug 2008 14:17:28 +0000

Thanks for the post. BTW, it’s MALARKEY, not MALARCHY.