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

July 6, 2005

,

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.

> > > > >

> >

July 7, 2005

Actually, I've always viewed it as the inverse (Paramedics are all licensed,

whether " licensed " or " certified " ). Certification shows proof of competency

whereas the act of licensure is the rendering of permission to engage in

occupational practice.

Mike

_____

From: [mailto: ] On

Behalf Of lnmolino@...

Sent: Tuesday, July 05, 2005 6:25 PM

To:

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

hallway...

In a message dated 7/5/2005 5:23:18 P.M. Central Daylight Time,

texsis74@... writes:

if a paramedic is licensed

Read some of what Gene Gandy and Dr. Bledsoe have said about the whole

concept of LP in Texas. As I understand it based on their statements NO

paramedics

are TRULY " licensed " .

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.

July 7, 2005

I agree, I must have misread or misinterpreted the post. As for the SA

hospital information, I would like to have one of those $35 hr wardclerk

jobs!

Lee

Re: Hospital violations by making you wait in the

hallway...

Lee,

I don't think Dudley was referring strictly to the physician as a

medical director of a service. I think he was making a generalized

statement that we could not accept delegation from a physician in

any form unless they were licensed in Texas. I have been unable to

find anything that says that we can't accept delegation from a

physician who is licensed to practice in good standing in another

state. As is the case in some occupational health settings, remote

medical site settings, offshore, etc. I was mainly referring to

working in a typical ER in the state of Texas in my original post

however, and I can't see where a non-Texas licensed physician would

be working as an attending in a Texas ER.

On another note, I ran across an ER here in the San area

just recently which has done away with all ancillary staff, ER techs

(EMT's and Paramedic's, Unit Clerks, etc. in the ER as of 1 year

ago. The MD's or DO's and RN's ONLY (No LVNS), are the only ones

allowed to do anything in the ER from enter orders to re-stock

supplies, to patient care, to lab draws and ECG's, etc. etc.

etc........ They believe this raises the standard of care and

increases the level of care received by the patient, whre I see it

as merely an effective cost cutting measure). Possibly overtaxing

the RN's and MD's and DO's trying to make them play unit clerk,

tech, etc. There are valid reasons for all of these positions,

although; they explained to me that Paramedic's are a liability to

the hospital (BS), and that LVN's have no place except on a floor or

in a nursing home (and never were intended to be used anywhere else

when the LVN / LPN was conceived)(BS), and that anyone can register

a patient and enter orders, so unit clerks are a waste of money.

Now, off my soapbox, except to say that their patient's take twice

to three times as long to be discharged from the ER or admitted to a

unit, or transferred, than any other facility in our RAC.

July 7, 2005