Re: What would you do?

April 18, 2001

First, paying EMTs less than minimum wage is against the law. Call the Labor

Board and complain. You may have back wages coming, and the service may have

to pay serious penalties for violation of the law.

Second, since the Nursing Home is attached to the hospital, this may make it

a part of the hospital campus, in which case the hospital is quite possibly

required by EMTALA to respond to all emergencies on its campus with an

appropriate medical team. Just calling EMS won't cut it. If they are in

violation of EMTALA, there are heavy fines ($50,000 for each occurrence, and

the individual doctors can be made to pay it, and also the hospital can lose

its Medicare funding) that can be levied. You need to blow the whistle on

these people.

There are numerous webpages on EMTALA. Just do a google.com search for

EMTALA and you'll get to the place that will tell you how to make a complaint.

You don't have to put up with this stuff. It sounds like this hospital is

getting some very bad advice from its legal people if, in fact, it has

actually sought legal advice. Most country lawyers wouldn't have a clue

about this, but there are plenty who do.

The notion that law requires you to take the patient out the door of the NH

and around the block sounds like an attempt to get around EMTALA. IT WON'T

WORK!!!

The foregoing is intended for information only and does not constitute legal

advice. I am not in the practice of law and do not give legal advice. Check

this out on your own with the proper authorities.

Gene

E. Gandy, JD, LP

EMS Professions Program

Tyler Junior College

Tyler, TX

April 18, 2001

IT'S CALLED MONEY!!!!!!!!!!!! If you have enough rank you can do it the way

you want, if not you'll get fried like an egg on a hot day.

RON

What would you do?

Heres a question that I am trying to get more input on. I work for a

hospital based EMS service. We have a station accross town from the

hospital. The hospital also has a nursing home attached to it. Recently we

were advised that we would respond to this nursing home and transport the

patients to the ED. In the past the hospital/NH staff would put the pt on a

stretcher or wheelchair and wheel them down the hall and to the ED. This

distance is anywhere from 100 to 200 feet. Apparently, the staff was putting

pts with broken hips in the chair and wheeling them down the hall, someone

called them on this so overnight EMS is transporting these victims. Okay so

far, but heres the kicker. We were told we would have to enter the NH

through a side street and then take the pts out through the same entrance,

load them in the ambulance, drive around the block and enter through the ER

drive because it was LAW. My way of thinking is this, Why cant we just

stabilize the pts, splint, treat yada, yada and put them on the EMS cot and

roll them 100 feet down the hall to the ER? I have to roll pts accross some

parking lots at trauma centers further than this. Whats taking them out of

the inside environment, through the weather, lifting them to the back of the

truck, driving around the block, unloading them into the weather again then

up the ER ramp going to do for them. I agree that EMS is better suited to

stabilize fractures than the aides at this facility and provide other

emergency care that wasnt being done in the past, HOWEVER, I dont understand

why we are being told we HAVE to transport via the ambulance to the ED. I

can clearly do the same job just as effectivly by rolling them down the hall

to the ED without the risks. I dont care if the still bill the patient for

transportting or not, but this " mandatory ambulance ride is ridiculous! Am I

correct in thinking logically? Is it required for Medicare that these pts be

" taken " via the ambulance? Is this a law? Cant this be medicare fruad?

Thoughts, comments, some calling medicare?

Thanks

PS: This is the same service that pays its EMTs $3.54 hour

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April 19, 2001

We have the same situation here in regard to the nursing home attached to the

hospital. The difference is that we are the ones who asked

that they call us for the fractures/dislocations/chest pain etc.... . The reason

for this is that we were concerned for the well being of

the residents of this facility. I have a sister that works there, and she is a

very good nurse, the problem is that she and and her

co-workers are trained to handle many situations, but managing the patient who

has just fallen and fractured a hip is one that they are ill

equiped to handle. As for taking the patient down the hallway to the ER, the

patient would have to be taken through the OB wing, with the

expectant mothers and newborns where infections that might be found in the

nursing home do not need to be. This facility has an infection

control plan that prevents these patients from being brought this way. Now we

can go through administration, which is like a maze of

hallways, then past the lobby and snack area, past registration ........ , but

loading and driving around the block is so much easier. Just

some thought on the same situation from another angle.

wrote:

> Heres a question that I am trying to get more input on. I work for a

> hospital based EMS service. We have a station accross town from the

> hospital. The hospital also has a nursing home attached to it. Recently we

> were advised that we would respond to this nursing home and transport the

> patients to the ED. In the past the hospital/NH staff would put the pt on a

> stretcher or wheelchair and wheel them down the hall and to the ED. This

> distance is anywhere from 100 to 200 feet. Apparently, the staff was putting

> pts with broken hips in the chair and wheeling them down the hall, someone

> called them on this so overnight EMS is transporting these victims. Okay so

> far, but heres the kicker. We were told we would have to enter the NH

> through a side street and then take the pts out through the same entrance,

> load them in the ambulance, drive around the block and enter through the ER

> drive because it was LAW. My way of thinking is this, Why cant we just

> stabilize the pts, splint, treat yada, yada and put them on the EMS cot and

> roll them 100 feet down the hall to the ER? I have to roll pts accross some

> parking lots at trauma centers further than this. Whats taking them out of

> the inside environment, through the weather, lifting them to the back of the

> truck, driving around the block, unloading them into the weather again then

> up the ER ramp going to do for them. I agree that EMS is better suited to

> stabilize fractures than the aides at this facility and provide other

> emergency care that wasnt being done in the past, HOWEVER, I dont understand

> why we are being told we HAVE to transport via the ambulance to the ED. I

> can clearly do the same job just as effectivly by rolling them down the hall

> to the ED without the risks. I dont care if the still bill the patient for

> transportting or not, but this " mandatory ambulance ride is ridiculous! Am I

> correct in thinking logically? Is it required for Medicare that these pts be

> " taken " via the ambulance? Is this a law? Cant this be medicare fruad?

>

> Thoughts, comments, some calling medicare?

>

> Thanks

>

> PS: This is the same service that pays its EMTs $3.54 hour

> _________________________________________________________________

> Get your FREE download of MSN Explorer at http://explorer.msn.com

>

April 19, 2001

On Thu, 19 Apr 2001 02:47:00 EDT wegandy@... writes:

> The notion that law requires you to take the patient out the door of

> the NH and around the block sounds like an attempt to get around

EMTALA.

> IT WON'T WORK!!!

Less charitably, Gene, consider this scenario... Whoever is telling the

service this is thinking: " They're just ambulance jockeys; All we have to

do is tell them is it's the law and they will be awestruck and do our

bidding "

Guess they don't know us very well, do they?

" Leadership is action, not position "

Larry RN ...and some other stuff

These are my opinions only, and do not necessarily reflect those of any

employers, organizations, family, or pets

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April 19, 2001

Yo, Coop!

I haven't explored this issue, so I can't be certain there isn't some kind

of regulation involved here, but my gut says not. I have heard that, " It's a

law, " routine run off on paramedics to justify one policy of stupidity and

self-interest or another countless times over the last quarter century.

Apparently (and perhaps with some justification), these people seem to think

we are not capable of investigating these things and will just take their

word for it. My advice is to find out. Start first with your regional TDH

field agent. It's part of his or her job to know about this stuff or to know

where to guide you for more information. There are also online resources and

search engines that can help you track down pertinent rules and laws. If it

is just a policy of the hospital and your company feels it is not in

patients' best interests, then you know where your duty lies.

Dave

What would you do?

> Heres a question that I am trying to get more input on. I work for a

> hospital based EMS service. We have a station accross town from the

> hospital. The hospital also has a nursing home attached to it. Recently we

> were advised that we would respond to this nursing home and transport the

> patients to the ED. In the past the hospital/NH staff would put the pt on

a

> stretcher or wheelchair and wheel them down the hall and to the ED. This

> distance is anywhere from 100 to 200 feet. Apparently, the staff was

putting

> pts with broken hips in the chair and wheeling them down the hall, someone

> called them on this so overnight EMS is transporting these victims. Okay

so

> far, but heres the kicker. We were told we would have to enter the NH

> through a side street and then take the pts out through the same entrance,

> load them in the ambulance, drive around the block and enter through the

ER

> drive because it was LAW. My way of thinking is this, Why cant we just

> stabilize the pts, splint, treat yada, yada and put them on the EMS cot

and

> roll them 100 feet down the hall to the ER? I have to roll pts accross

some

> parking lots at trauma centers further than this. Whats taking them out of

> the inside environment, through the weather, lifting them to the back of

the

> truck, driving around the block, unloading them into the weather again

then

> up the ER ramp going to do for them. I agree that EMS is better suited to

> stabilize fractures than the aides at this facility and provide other

> emergency care that wasnt being done in the past, HOWEVER, I dont

understand

> why we are being told we HAVE to transport via the ambulance to the ED. I

> can clearly do the same job just as effectivly by rolling them down the

hall

> to the ED without the risks. I dont care if the still bill the patient for

> transportting or not, but this " mandatory ambulance ride is ridiculous! Am

I

> correct in thinking logically? Is it required for Medicare that these pts

be

> " taken " via the ambulance? Is this a law? Cant this be medicare fruad?

>

> Thoughts, comments, some calling medicare?

>

> Thanks

>

> PS: This is the same service that pays its EMTs $3.54 hour

> _________________________________________________________________

> Get your FREE download of MSN Explorer at http://explorer.msn.com

>

April 19, 2001

According to our EMTALA guru here in the ER (RN who studies this stuff

religiously), the ER is responsible for all persons within 250 feet of its

doors. Or, more simply, if you fall down go boom within 250 feet of the ER,

the ER MUST send someone to evaluate the patient. If the patient is found to

be unstable, the ER must initiate an 'appropriate response' as defined by

the ER SOP. This means that they CAN call the ambulance.

However, as soon as you walk up to that patient and say, " Hi, I am so and

so, an EMT with such and such ambulance. What seems to be the problem

today? " That care of that patient from the scene to the ER is now YOUR

responsiblity (they patient has still come to the ER, so the ER is also

responsibile for the care provided).

What you need to do (after you report the EMTALA and FLSA violations) is get

a copy of the ER's SOP, get your Medical Director involved, and fix the durn

problem.

Okay, " What would I do? " Treat the patient as needed (O2, 1 + 2 assessment,

dress/splint injuries [including spinal immob], start and IV [if indicated],

administer medications [if indicated]), place the patient on my cot and walk

the cot down the hall, across the parking lot (unless it was raining, then I

would put the patient in the ambulance and drive the 20 feet), and to the

ER. As far as I know (someone from TDH correct me if I am wrong), nothing

says the patient has to go into the ambulance, just that the patient has to

go to the hospital by " the most appropriate means " . Seems to me that a short

ride on the cot is a lot safer for all concerned (especially the responders

backs) than a load/unload to the truck (risk of gear collapse and patient

being dropped).

Of course, I work for a service that allows field c-spine clearance, so

maybe I am biased?

Webb, LP

FLW EMS, MO

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April 19, 2001

I thik Gene is correct. Actually, the essence of EMTALA states that once

your tires hit the property of the hospital, they become the hospital's

patient. Your care ceases, and their care begins. The premesis is any

connected structure of the hospital. Now, they cannot push someone across

the parking lot to a non-connected structure....they must go by

ambulance.......however, transporting a patient off of the premesis without a

transfer order, MOT, etc. may constitute a violation, since the nursing home

is actually part of the hospital. I have a sneaky suspicion that they are

trying to bill for the ambulance service as well. If so, this is Medicare

and/or Medicaid fraud. Since you are hospital employees, you may render care

in their facility (but they may not bill for ambulance services for it),

however there has been much debate over the years regarding hospital based

ambulances being an actual extension of the hospital.........I am not sure

leaving the grounds and coming back on would be legal in this case. I know

for a fact that it isn't illegal to move the patients through the hospital as

long as there is a covered coridor connecting the facility. However, there

are some places such as UTMB in Galveston which use EMS to respond to certain

areas of the hospital which are primarily administrative, or educational

areas, and not actual patient care areas. This is something you really

should talk to TDH about, and also call JCAHO. There could be an

accredidation problem for the hospital with doing this.

As for the wages, it is illegal. I got your e-mail , and I am in the

process of replying to it. I just wanted to calculate up some #'s first and

get some info together before I replied to it. I will send it shortly.

Take care,

Blum, EMT-P

April 19, 2001

EMTALA also has a 250 ft rule now.

Ron