Re: Hospital violations by making you wait in the hallway...

[Guest guest]

RIGHT ON, LARRY! Good advice.

Gene

> You are absolutely correct.  When the patient hits the hospital property

> he/she is the responsibility of the ED.  EMTALA is very clear on this issue.

> I know from having served on the San Hospital's EMS Diversion Task

> Force for many years and having served as the recent Chairman of the 5

> Baptist hospital ED's for many years.

>

> You are staying around because you are a nice guy and want to do what is

> best for the patient.  But I will tell you unequivocally, that by staying

> with your patient in the ED you are not helping to fix the problem and you

> are neglecting your prime objective ---- to transport patients and practice

> medicine in the streets.  Is the ED staff going to help you do your job?  Of

> course not.

>

> Sometimes it takes tough love to get necessary changes made.  Overcrowding

> in the ED is not our fault.  It is not the fault of the ED either, but it is

> the fault of the hospital system as a whole.  One EMTALA fine and loosing

> Medicare Certification will get their attention.  They have the resources to

> fix the problem. Lets help them by doing our job right, instead of enabling

> them to continue their dysfunctional operations.

>

> Best,

>

>

> Larry MD

>

> > I am sure there are those who know more than I, but through recent events

> I

> > have been made aware that once the patient is on hospital property,

> regardless

> > of whether the ED has accepted him/her, that patient is the hospital's

> > responsibility. EMTALA. Excessive delays do constitute an EMTALA violation

> as

> > I understand it.

> >

> > ________________________________

> >

> > From: on behalf of Mark Sastre

> > Sent: Mon 7/4/2005 5:39 PM

> > To:

> > Subject: Hospital violations by making you wait in the

> hallway...

> >

> >

> >

> > Just recently, a hospital made me wait in the hallway with my 'low

> > priority' patient until they could find a room for him. Meanwhile,

> > many other calls are dropping and I need to get in service to cover

> > the city. The ER personnel stated that the " patient is not our

> > responsibilty until we take report from you. You have to stay with

> > that patient to monitor him. " What kind of violation is this in

> > regards to EMTALA, RAC, or GETAC? Where can I find the literature to

> > back this to prevent me from just quoting 'hearsay'? I have a copy of a

> > March 2002 letter from the " Center for Medicare & Medicaid Services " .

> > I believe it contains too many 'coulds' and 'may's' to deliver any

> > definitiveness to hospitals.  Do you know the actual statutes being

> > violated?  thnx. FF/P.

> >

> >

> >

> >

> >

> >

> >

> >

> >

> >

[Guest guest]

You are absolutely correct. When the patient hits the hospital property

he/she is the responsibility of the ED. EMTALA is very clear on this issue.

I know from having served on the San Hospital's EMS Diversion Task

Force for many years and having served as the recent Chairman of the 5

Baptist hospital ED's for many years.

You are staying around because you are a nice guy and want to do what is

best for the patient. But I will tell you unequivocally, that by staying

with your patient in the ED you are not helping to fix the problem and you

are neglecting your prime objective ---- to transport patients and practice

medicine in the streets. Is the ED staff going to help you do your job? Of

course not.

Sometimes it takes tough love to get necessary changes made. Overcrowding

in the ED is not our fault. It is not the fault of the ED either, but it is

the fault of the hospital system as a whole. One EMTALA fine and loosing

Medicare Certification will get their attention. They have the resources to

fix the problem. Lets help them by doing our job right, instead of enabling

them to continue their dysfunctional operations.

Best,

Larry MD

> I am sure there are those who know more than I, but through recent events I

> have been made aware that once the patient is on hospital property, regardless

> of whether the ED has accepted him/her, that patient is the hospital's

> responsibility. EMTALA. Excessive delays do constitute an EMTALA violation as

> I understand it.

>

> ________________________________

>

> From: on behalf of Mark Sastre

> Sent: Mon 7/4/2005 5:39 PM

> To:

> Subject: Hospital violations by making you wait in the hallway...

>

>

>

> Just recently, a hospital made me wait in the hallway with my 'low

> priority' patient until they could find a room for him. Meanwhile,

> many other calls are dropping and I need to get in service to cover

> the city. The ER personnel stated that the " patient is not our

> responsibilty until we take report from you. You have to stay with

> that patient to monitor him. " What kind of violation is this in

> regards to EMTALA, RAC, or GETAC? Where can I find the literature to

> back this to prevent me from just quoting 'hearsay'? I have a copy of a

> March 2002 letter from the " Center for Medicare & Medicaid Services " .

> I believe it contains too many 'coulds' and 'may's' to deliver any

> definitiveness to hospitals. Do you know the actual statutes being

> violated? thnx. FF/P.

>

>

>

>

>

>

>

>

>

>

[Guest guest]

You are absolutely correct. When the patient hits the hospital property

he/she is the responsibility of the ED. EMTALA is very clear on this issue.

I know from having served on the San Hospital's EMS Diversion Task

Force for many years and having served as the recent Chairman of the 5

Baptist hospital ED's for many years.

You are staying around because you are a nice guy and want to do what is

best for the patient. But I will tell you unequivocally, that by staying

with your patient in the ED you are not helping to fix the problem and you

are neglecting your prime objective ---- to transport patients and practice

medicine in the streets. Is the ED staff going to help you do your job? Of

course not.

Sometimes it takes tough love to get necessary changes made. Overcrowding

in the ED is not our fault. It is not the fault of the ED either, but it is

the fault of the hospital system as a whole. One EMTALA fine and loosing

Medicare Certification will get their attention. They have the resources to

fix the problem. Lets help them by doing our job right, instead of enabling

them to continue their dysfunctional operations.

Best,

Larry MD

> I am sure there are those who know more than I, but through recent events I

> have been made aware that once the patient is on hospital property, regardless

> of whether the ED has accepted him/her, that patient is the hospital's

> responsibility. EMTALA. Excessive delays do constitute an EMTALA violation as

> I understand it.

>

> ________________________________

>

> From: on behalf of Mark Sastre

> Sent: Mon 7/4/2005 5:39 PM

> To:

> Subject: Hospital violations by making you wait in the hallway...

>

>

>

> Just recently, a hospital made me wait in the hallway with my 'low

> priority' patient until they could find a room for him. Meanwhile,

> many other calls are dropping and I need to get in service to cover

> the city. The ER personnel stated that the " patient is not our

> responsibilty until we take report from you. You have to stay with

> that patient to monitor him. " What kind of violation is this in

> regards to EMTALA, RAC, or GETAC? Where can I find the literature to

> back this to prevent me from just quoting 'hearsay'? I have a copy of a

> March 2002 letter from the " Center for Medicare & Medicaid Services " .

> I believe it contains too many 'coulds' and 'may's' to deliver any

> definitiveness to hospitals. Do you know the actual statutes being

> violated? thnx. FF/P.

>

>

>

>

>

>

>

>

>

>

[Guest guest]

Now I may be missing something or perhaps simply unaware, but,

it is my understanding that in order for there to be a valid transfer

of care there must take place a face to face conversation between the

medic and a person of same or higher level of care in the hospital.

This serves two specific purposes. First, the relationship between

the service's medical director and the patient must be severed.

Transfer of care to another physician by virtue of reception by

hospital staff will accomplish that end. By the way, according to

JCHAO an RN must do the initial assessment and discharge assessment.

So, that person, from everyones perspective, should be an RN.

Secondly, it insures that ED staff is aware not only of the patients

presence but also of their triage catagory and relative disposition

after your treatment. Unless I have misunderstood the advice given

here, it has been suggested that the patient be left in the hallway

without giving report to the hospital staff. Would this not place the

medics in a position for abandonment issues? We have always taught

that in this specific situation, as it is written in several texts,

leaving a patient in the ED without a proper transfer of care may be

grounds for abandonment, a lawsuit that would include not just the

medic but the service and hospital. I'm not trying to get everyone's

feathers ruffled here. I may just be unaware of some other laws

pertaining to this issue that would make it OK to do this. Thanks.

> RIGHT ON, LARRY! Good advice.

>

> Gene

> In a message dated 7/4/05 23:45:19, miller@g... writes:

>

>

> > You are absolutely correct.  When the patient hits the hospital

property

> > he/she is the responsibility of the ED.  EMTALA is very clear on

this issue.

> > I know from having served on the San Hospital's EMS

Diversion Task

> > Force for many years and having served as the recent Chairman of

the 5

> > Baptist hospital ED's for many years.

> >

> > You are staying around because you are a nice guy and want to do

what is

> > best for the patient.  But I will tell you unequivocally, that by

staying

> > with your patient in the ED you are not helping to fix the

problem and you

> > are neglecting your prime objective ---- to transport patients

and practice

> > medicine in the streets.  Is the ED staff going to help you do

your job?  Of

> > course not.

> >

> > Sometimes it takes tough love to get necessary changes made. 

Overcrowding

> > in the ED is not our fault.  It is not the fault of the ED

either, but it is

> > the fault of the hospital system as a whole.  One EMTALA fine and

loosing

> > Medicare Certification will get their attention.  They have the

resources to

> > fix the problem. Lets help them by doing our job right, instead

of enabling

> > them to continue their dysfunctional operations.

> >

> > Best,

> >

> >

> > Larry MD

> >

> > > I am sure there are those who know more than I, but through

recent events

> > I

> > > have been made aware that once the patient is on hospital

property,

> > regardless

> > > of whether the ED has accepted him/her, that patient is the

hospital's

> > > responsibility. EMTALA. Excessive delays do constitute an

EMTALA violation

> > as

> > > I understand it.

> > >

> > >

[Guest guest]

Now I may be missing something or perhaps simply unaware, but,

it is my understanding that in order for there to be a valid transfer

of care there must take place a face to face conversation between the

medic and a person of same or higher level of care in the hospital.

This serves two specific purposes. First, the relationship between

the service's medical director and the patient must be severed.

Transfer of care to another physician by virtue of reception by

hospital staff will accomplish that end. By the way, according to

JCHAO an RN must do the initial assessment and discharge assessment.

So, that person, from everyones perspective, should be an RN.

Secondly, it insures that ED staff is aware not only of the patients

presence but also of their triage catagory and relative disposition

after your treatment. Unless I have misunderstood the advice given

here, it has been suggested that the patient be left in the hallway

without giving report to the hospital staff. Would this not place the

medics in a position for abandonment issues? We have always taught

that in this specific situation, as it is written in several texts,

leaving a patient in the ED without a proper transfer of care may be

grounds for abandonment, a lawsuit that would include not just the

medic but the service and hospital. I'm not trying to get everyone's

feathers ruffled here. I may just be unaware of some other laws

pertaining to this issue that would make it OK to do this. Thanks.

> RIGHT ON, LARRY! Good advice.

>

> Gene

> In a message dated 7/4/05 23:45:19, miller@g... writes:

>

>

> > You are absolutely correct.  When the patient hits the hospital

property

> > he/she is the responsibility of the ED.  EMTALA is very clear on

this issue.

> > I know from having served on the San Hospital's EMS

Diversion Task

> > Force for many years and having served as the recent Chairman of

the 5

> > Baptist hospital ED's for many years.

> >

> > You are staying around because you are a nice guy and want to do

what is

> > best for the patient.  But I will tell you unequivocally, that by

staying

> > with your patient in the ED you are not helping to fix the

problem and you

> > are neglecting your prime objective ---- to transport patients

and practice

> > medicine in the streets.  Is the ED staff going to help you do

your job?  Of

> > course not.

> >

> > Sometimes it takes tough love to get necessary changes made. 

Overcrowding

> > in the ED is not our fault.  It is not the fault of the ED

either, but it is

> > the fault of the hospital system as a whole.  One EMTALA fine and

loosing

> > Medicare Certification will get their attention.  They have the

resources to

> > fix the problem. Lets help them by doing our job right, instead

of enabling

> > them to continue their dysfunctional operations.

> >

> > Best,

> >

> >

> > Larry MD

> >

> > > I am sure there are those who know more than I, but through

recent events

> > I

> > > have been made aware that once the patient is on hospital

property,

> > regardless

> > > of whether the ED has accepted him/her, that patient is the

hospital's

> > > responsibility. EMTALA. Excessive delays do constitute an

EMTALA violation

> > as

> > > I understand it.

> > >

> > >

[Guest guest]

Now I may be missing something or perhaps simply unaware, but,

it is my understanding that in order for there to be a valid transfer

of care there must take place a face to face conversation between the

medic and a person of same or higher level of care in the hospital.

This serves two specific purposes. First, the relationship between

the service's medical director and the patient must be severed.

Transfer of care to another physician by virtue of reception by

hospital staff will accomplish that end. By the way, according to

JCHAO an RN must do the initial assessment and discharge assessment.

So, that person, from everyones perspective, should be an RN.

Secondly, it insures that ED staff is aware not only of the patients

presence but also of their triage catagory and relative disposition

after your treatment. Unless I have misunderstood the advice given

here, it has been suggested that the patient be left in the hallway

without giving report to the hospital staff. Would this not place the

medics in a position for abandonment issues? We have always taught

that in this specific situation, as it is written in several texts,

leaving a patient in the ED without a proper transfer of care may be

grounds for abandonment, a lawsuit that would include not just the

medic but the service and hospital. I'm not trying to get everyone's

feathers ruffled here. I may just be unaware of some other laws

pertaining to this issue that would make it OK to do this. Thanks.

> RIGHT ON, LARRY! Good advice.

>

> Gene

> In a message dated 7/4/05 23:45:19, miller@g... writes:

>

>

> > You are absolutely correct.  When the patient hits the hospital

property

> > he/she is the responsibility of the ED.  EMTALA is very clear on

this issue.

> > I know from having served on the San Hospital's EMS

Diversion Task

> > Force for many years and having served as the recent Chairman of

the 5

> > Baptist hospital ED's for many years.

> >

> > You are staying around because you are a nice guy and want to do

what is

> > best for the patient.  But I will tell you unequivocally, that by

staying

> > with your patient in the ED you are not helping to fix the

problem and you

> > are neglecting your prime objective ---- to transport patients

and practice

> > medicine in the streets.  Is the ED staff going to help you do

your job?  Of

> > course not.

> >

> > Sometimes it takes tough love to get necessary changes made. 

Overcrowding

> > in the ED is not our fault.  It is not the fault of the ED

either, but it is

> > the fault of the hospital system as a whole.  One EMTALA fine and

loosing

> > Medicare Certification will get their attention.  They have the

resources to

> > fix the problem. Lets help them by doing our job right, instead

of enabling

> > them to continue their dysfunctional operations.

> >

> > Best,

> >

> >

> > Larry MD

> >

> > > I am sure there are those who know more than I, but through

recent events

> > I

> > > have been made aware that once the patient is on hospital

property,

> > regardless

> > > of whether the ED has accepted him/her, that patient is the

hospital's

> > > responsibility. EMTALA. Excessive delays do constitute an

EMTALA violation

> > as

> > > I understand it.

> > >

> > >

[Guest guest]

> Now I may be missing something or perhaps simply unaware, but,

> it is my understanding that in order for there to be a valid

transfer

> of care there must take place a face to face conversation between

the

> medic and a person of same or higher level of care in the hospital.

> This serves two specific purposes. First, the relationship between

> the service's medical director and the patient must be severed.

> Transfer of care to another physician by virtue of reception by

> hospital staff will accomplish that end. By the way, according to

> JCHAO an RN must do the initial assessment and discharge

assessment.

> So, that person, from everyones perspective, should be an RN.

What about emergency departments that staff LVNs? A registered nurse

could delegate the task of initial assessment to an LVN for purposes

of triage which they are more than qualified to do. From that point

of view, I would venture to say that the EMS medical directors

relationship with the patient has been severed once the LVN has

received a report from EMS personnel.

> Secondly, it insures that ED staff is aware not only of the

patients

> presence but also of their triage catagory and relative disposition

> after your treatment. Unless I have misunderstood the advice given

> here, it has been suggested that the patient be left in the hallway

> without giving report to the hospital staff. Would this not place

the

> medics in a position for abandonment issues? We have always taught

> that in this specific situation, as it is written in several texts,

> leaving a patient in the ED without a proper transfer of care may

be

> grounds for abandonment, a lawsuit that would include not just the

> medic but the service and hospital. I'm not trying to get

everyone's

> feathers ruffled here. I may just be unaware of some other laws

> pertaining to this issue that would make it OK to do this. Thanks.

>

From what I understand of JCHAO and EMTALA, a patient who presents to

an emergency department, regardless of mode of travel taken, must

have an appropriate screening examination and/or stabilizing

treatment / transfer to a higher facility. From that point of view,

the EMS personnel jobs are done when the patient presents to the

emergency department, whether or not the nurses have been given a

report.

Alfonso R. Ochoa

[Guest guest]

> Now I may be missing something or perhaps simply unaware, but,

> it is my understanding that in order for there to be a valid

transfer

> of care there must take place a face to face conversation between

the

> medic and a person of same or higher level of care in the hospital.

> This serves two specific purposes. First, the relationship between

> the service's medical director and the patient must be severed.

> Transfer of care to another physician by virtue of reception by

> hospital staff will accomplish that end. By the way, according to

> JCHAO an RN must do the initial assessment and discharge

assessment.

> So, that person, from everyones perspective, should be an RN.

What about emergency departments that staff LVNs? A registered nurse

could delegate the task of initial assessment to an LVN for purposes

of triage which they are more than qualified to do. From that point

of view, I would venture to say that the EMS medical directors

relationship with the patient has been severed once the LVN has

received a report from EMS personnel.

> Secondly, it insures that ED staff is aware not only of the

patients

> presence but also of their triage catagory and relative disposition

> after your treatment. Unless I have misunderstood the advice given

> here, it has been suggested that the patient be left in the hallway

> without giving report to the hospital staff. Would this not place

the

> medics in a position for abandonment issues? We have always taught

> that in this specific situation, as it is written in several texts,

> leaving a patient in the ED without a proper transfer of care may

be

> grounds for abandonment, a lawsuit that would include not just the

> medic but the service and hospital. I'm not trying to get

everyone's

> feathers ruffled here. I may just be unaware of some other laws

> pertaining to this issue that would make it OK to do this. Thanks.

>

From what I understand of JCHAO and EMTALA, a patient who presents to

an emergency department, regardless of mode of travel taken, must

have an appropriate screening examination and/or stabilizing

treatment / transfer to a higher facility. From that point of view,

the EMS personnel jobs are done when the patient presents to the

emergency department, whether or not the nurses have been given a

report.

Alfonso R. Ochoa

[Guest guest]

> Now I may be missing something or perhaps simply unaware, but,

> it is my understanding that in order for there to be a valid

transfer

> of care there must take place a face to face conversation between

the

> medic and a person of same or higher level of care in the hospital.

> This serves two specific purposes. First, the relationship between

> the service's medical director and the patient must be severed.

> Transfer of care to another physician by virtue of reception by

> hospital staff will accomplish that end. By the way, according to

> JCHAO an RN must do the initial assessment and discharge

assessment.

> So, that person, from everyones perspective, should be an RN.

What about emergency departments that staff LVNs? A registered nurse

could delegate the task of initial assessment to an LVN for purposes

of triage which they are more than qualified to do. From that point

of view, I would venture to say that the EMS medical directors

relationship with the patient has been severed once the LVN has

received a report from EMS personnel.

> Secondly, it insures that ED staff is aware not only of the

patients

> presence but also of their triage catagory and relative disposition

> after your treatment. Unless I have misunderstood the advice given

> here, it has been suggested that the patient be left in the hallway

> without giving report to the hospital staff. Would this not place

the

> medics in a position for abandonment issues? We have always taught

> that in this specific situation, as it is written in several texts,

> leaving a patient in the ED without a proper transfer of care may

be

> grounds for abandonment, a lawsuit that would include not just the

> medic but the service and hospital. I'm not trying to get

everyone's

> feathers ruffled here. I may just be unaware of some other laws

> pertaining to this issue that would make it OK to do this. Thanks.

>

From what I understand of JCHAO and EMTALA, a patient who presents to

an emergency department, regardless of mode of travel taken, must

have an appropriate screening examination and/or stabilizing

treatment / transfer to a higher facility. From that point of view,

the EMS personnel jobs are done when the patient presents to the

emergency department, whether or not the nurses have been given a

report.

Alfonso R. Ochoa

[Guest guest]

If your patient codes in the hall of the hospital your 're having a bad day

he's having a very bad day.

Louis N. Molino, Sr., CET

FF/NREMT-B/FSI/EMSI

LNMolino@...

(IFW Office)

(Cell Phone)

(IFW Fax)

" A Texan with a Jersey Attitude "

The comments contained in this E-mail are the opinions of the author and the

author alone. I in no way ever intend to speak for any person or

organization that I am in any way whatsoever involved or associated with unless

I

specifically state that I am doing so. Further this E-mail is intended only for

its

stated recipient and may contain private and or confidential materials

retransmission is strictly prohibited unless placed in the public domain by the

original author.

[Guest guest]

If your patient codes in the hall of the hospital your 're having a bad day

he's having a very bad day.

Louis N. Molino, Sr., CET

FF/NREMT-B/FSI/EMSI

LNMolino@...

(IFW Office)

(Cell Phone)

(IFW Fax)

" A Texan with a Jersey Attitude "

The comments contained in this E-mail are the opinions of the author and the

author alone. I in no way ever intend to speak for any person or

organization that I am in any way whatsoever involved or associated with unless

I

specifically state that I am doing so. Further this E-mail is intended only for

its

stated recipient and may contain private and or confidential materials

retransmission is strictly prohibited unless placed in the public domain by the

original author.

[Guest guest]

If your patient codes in the hall of the hospital your 're having a bad day

he's having a very bad day.

Louis N. Molino, Sr., CET

FF/NREMT-B/FSI/EMSI

LNMolino@...

(IFW Office)

(Cell Phone)

(IFW Fax)

" A Texan with a Jersey Attitude "

The comments contained in this E-mail are the opinions of the author and the

author alone. I in no way ever intend to speak for any person or

organization that I am in any way whatsoever involved or associated with unless

I

specifically state that I am doing so. Further this E-mail is intended only for

its

stated recipient and may contain private and or confidential materials

retransmission is strictly prohibited unless placed in the public domain by the

original author.

[Guest guest]

:

You are absolutely right. To simply leave the patient without given a report

whether written, oral or otherwise would hover over abandonment. However, I

think the issue here is that perhaps the staff did not take the report

because they (E/R) would then be responsible and according to the medic's

e-mail, there was no room at the inn. We as EMS Professionals must leave a

report with the receiving facility. It is my opinion that the medic had

every intention of leaving a report. Giving a repot is easy. The hard part

is giving the report in a timely manner when the E/R is full.

Re: Hospital violations by making you wait in the

hallway...

Now I may be missing something or perhaps simply unaware, but,

it is my understanding that in order for there to be a valid transfer

of care there must take place a face to face conversation between the

medic and a person of same or higher level of care in the hospital.

This serves two specific purposes. First, the relationship between

the service's medical director and the patient must be severed.

Transfer of care to another physician by virtue of reception by

hospital staff will accomplish that end. By the way, according to

JCHAO an RN must do the initial assessment and discharge assessment.

So, that person, from everyones perspective, should be an RN.

Secondly, it insures that ED staff is aware not only of the patients

presence but also of their triage catagory and relative disposition

after your treatment. Unless I have misunderstood the advice given

here, it has been suggested that the patient be left in the hallway

without giving report to the hospital staff. Would this not place the

medics in a position for abandonment issues? We have always taught

that in this specific situation, as it is written in several texts,

leaving a patient in the ED without a proper transfer of care may be

grounds for abandonment, a lawsuit that would include not just the

medic but the service and hospital. I'm not trying to get everyone's

feathers ruffled here. I may just be unaware of some other laws

pertaining to this issue that would make it OK to do this. Thanks.

> RIGHT ON, LARRY! Good advice.

>

> Gene

> In a message dated 7/4/05 23:45:19, miller@g... writes:

>

>

> > You are absolutely correct.  When the patient hits the hospital

property

> > he/she is the responsibility of the ED.  EMTALA is very clear on

this issue.

> > I know from having served on the San Hospital's EMS

Diversion Task

> > Force for many years and having served as the recent Chairman of

the 5

> > Baptist hospital ED's for many years.

> >

> > You are staying around because you are a nice guy and want to do

what is

> > best for the patient.  But I will tell you unequivocally, that by

staying

> > with your patient in the ED you are not helping to fix the

problem and you

> > are neglecting your prime objective ---- to transport patients

and practice

> > medicine in the streets.  Is the ED staff going to help you do

your job?  Of

> > course not.

> >

> > Sometimes it takes tough love to get necessary changes made. 

Overcrowding

> > in the ED is not our fault.  It is not the fault of the ED

either, but it is

> > the fault of the hospital system as a whole.  One EMTALA fine and

loosing

> > Medicare Certification will get their attention.  They have the

resources to

> > fix the problem. Lets help them by doing our job right, instead

of enabling

> > them to continue their dysfunctional operations.

> >

> > Best,

> >

> >

> > Larry MD

> >

> > > I am sure there are those who know more than I, but through

recent events

> > I

> > > have been made aware that once the patient is on hospital

property,

> > regardless

> > > of whether the ED has accepted him/her, that patient is the

hospital's

> > > responsibility. EMTALA. Excessive delays do constitute an

EMTALA violation

> > as

> > > I understand it.

> > >

> > >

[Guest guest]

:

You are absolutely right. To simply leave the patient without given a report

whether written, oral or otherwise would hover over abandonment. However, I

think the issue here is that perhaps the staff did not take the report

because they (E/R) would then be responsible and according to the medic's

e-mail, there was no room at the inn. We as EMS Professionals must leave a

report with the receiving facility. It is my opinion that the medic had

every intention of leaving a report. Giving a repot is easy. The hard part

is giving the report in a timely manner when the E/R is full.

Re: Hospital violations by making you wait in the

hallway...

Now I may be missing something or perhaps simply unaware, but,

it is my understanding that in order for there to be a valid transfer

of care there must take place a face to face conversation between the

medic and a person of same or higher level of care in the hospital.

This serves two specific purposes. First, the relationship between

the service's medical director and the patient must be severed.

Transfer of care to another physician by virtue of reception by

hospital staff will accomplish that end. By the way, according to

JCHAO an RN must do the initial assessment and discharge assessment.

So, that person, from everyones perspective, should be an RN.

Secondly, it insures that ED staff is aware not only of the patients

presence but also of their triage catagory and relative disposition

after your treatment. Unless I have misunderstood the advice given

here, it has been suggested that the patient be left in the hallway

without giving report to the hospital staff. Would this not place the

medics in a position for abandonment issues? We have always taught

that in this specific situation, as it is written in several texts,

leaving a patient in the ED without a proper transfer of care may be

grounds for abandonment, a lawsuit that would include not just the

medic but the service and hospital. I'm not trying to get everyone's

feathers ruffled here. I may just be unaware of some other laws

pertaining to this issue that would make it OK to do this. Thanks.

> RIGHT ON, LARRY! Good advice.

>

> Gene

> In a message dated 7/4/05 23:45:19, miller@g... writes:

>

>

> > You are absolutely correct.  When the patient hits the hospital

property

> > he/she is the responsibility of the ED.  EMTALA is very clear on

this issue.

> > I know from having served on the San Hospital's EMS

Diversion Task

> > Force for many years and having served as the recent Chairman of

the 5

> > Baptist hospital ED's for many years.

> >

> > You are staying around because you are a nice guy and want to do

what is

> > best for the patient.  But I will tell you unequivocally, that by

staying

> > with your patient in the ED you are not helping to fix the

problem and you

> > are neglecting your prime objective ---- to transport patients

and practice

> > medicine in the streets.  Is the ED staff going to help you do

your job?  Of

> > course not.

> >

> > Sometimes it takes tough love to get necessary changes made. 

Overcrowding

> > in the ED is not our fault.  It is not the fault of the ED

either, but it is

> > the fault of the hospital system as a whole.  One EMTALA fine and

loosing

> > Medicare Certification will get their attention.  They have the

resources to

> > fix the problem. Lets help them by doing our job right, instead

of enabling

> > them to continue their dysfunctional operations.

> >

> > Best,

> >

> >

> > Larry MD

> >

> > > I am sure there are those who know more than I, but through

recent events

> > I

> > > have been made aware that once the patient is on hospital

property,

> > regardless

> > > of whether the ED has accepted him/her, that patient is the

hospital's

> > > responsibility. EMTALA. Excessive delays do constitute an

EMTALA violation

> > as

> > > I understand it.

> > >

> > >

[Guest guest]

:

You are absolutely right. To simply leave the patient without given a report

whether written, oral or otherwise would hover over abandonment. However, I

think the issue here is that perhaps the staff did not take the report

because they (E/R) would then be responsible and according to the medic's

e-mail, there was no room at the inn. We as EMS Professionals must leave a

report with the receiving facility. It is my opinion that the medic had

every intention of leaving a report. Giving a repot is easy. The hard part

is giving the report in a timely manner when the E/R is full.

Re: Hospital violations by making you wait in the

hallway...

Now I may be missing something or perhaps simply unaware, but,

it is my understanding that in order for there to be a valid transfer

of care there must take place a face to face conversation between the

medic and a person of same or higher level of care in the hospital.

This serves two specific purposes. First, the relationship between

the service's medical director and the patient must be severed.

Transfer of care to another physician by virtue of reception by

hospital staff will accomplish that end. By the way, according to

JCHAO an RN must do the initial assessment and discharge assessment.

So, that person, from everyones perspective, should be an RN.

Secondly, it insures that ED staff is aware not only of the patients

presence but also of their triage catagory and relative disposition

after your treatment. Unless I have misunderstood the advice given

here, it has been suggested that the patient be left in the hallway

without giving report to the hospital staff. Would this not place the

medics in a position for abandonment issues? We have always taught

that in this specific situation, as it is written in several texts,

leaving a patient in the ED without a proper transfer of care may be

grounds for abandonment, a lawsuit that would include not just the

medic but the service and hospital. I'm not trying to get everyone's

feathers ruffled here. I may just be unaware of some other laws

pertaining to this issue that would make it OK to do this. Thanks.

> RIGHT ON, LARRY! Good advice.

>

> Gene

> In a message dated 7/4/05 23:45:19, miller@g... writes:

>

>

> > You are absolutely correct.  When the patient hits the hospital

property

> > he/she is the responsibility of the ED.  EMTALA is very clear on

this issue.

> > I know from having served on the San Hospital's EMS

Diversion Task

> > Force for many years and having served as the recent Chairman of

the 5

> > Baptist hospital ED's for many years.

> >

> > You are staying around because you are a nice guy and want to do

what is

> > best for the patient.  But I will tell you unequivocally, that by

staying

> > with your patient in the ED you are not helping to fix the

problem and you

> > are neglecting your prime objective ---- to transport patients

and practice

> > medicine in the streets.  Is the ED staff going to help you do

your job?  Of

> > course not.

> >

> > Sometimes it takes tough love to get necessary changes made. 

Overcrowding

> > in the ED is not our fault.  It is not the fault of the ED

either, but it is

> > the fault of the hospital system as a whole.  One EMTALA fine and

loosing

> > Medicare Certification will get their attention.  They have the

resources to

> > fix the problem. Lets help them by doing our job right, instead

of enabling

> > them to continue their dysfunctional operations.

> >

> > Best,

> >

> >

> > Larry MD

> >

> > > I am sure there are those who know more than I, but through

recent events

> > I

> > > have been made aware that once the patient is on hospital

property,

> > regardless

> > > of whether the ED has accepted him/her, that patient is the

hospital's

> > > responsibility. EMTALA. Excessive delays do constitute an

EMTALA violation

> > as

> > > I understand it.

> > >

> > >

[Guest guest]

> RNs cannot delegate triage or anything else to an LVN if it is

initial care.

> That is the law. LVNs can only treat patients in the ER after they

have

> been triaged and assigned to that patient.

>

The whole rational behind my statement is in your terms. For instance,

I have come across many situations where I transported a patient to an

ED and the charge nurse stated something to the extent of " pt the

patient in room 5 " from the basis of my radio report. Since an LVN was

staffed to room 5, s/he would take over patient care without a RN being

actually present.

Alfonso R. Ochoa

[Guest guest]

It would still be your patient. Care has not been transfered to the receiveing

facility, in the form of verbal or written report, and the hospital staff have

not began their own care of the patient. Imagine for a second, a similar

situation. Your are in the back of your unit with a critical patient waiting

for air medical. They land and approach your unit. Just then the patient

codes. Is he now their patient just because they are on scene and there for

him? No, because he hasn't been transfered to their care, and he is still in

your unit. Same here, the patient is still on your stretcher in the hallway.

Call a code, work the patient, and give report as you can. Then maybe you can

get your stretcher back ;-)

Live for today, tomarrow is not here yet and laugh at yourself often before

someone else does.

McGee, EMT-I

---------------------------------

Sell on Yahoo! Auctions - No fees. Bid on great items.

[Guest guest]

It would still be your patient. Care has not been transfered to the receiveing

facility, in the form of verbal or written report, and the hospital staff have

not began their own care of the patient. Imagine for a second, a similar

situation. Your are in the back of your unit with a critical patient waiting

for air medical. They land and approach your unit. Just then the patient

codes. Is he now their patient just because they are on scene and there for

him? No, because he hasn't been transfered to their care, and he is still in

your unit. Same here, the patient is still on your stretcher in the hallway.

Call a code, work the patient, and give report as you can. Then maybe you can

get your stretcher back ;-)

Live for today, tomarrow is not here yet and laugh at yourself often before

someone else does.

McGee, EMT-I

---------------------------------

Sell on Yahoo! Auctions - No fees. Bid on great items.

[Guest guest]

From: [mailto: ]On

>>This is why paramedic or EMT-I's working as ER techs cannot triage

patients. They are not being mean,

>>their licensing board won't let them.

In the DFW area, I worked as a Paramedic in the ER (Baylor), I triaged many

MANY nights. Interpretation (or misinterpretation) of the NPA is one of the

most over used and abused excuses I have heard for reasons to disallowing

medics to triage or perform in an ER to their capabilities.

Certainly not picking on you personally, but while in the ER, I worked for

the Doc, the nurses that I worked with didn't have to delegate anything to

me, the Doc did, as did our policies and protocols.

Hatfield FF/EMT-P

[Guest guest]

From: [mailto: ]On

>>This is why paramedic or EMT-I's working as ER techs cannot triage

patients. They are not being mean,

>>their licensing board won't let them.

In the DFW area, I worked as a Paramedic in the ER (Baylor), I triaged many

MANY nights. Interpretation (or misinterpretation) of the NPA is one of the

most over used and abused excuses I have heard for reasons to disallowing

medics to triage or perform in an ER to their capabilities.

Certainly not picking on you personally, but while in the ER, I worked for

the Doc, the nurses that I worked with didn't have to delegate anything to

me, the Doc did, as did our policies and protocols.

Hatfield FF/EMT-P

[Guest guest]

From: [mailto: ]On

>>This is why paramedic or EMT-I's working as ER techs cannot triage

patients. They are not being mean,

>>their licensing board won't let them.

In the DFW area, I worked as a Paramedic in the ER (Baylor), I triaged many

MANY nights. Interpretation (or misinterpretation) of the NPA is one of the

most over used and abused excuses I have heard for reasons to disallowing

medics to triage or perform in an ER to their capabilities.

Certainly not picking on you personally, but while in the ER, I worked for

the Doc, the nurses that I worked with didn't have to delegate anything to

me, the Doc did, as did our policies and protocols.

Hatfield FF/EMT-P

[Guest guest]

In a message dated 7/6/2005 1:25:18 P.M. Central Daylight Time,

ExLngHrn@... writes:

Sort of reminds me of a medieval guild wanting to jealously guard its skills

and territory.

Like the BAR?

Louis N. Molino, Sr., CET

FF/NREMT-B/FSI/EMSI

LNMolino@...

(IFW Office)

(Cell Phone)

(IFW Fax)

" A Texan with a Jersey Attitude "

The comments contained in this E-mail are the opinions of the author and the

author alone. I in no way ever intend to speak for any person or

organization that I am in any way whatsoever involved or associated with unless

I

specifically state that I am doing so. Further this E-mail is intended only for

its

stated recipient and may contain private and or confidential materials

retransmission is strictly prohibited unless placed in the public domain by the

original author.

[Guest guest]

In a message dated 7/6/2005 1:25:18 P.M. Central Daylight Time,

ExLngHrn@... writes:

Sort of reminds me of a medieval guild wanting to jealously guard its skills

and territory.

Like the BAR?

Louis N. Molino, Sr., CET

FF/NREMT-B/FSI/EMSI

LNMolino@...

(IFW Office)

(Cell Phone)

(IFW Fax)

" A Texan with a Jersey Attitude "

The comments contained in this E-mail are the opinions of the author and the

author alone. I in no way ever intend to speak for any person or

organization that I am in any way whatsoever involved or associated with unless

I

specifically state that I am doing so. Further this E-mail is intended only for

its

stated recipient and may contain private and or confidential materials

retransmission is strictly prohibited unless placed in the public domain by the

original author.

[Guest guest]

,

Let me step in here...because I believe...if all the other steps I outlined have

been completed (meeting with ED and Hospital Admin, working together to find

solutions, making reports to CMS, etc) that it might be acceptable to leave

patients in the hallway...but here is my point.

First, if the ED is holding you in the hall on your stretcher they know you are

there...and chances are they have triaged your patient...are they holding you

there doing CPR...or with a status seizure patient??? Or are they holding you

with an orthopeadic injury or abdominal pain? They have triaged and received a

report (albeit limited).

So, with all that being said, if the ED is uncooperative, the hospital won't

work with your EMS agency, and reporting the violations have done

nothing...agencies around the country have developed and/or found ways to remove

the patient from the stretcher and leave them in the ED...while the EMS unit

returns to service and to their service area.

I see no difference in this delay in returning to service (if criteria have been

met) so that we can serve our citizens who are waiting to call 911 and the

arguements many used to not want to do DUI blood draws...it takes us out of

service in limited resource areas....so does waiting in hallways with

patients...often times for much longer.

So...that being said...if after multiple attempts and steps at varying levels of

yoru local and regional EMS/Hospital structures....you have an ED that will not

cooperate and continues to hold patients on EMS stretchers...then yes I do

advocate leaving the patients on a backboard, in a wheel chair, on a bed

obtained from surgery holding...whatever....NOT to teach the hospital a lesson

but to get your crew out of the hospital and back available.

Dudley

Re: Hospital violations by making you wait in the

hallway...

Thank you, Gene. That did clarify it for me. I got the initial

impression that it was being suggested to leave the patient there to

teach the ED a lesson.

> > > RIGHT ON, LARRY! Good advice.

> > >

> > > Gene

> > > In a message dated 7/4/05 23:45:19, miller@g... writes:

> > >

> > >

> > > > You are absolutely correct. When the patient hits the

hospital

> > property

> > > > he/she is the responsibility of the ED. EMTALA is very

clear on

> > this issue.

> > > > I know from having served on the San Hospital's EMS

> > Diversion Task

> > > > Force for many years and having served as the recent

Chairman of

> > the 5

> > > > Baptist hospital Ed's for many years.

> > > >

> > > > You are staying around because you are a nice guy and want

to do

> > what is

> > > > best for the patient. But I will tell you unequivocally,

that by

> > staying

> > > > with your patient in the ED you are not helping to fix the

> > problem and you

> > > > are neglecting your prime objective ---- to transport

patients

> > and practice

> > > > medicine in the streets. Is the ED staff going to help you

do

> > your job? Of

> > > > course not.

> > > >

> > > > Sometimes it takes tough love to get necessary changes made.

> > Overcrowding

> > > > in the ED is not our fault. It is not the fault of the ED

> > either, but it is

> > > > the fault of the hospital system as a whole. One EMTALA

fine and

> > loosing

> > > > Medicare Certification will get their attention. They have

the

> > resources to

> > > > fix the problem. Lets help them by doing our job right,

instead

> > of enabling

> > > > them to continue their dysfunctional operations.

> > > >

> > > > Best,

> > > >

> > > >

> > > > Larry MD

> > > >

> > > > > I am sure there are those who know more than I, but through

> > recent events

> > > > I

> > > > > have been made aware that once the patient is on hospital

> > property,

> > > > regardless

> > > > > of whether the ED has accepted him/her, that patient is the

> > hospital's

> > > > > responsibility. EMTALA. Excessive delays do constitute an

> > EMTALA violation

> > > > as

> > > > > I understand it.

> > > > >

> > > > >

> >

> >

> >

> >

> >

> >

[Guest guest]

,

Let me step in here...because I believe...if all the other steps I outlined have

been completed (meeting with ED and Hospital Admin, working together to find

solutions, making reports to CMS, etc) that it might be acceptable to leave

patients in the hallway...but here is my point.

First, if the ED is holding you in the hall on your stretcher they know you are

there...and chances are they have triaged your patient...are they holding you

there doing CPR...or with a status seizure patient??? Or are they holding you

with an orthopeadic injury or abdominal pain? They have triaged and received a

report (albeit limited).

So, with all that being said, if the ED is uncooperative, the hospital won't

work with your EMS agency, and reporting the violations have done

nothing...agencies around the country have developed and/or found ways to remove

the patient from the stretcher and leave them in the ED...while the EMS unit

returns to service and to their service area.

I see no difference in this delay in returning to service (if criteria have been

met) so that we can serve our citizens who are waiting to call 911 and the

arguements many used to not want to do DUI blood draws...it takes us out of

service in limited resource areas....so does waiting in hallways with

patients...often times for much longer.

So...that being said...if after multiple attempts and steps at varying levels of

yoru local and regional EMS/Hospital structures....you have an ED that will not

cooperate and continues to hold patients on EMS stretchers...then yes I do

advocate leaving the patients on a backboard, in a wheel chair, on a bed

obtained from surgery holding...whatever....NOT to teach the hospital a lesson

but to get your crew out of the hospital and back available.

Dudley

Re: Hospital violations by making you wait in the

hallway...

Thank you, Gene. That did clarify it for me. I got the initial

impression that it was being suggested to leave the patient there to

teach the ED a lesson.

> > > RIGHT ON, LARRY! Good advice.

> > >

> > > Gene

> > > In a message dated 7/4/05 23:45:19, miller@g... writes:

> > >

> > >

> > > > You are absolutely correct. When the patient hits the

hospital

> > property

> > > > he/she is the responsibility of the ED. EMTALA is very

clear on

> > this issue.

> > > > I know from having served on the San Hospital's EMS

> > Diversion Task

> > > > Force for many years and having served as the recent

Chairman of

> > the 5

> > > > Baptist hospital Ed's for many years.

> > > >

> > > > You are staying around because you are a nice guy and want

to do

> > what is

> > > > best for the patient. But I will tell you unequivocally,

that by

> > staying

> > > > with your patient in the ED you are not helping to fix the

> > problem and you

> > > > are neglecting your prime objective ---- to transport

patients

> > and practice

> > > > medicine in the streets. Is the ED staff going to help you

do

> > your job? Of

> > > > course not.

> > > >

> > > > Sometimes it takes tough love to get necessary changes made.

> > Overcrowding

> > > > in the ED is not our fault. It is not the fault of the ED

> > either, but it is

> > > > the fault of the hospital system as a whole. One EMTALA

fine and

> > loosing

> > > > Medicare Certification will get their attention. They have

the

> > resources to

> > > > fix the problem. Lets help them by doing our job right,

instead

> > of enabling

> > > > them to continue their dysfunctional operations.

> > > >

> > > > Best,

> > > >

> > > >

> > > > Larry MD

> > > >

> > > > > I am sure there are those who know more than I, but through

> > recent events

> > > > I

> > > > > have been made aware that once the patient is on hospital

> > property,

> > > > regardless

> > > > > of whether the ED has accepted him/her, that patient is the

> > hospital's

> > > > > responsibility. EMTALA. Excessive delays do constitute an

> > EMTALA violation

> > > > as

> > > > > I understand it.

> > > > >

> > > > >

> >

> >

> >

> >

> >

> >