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(Message started by: athos on Jan 20^th, 2004, 2:20am)

Title: medical screening examination ... Still Binding?
Post by athos on Jan 20^th, 2004, 2:20am

Is this still binding? Or has legislation changed?

I have been looking this up because of a recent visit to the ER where I spent more than 4 hours and 3 consecutive bouts of CH in the waiting room before even being seen by the triage nurse. Then it was another 3 hours bofore I was "treated" so to speak. So I am wondering if this is still a legal statute that can be enforced when visiting and ER with a CH bout.

Here is some of what I have found.

Quote:

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

Requirement to determine the existence of an emergency medical condition.

Federal law requires that all patients who present to the emergency department have a medical screening examination (MSE) to determine the existence of an emergency medical condition (EMC). This examination should be performed prior to obtaining financial information; prior authorization from a managed care organization is not permitted before MSE and stabilizing treatment.

The MSE must not be delayed. HCFA has cited some EDs in which patients have waited extended times prior to ED evaluation.

Triage is not considered an MSE. MSE must include history, physical examination, ancillary services routinely available to the ED (if indicated), and, when needed, services of an on-call physician to determine if an EMC exists.

The law does not require all patients to receive treatment within the emergency department if they do not have an EMC. A stable patient who does not have an EMC, as determined by the MSE, may be referred elsewhere (see Transfer to other hospitals). Referral cannot be based on finance, race, sex, age, membership in Health Maintenance Organizations (HMOs), insurance plans, or provider panels.

Legislation in numerous states, prior to revised federal law, also required EDs to provide care for all patients meeting a prudent layperson definition of EMC.

The prudent layperson definition of an EMC is widely interpreted yet generally defined as a medical condition that a nonmedical person with an average knowledge of the world would consider as needing emergency care. A recent survey of 1000 laypersons in the field attempted to define the prudent layperson definition for a number of specific complaints. Even among widely divergent socioeconomic groups, there was good agreement on what conditions needed ED care.

--------------[

So what I am asking is if the Medical Screening Examination is still required in a timely fashion and subsequent treatment based on the MSE

The reason I am asking is because I know that I have be treated poorly because I have Chronic Headaches. Even discriminated against because of them. I know that others of us have as well.

I would just like a little leverage going in when I have to wait through, while in CH hell, until they decide to finally treat me.

Title: Re: medical screening examination ... Still Bindin
Post by athos on Jan 20^th, 2004, 3:19am

More

Exerpts from Federal Emergency Medical Treatment and Active Labor Act, also known as COBRA or the Patient Anti-Dumping Law.

http://www.uplaw.net/statute.txt

Quote:

(d) Enforcement

(1) Civil money penalties
(A) A participating hospital that negligently violates a
requirement of this section is subject to a civil money penalty of not more than $50,000 (or not more than $25,000 in the case of a hospital with less than 100 beds) for each such violation. The provisions of section 1320a-7a of this title (other than subsections (a) and (b)) shall apply to a civil money penalty under this subparagraph in the same manner as such provisions apply with respect to a penalty or proceeding under section 1320a-7a(a) of this title.
(B) Subject to subparagraph (C), any physician who is
responsible for the examination, treatment, or transfer of an individual in a participating hospital, including a physician on-call for the care of such an individual or a physician working at or on-call at a hospital that is subject to the requirements of subsection (g), and who negligently violates a requirement of this section, including a physician who -
(i) signs a certification under subsection (c)(1)(A) of this section that the medical benefits reasonably to be expected from a transfer to another facility outweigh the risks associated with the transfer, if the physician knew or should have known that the benefits did not outweigh the risks,
(ii) misrepresents an individual's condition or other information, including a hospital's obligations under this section,
(iii) fails or refuses to appear within a reasonable time at a hospital subject to the requirements of subsection (g) in order to provide an appropriate medical screening examination as required by subsection (a), or necessary stabilizing treatment as required by subsection (b), or
(iv) fails or refuses to accept an appropriate transfer of a patient to a hospital that has specialized capabilities or facilities as defined
in subsection (g),".

is subject to a civil money penalty of not more than $50,000 for each such violation and, if the violation is is (FOOTNOTE 2) gross and flagrant or is repeated, to exclusion from participation in this subchapter and State health care programs. The provisions of section 1320a-7a of this title (other than the first and second sentences of subsection (a) and subsection (b))
shall apply to a civil money penalty and exclusion under this subparagraph in the same manner as such provisions apply with respect to a penalty, exclusion, or proceeding under section 1320a-7a(a) of this title.

cont'

Title: Re: medical screening examination ... Still Bindin
Post by athos on Jan 20^th, 2004, 3:23am

Even More...

Quote:

(e) Definitions

In this section:
(1) The term ''emergency medical condition'' means -
(A) 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 -
(i) placing the health of the individual (or, with respect to a pregnant woman, the health of the woman or her unborn child) in serious jeopardy,
(ii) serious impairment to bodily functions, or
(iii) serious dysfunction of any bodily organ or part; or
(B) with respect to a pregnant women (FOOTNOTE 3) who is having contractions -
(FOOTNOTE 3) So in original. Probably should be ''woman''.
(i) that there is inadequate time to effect a safe transfer to another hospital before delivery, or
(ii) that transfer may pose a threat to the health or safety of the woman or the unborn child.
(2) The term ''participating hospital'' means hospital that has entered into a provider agreement under section 1395cc of this title.
(3)(A) The term ''to stabilize'' means, with respect to an emergency medical condition described in paragraph (1)(A), to provide such medical treatment of the condition as may be necessary to assure, within reasonable medical probability, that no material deterioration of the condition is likely to result from or occur during the transfer of the individual from a facility, or, with respect to an emergency medical condition described in paragraph (1)(B), to deliver (including the placenta).
(B) The term ''stabilized'' means, with respect to an emergency medical condition described in paragraph (1)(A), that no material deterioration of the condition is likely, within reasonable medical probability, to result from or occur during the transfer of the individual from a facility, or, with respect to an emergency medical condition described in paragraph (1)(B), that the woman has delivered (including the placenta).
(4) The term ''transfer'' means the movement (including the discharge) of an individual outside a hospital's facilities at the direction of any person employed by (or affiliated or associated, directly or indirectly, with) the hospital, but does not include such a movement of an individual who (A) has been declared dead, or (B) leaves the facility without the permission of any such person.
(5) The term ''hospital'' includes a rural primary care
hospital (as defined in section 1395x(mm)(1) of this title).

(g) Nondiscrimination

A participating hospital that has specialized capabilities or facilities (such as burn units, shock-trauma units, neonatal intensive care units, or (with respect to rural areas) regional referral centers as identified by the Secretary in regulation) shall not refuse to accept an appropriate transfer of an individual who requires such specialized capabilities or facilities if the hospital has the capacity to treat the individual.
(h) No delay in examination or treatment
A participating hospital may not delay provision of an
appropriate medical screening examination required under subsection
(a) of this section or further medical examination and treatment required under subsection (b) of this section in order to inquire about the individual's method of payment or insurance status.
(i) Whistleblower protections A participating hospital may not penalize or take adverse action against a qualified medical person described in subsection (c)(1)(A)(iii) of this section or a physician because the person or physician refuses to authorize the transfer of an individual with an emergency medical condition that has not been stabilized or against any hospital employee because the employee reports aviolation of a requirement of this section.

Ok that is more than enough.... let me know what the group thinks about this.... I want to make a statement in this small town... CH'ers are not drug seekers, not fakers, not attention seekers... what we are seeking is relief.

I may be barking up the wrong hill, but I am barking, and if I go to the hospital administration with this I think I will be noticed...

Does anyone think that this is too much?

Athos

Title: Re: medical screening examination ... Still Bindin
Post by chronic_chic on Jan 20^th, 2004, 6:41am

I don't know about this Athos. In our Emergency Room in Philly, this is how things work...and I'm just going to explain it...I'm not saying this is RIGHT. A patient comes in, they have to come to registration and give their name, date of birth, and cheif complaint. We check and see if they have ever been to our hospital before. IF the complaint is something like chest pains, stroke symptoms, bleeding profusely, diabetes out of control, proven extremely high blood pressure, or they are elderly with certain symptoms, then we call triage to alert them that there is a patient who needs to be seen first. Otherwise triage sees them first come, first serve. Once a patient sees triage, if deemed necessary, they are taken straight back to the ED. If not, they are sent back out to the waiting room to wait. Either way, we have to register them. If they are in the waiting room, we call them up to get their information, and the rate at which we call them up does NOT effect the rate at which they will be seen in the back. (Sometimes we get bogged down and people complain that they haven't been registered yet and it's holding them up from being seen....no...they'll take you anyways...then we just have to register you at bedside). If you're already in the back, then we have to do a bedside registration.
At our hospital, there are many beds, but many of the beds are in the hall outside the rooms....not the primo conditions for someone having a migraine/cluster/any type of headache attack. This is why I try to tell headache patients to stay away from the ER...although they DO get them the right meds at our ER, the conditions can often exacerbate the headaches before getting the treatment. If you're in the waiting room, sometimes it can be hours before receiving treatment or sometimes the wait is fast. It depends on how busy the night is. In an inner city hospital, you never know. However, the nurses in the back determine who will go back first once someone has been triaged.
In triage, a number is given to each patient. This number refers to the severity of a patients condition from 0-5. A 0 means they are pretty much dead. A 5 means they can wait. The nurses have to give treatment to the 1's and 2's first because they are generally there for something very serious, but to be honest, few people are rated with a 1 or 2. Most people are rated with 3's. I'd take my bets that a CH patient would get a 3 rating as well. This would mean that treatment would occur as quickly as possible, but still relatively in the order that you got there.
SOOOOOOOooooooo that being said....sometimes you are forced to wait a long time, but sometimes you get lucky and go back pretty darn fast. In center city Philly, you never know. Some nights the ER gets crowded because people get bored on the streets and feel like the ER is the place to hang out. I'm not kidding.
I think the term EMC is generally going to refer to someone in the condition of trauma, heart attack, stroke, labor, prominently bleeding, etc. Something with the risk of imminent death. However, I could be wrong. I wish you the best of luck in your fight and let me know if there's anything I can do!
~Lizzie :)

Title: Re: medical screening examination ... Still Bindin
Post by t_h_b on Jan 20^th, 2004, 7:26am

Yes, the ER must still conduct a comprehensive Medical Screening Exam unless it is clear from the patient's request that they are not requesting examnination or treatment for an Emergency Medical Condition (i.e., are requesting suture removal). A non-advanced practice RN can perform the basic MSE which implies that an MD or NP or PA must conduct the comprehensive exam.

Under the prudent layperson definition of an emergency, severe pain is considered a valid emergency.

All of this is still valid and current and enforceable. It is more of a regulatory issue than something you can call the police for but you can always report violations to the JCAHO (Joint Commission for the Accreditation of Hospital Organizations) as well as the appropriate state governing bodies such as the health and/or insurance departments.

Your insurance company may have a contract with the hospital and the quality department both there and in the hospital might be interested. At the insurance company where I work we investigate cases where there is no documentation of appropriate treatment for pain. Although we are very conscientious, we usually find out about it by chance when reviewing an ER case to determine the appropriate payment to the hospital.

The ER doc might intervene if he were aware of a violation in progress. The hospital administrators and the Nursing Supervisor who is on duty (even at night) might be interested in violations as well. The Nurse Manager in the ER might be able to help, too.

The failure to appropriately treat pain is also reportable.

It would be best to not be threatening but it would be appropriate to let the staff at the hospital know that you know the law and your rights and ask to speak to someone higher up if there is a problem.

However, if there are gunshots and motor vehicle accidents in the ER, you're still going to have to wait. If you know you have a cluster headache, it is not immediately life-threatening. However, a severe headache of unknown cause might be a subarachnoid hemorrhage or something else life-threatening.

If you need oxygen, it might not hurt to keep telling everyone (from the registrar to the triage RN to the MD), "I need oxygen now. Please give me oxygen now." That would let them know that you need something that they could give you without you having to wait to be examined and treated. Everybody who works in the ER knows how to hook someone up to oxygen.

Title: Re: medical screening examination ... Still Bindin
Post by athos on Jan 20^th, 2004, 12:03pm

Thanks for the input...

The situation I am referring to was during a "slow" time... There were no ambulances... I checked... and room space was abundant... It was the Dr's choice to let me sit, nothing more... I am in the process of request my treatment record at the hospital... registration times... Treatment times, and discharge times... and other areas such as situations that may have caused the delay...

Now once I was taken to an examination room I waited another 45 min, only to be seen by a med student... another. There he asked what work and what did not... I told him that O2 did not and Torodol did not... I told him that I was allergic to Triptans and that they make me stop breathing.

Once the Doctor showed up.... He put me on O2 and gave me torodol, which just makes me itch, and some other hairbraind drug.

After 2 hours dealing with that and his comments and lack civility, they finally gave me something that knocked me out for the next 6 hours.... And they subsequently charged me well over $2000!

The ER was not busy there were no gunshot wounds etc.... I would completely understand if there were. I remember being in inner city dertoit in 88 in an ER and that was an experience I will never forget.

Title: Re: medical screening examination ... Still Bindin
Post by t_h_b on Jan 20^th, 2004, 6:02pm

It might help at the ER if you know what you need. At least that ER doc gave you O2 and tried to do something about the pain. Obviously the ER doc didn't read what the resident had written. You can always refuse a medication, especially if you know it didn't work in the past. You really shouldn't expect an ER doc to come up with some treatment for CH that you don't already know about and ask for except for the usual meds and O2. From what I have read here narcotics don't work too well for CH so if you tell them that right off the bat they won't be suspicious that you are merely drug-seeking.

I'm curious as to what he gave you that knocked you out for six hours and whether you spent that time at home or in the ER. (I might want some of that stuff!) Allso, what was the other, "hare-brained" drug, if you know?

That bill is very high for an ER visit unless they did CT scans or MRI or something. Surely if you talk to the financial department at the hospital they will reduce it and work out payments. If you had insurance and it were a contracted hospital they would probably pay about a tenth or less of what you were billed.

If you're trying to investigate your treatment you need to request your medical record. The patient rep or equivalent should be able to help you with your complaint. Also, complaints addressed to the head of the hospital are usually passed off to someone who takes them seriously.

Good luck.

Title: Re: medical screening examination ... Still Bindin
Post by chronic_chic on Jan 20^th, 2004, 9:31pm

Athos,
Did you see my ER form link under the other ER post on the meds board? PM or msg me on msn if you want it. A doc can fill it out with what you SHOULD get when you go to the ER with what works for you. It can be signed by your doc and put on their letterhead even so that it is fully legitimate. This way, they won't just give you any old thing. And they will also be more likely to treat you like a real human, instead of a drug seeker. Let me know if you would like the link to these forms. There is one for your doctor to fill out and one that you yourself can fill out. Hope this helps you.

Hugz,
Lizzie

Title: Re: medical screening examination ... Still Bindin
Post by athos on Jan 20^th, 2004, 11:06pm

these guys on a seperate occasion overdosed me with Nubain.... the same doc... doc Ward

They gave me one shot the highest dose they are supposed to give..... within 5 min they gave me the same amount... I did not know what they were doing, I was out of it as you can imagine.. The second shot was a surprise but I thought it was something else that they were giving me... Phenegren or visteral.. but no a double dose of a narcotic...

Title: Re: medical screening examination ... Still Bindin
Post by hdbngr on Jan 21^st, 2004, 5:46pm

Seems like the law of averages should work and at least some of us should have had a positive experience in the ER by now. Yuck.

My sister is an RN in the ER, and explained that they usually see at least 80 patients every week for headache. She said red flags go up with staff if you have visited the ER more than three times for the same complaint, state that O2 doesn't work for you, or that you have no luck with regular anti-inflammatory medication (Toradol)/Triptan class meds.

Considering most staff don't distinguish between cluster and migraine, or drug-seeking behavior, the odds are against us. My primary has offered to send a standing written order to the ER so that they know it's legit. I took her up on this once and the ER couldn't find the order until the next day, but it's a good idea in theory....

Now, when it gets unbearable, I go the her office and she injects Toradal, a wollop dose of Phenergan, and can do a magnesium IV, which sometimes helps, saving the trip, wait, expense and scorn that followed before.