Re: Re: EMTALA – ANTI-DUMPING ACT:

[Guest guest]

Every patient sent out of an Emergency Department after a Carbon Monoxide

exposure that wasn't treated with hyperbaric oxygen could invoke this act

against the hospital.

KP Stoller, MD

Assistant Clinical Professor, Pediatrics

UNM, School of Medicine

Medical Director, Hyperbaric Medical Center of New Mexico

www.hbotnm.com

-- " sly243 " <sly243@...> wrote:

Leave HBOT out of it, not necessary to allege or prove under

EMTALA...

Take a look at an absolutely on point legal brief:

http://pages.prodigy.net/mark_bower/legalbrief/update.htm

Medical screening and stabalization is what is mandatory before

discharge otherwise it is an absolute violation. Once it is found

that the hospital has discharged a patient without " stabilizing "

an " emergency medical condition " , absolute liability is imposed by

the statute. The EMTALA does not use the terms " negligence "

or " malpractice " (42 U.S.C. §1395dd[d][3][A]). The courts have

found that the absence of such terms was intentional, reflecting

congressional intent to impose absolute, or strict, liability on a

hospital for failure to comply with EMTALA's requirements.

Definitions are the key here...

" Stabilized " , as defined in 42 U.S.C. §1395dd[e][4], refers to

whether " no material deterioration of the condition is likely,

within reasonable medical probability, to result from the transfer

of the individual from a facility. " It does not mean that the

plaintiff's vital signs were regular or normal - which is

way " stable " is typically used in Emergency Room parlance. That may

be all that the Emergency Room Records document.

Whether or not the plaintiff's condition was " stable " within the

statutory meaning is a question of fact for a jury to determine. The

defendant's insistence that the patient was stable, which plaintiff

(and plaintiff's experts) dispute, is an argument which can only be

decided by the trier of the facts. Summary judgment is unavailable.

To make out a prima face case for damages under the " Anti-Dumping

Act " , the plaintiff must prove the following:

1. The patient had an " emergency medical condition " . An " emergency

medical condition " is defined in 42 U.S.C. §1395dd[e][1] as " a

medical condition manifesting itself by acute symptoms of sufficient

severity (including severe pain) such that the absence of immediate

medical attention could reasonably be expected to result in (A)

placing the patient's health in serious jeopardy, ( serious

impairment of bodily functions, or © serious dysfunction of any

bodily organ or part.

2. The patient was not " stabilized " , as defined in 42 U.S.C. §1395dd

[e][4]; that is, whether " no material deterioration of the

condition is likely, within reasonable medical probability, to

result from the transfer of the individual from a facility. "

3. That the patient was " transferred " (i.e. - discharged) from the

hospital. Note that the word " transfer " has a specific statutory

meaning, and is not used in the common sense, meaning being sent

from one hospital to another; but means " the movement (including the

discharge) of a patient outside a hospital's facilities at the

direction of any person employed by .... the hospital. " 42 U.S.C.

§1395dd[e][5]. Ordinarily, this allegation will not be in serious

dispute.

4. The patient suffered " personal harm as a direct result of a

participating hospital's violation of this section.... " 42. U.S.C.

§1395dd[3]. Note that the " direct result " standard may be more

exacting than the " proximate cause " standard which we are used to

under state law requirements.

Is not a SPECT Scan an appropriate screen to verify stabalization of

cerbral damage? If the brain is not receiving sufficient oxygen

subsequent scans every 4 hours or so will likely indicate the brain

is not stabalized... Not sure. So what are the medically accepted

standard for screening of stabalization of neurological conditions?

ie. stroke, hemmorage etc... eeg? ct?

More Interesting information found can be found if you google

EMTALA SPECT SCAN.

The position and point I am trying to make is there is an absolute

Anti-Dumping federal law that mandates each and every emergency

treatment visit. Under this Federal law discharge is only allowed

upon stabalization of the patient period.

> EMTALA – ANTI-DUMPING ACT:

>

> One could postulate:

>

> 1. SPECT Scanning is proper and necessary for screening of

traumatic

> brain injury.

> 2. HBOT is a necessary treatment to provide Oxygen in order to

> stabalize condition.

> 3. Treatments should continue until SPECT scan shows the brain

> condition has stabalized and tissues are no longer deteriorating.

>

> ------------------------------------------------------------------

>

> This is a very powerful federal statute!

>

> http://pages.prodigy.net/mark_bower/legalbrief/update.htm

> http://www.rodey.com/publications/article13.pdf

> http://www.citizen.org/questionablehospitals/qhcompletereport.pdf

>

> Comments please...

>

>

>

>

>

>

>

>

> " I know the plans I have for you, " declares the Lord, " plans to

prosper you and not to harm you, plans to give you a future and a

hope. " [ 29:11]

>

_._._._._._._._._._._._._._._._._._._._._._._._._._._._._._._._._._._

.._._.

> Join the International Hyperbaric Medical Association

http://www.hyperbaricmedicalassociation.org/docs/JOIN_Friends_Apr04.p

df

>

> Is HBOT at your hospital?

http://apps.nlm.nih.gov/medlineplus/directories/index.cfm

>

> EPSDT decisions http://healthlaw.org/pubs/200308.epsdtdocket.html

>

> Unrestricted downloads of 50+ pdf files on HBOT efficacy

medicaid/files/ ,

2/files/ and

http://www.drneubauerhbo.com/papers.htm

>

> Download your state EPSDT program

http://www.hcfa.gov/medicaid/stateplan/Map.asp by doing a search on

the word " ameliorate " . State Medicaid websites http://www.medi-

cal.ca.gov/RelSites_Oth_States.asp . Medicaid waiver programs:

http://www.geocities.com/HotSprings/Villa/1029/medicaid.html

>

> Find a hyperbaric clinic http://www.netnet.net/mums/hbolistAK-

FL.htm, http://www.netnet.net/mums/hbolistGA-NC.htm,

http://www.netnet.net/mums/hbolistOH-WI.htm

>

> HBOT can save billions of dollars and millions of heartaches.

Subscribe to by sending a blank email to

mailto:medicaid-subscribe

>

[Guest guest]

EEGs are used to determine if one's brain is on and by how much. This has

remained unchanged for decades and I assume it continues to be used because it

is non-invasive and a neurologist has to read it ($).

SPECT scans are invasive (radioactive tracer) but give functional anatomical

evidence re bood flow to brain areas and indirectly of metabolic activity. There

is about 85% correlation with clinical conditions, but for some reason brain

SPECT scans remain a relatively under utilized tool (few know how to read them

correctly I hear).

Hope that helps

KP Stoller, MD

Assistant Clinical Professor, Pediatrics

UNM, School of Medicine

Medical Director, Hyperbaric Medical Center of New Mexico

www.hbotnm.com

-- " sly243 " <sly243@...> wrote:

KP,

I am not advocating or encouraging litigation against ER Doctors or

Hospitals, they are saviors and our protectors... I am stating

that certain federal statutes are in place to protect each and every

patient. Screening and stabalization is absolutely required prior

to discharge or transfer.

I hope to learn from this open discussion on how stroke and comatose

patients are neurologically screened and stabalized before being

discharged and declared PVS/Custodial.

In my instant situation... My 65 yr old Father was treated by

emergency surgeries on 9-28. ICU admitted from 9/29 - 10/26 and

discharged to an LTAC from 10/26 - 12/18, Nursing Home 12/18 - 12/26

and readmitted on emergency basis on 12/26 - 12/30 for SEPSIS. He

was discharged on 12/30 with a fever and without any prearranged

accepting facility. When we offered to take him home they stated he

requires skilled care and refused to discharge into our care.

Furthermore... Until 12/29 no neurologist had ever consulted or

been assigned to my father until a demand as guardian was served

upon the treating physician. To pacify us they stated EEG scans

have been scheduled but on 12/30 I received a voice mail first

stating the EEG is scheduled for 1/23 because no emergency exists

and finally another one stating the EEG test has been cancelled. I

learned he was discharged in the morning after i received a call

from a social worker scrambling to find a place to deliver him to.

So I am deeply puzzled as to what type of screening determined he is

neurologically stable to be discharged. Keep in mind he is insured

by Anthem BCBS ERISA plan (primary) medicare (secondary) although

this should not be of any concern according to EMTALA (yeah

right!).

Would a Spect Scan be appropriate? What would the normal course of

treatments be to prevent further neurological damage and stabalize

the brain? I certainly do not believe " we'll just have to wait and

see " is or should be the standard of care for such emergency

situations.

I would much rather have him properly screened, treated and

stabalized than resort to litigating for blood money.

> > EMTALA – ANTI-DUMPING ACT:

> >

> > One could postulate:

> >

> > 1. SPECT Scanning is proper and necessary for screening of

> traumatic

> > brain injury.

> > 2. HBOT is a necessary treatment to provide Oxygen in order to

> > stabalize condition.

> > 3. Treatments should continue until SPECT scan shows the brain

> > condition has stabalized and tissues are no longer deteriorating.

> >

> > -----------------------------------------------------------------

-

> >

> > This is a very powerful federal statute!

> >

> > http://pages.prodigy.net/mark_bower/legalbrief/update.htm

> > http://www.rodey.com/publications/article13.pdf

> > http://www.citizen.org/questionablehospitals/qhcompletereport.pdf

> >

> > Comments please...

> >

> >

> >

> >

> >

> >

> >

> >

> > " I know the plans I have for you, " declares the Lord, " plans to

> prosper you and not to harm you, plans to give you a future and a

> hope. " [ 29:11]

> >

>

_._._._._._._._._._._._._._._._._._._._._._._._._._._._._._._._._._._

> ._._.

> > Join the International Hyperbaric Medical Association

>

http://www.hyperbaricmedicalassociation.org/docs/JOIN_Friends_Apr04.p

> df

> >

> > Is HBOT at your hospital?

> http://apps.nlm.nih.gov/medlineplus/directories/index.cfm

> >

> > EPSDT decisions http://healthlaw.org/pubs/200308.epsdtdocket.html

> >

> > Unrestricted downloads of 50+ pdf files on HBOT efficacy

> medicaid/files/ ,

> 2/files/ and

> http://www.drneubauerhbo.com/papers.htm

> >

> > Download your state EPSDT program

> http://www.hcfa.gov/medicaid/stateplan/Map.asp by doing a search

on

> the word " ameliorate " . State Medicaid websites http://www.medi-

> cal.ca.gov/RelSites_Oth_States.asp . Medicaid waiver programs:

> http://www.geocities.com/HotSprings/Villa/1029/medicaid.html

> >

> > Find a hyperbaric clinic http://www.netnet.net/mums/hbolistAK-

> FL.htm, http://www.netnet.net/mums/hbolistGA-NC.htm,

> http://www.netnet.net/mums/hbolistOH-WI.htm

> >

> > HBOT can save billions of dollars and millions of heartaches.

> Subscribe to by sending a blank email to

> mailto:medicaid-subscribe

> >