Hospital refusing patient?

MikeEMTB

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Has anyone ever had a hospital refuse a patient for reasons other than the patient meets trauma criteria and wasn't brought to a trauma center etc... I had brought in a psych patient (definitely harm to himself and others and was seeking treatment) to a hospital who had been admitted and discharged earlier (prematurely in my opinion). When we brought him back to said facility (our only psych center) the hospital initially denied to accept him and only when supervisors from both sides were brought in did they finally agree ~1 hour total. Does a hospital actually have the right to refuse to accept and treat a patient? I know about EMTLA but I don't know if this was a violation because it didn't have to do with the individuals ability to pay just the hospitals unwillingness to keep the individual for treatment.
 

Akulahawk

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If a patient shows back up at the same hospital after being discharged, the only thing the ED must do is a MSE and if that shows there's been no changes since discharge and there's no current medical/psychiatric emergency at that time, then the patient can be discharged right then.
 
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MikeEMTB

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If a patient shows back up at the same hospital after being discharged, the only thing the ED must do is a MSE and if that shows there's been no changes since discharge and there's no current medical/psychiatric emergency at that time, then the patient can be discharged right then.
But then that means that they must accept and triage the patient from EMS as opposed to just refusing to do any of the above, correct?
 

OnceAnEMT

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The crew could be held liable for going to a different facility if the patient didn't request such. The ED should have "accepted" the patient one way or another. We can't just turn folks away. Even if they get discharged, walk out of the department, go sit in the waiting room for 5 minutes, then decide they want to check back in, we do it (and this happens frequently). A conversation will be had, sure, but no one would (or should...) ever flatly say "No." This is of course for hospitals under EMTALA (accept Medicaid/Medicare).

Now, much further than that goes over my head. As a public hospital I do not believe we can turn away/"refuse" patients after the MSE, but I could be wrong there. Even when PD brings in the patient that is a jerk of a drunk and doesn't need to M2F in our facility, that patient still gets a triage, MSE, and full discharge in a matter of minutes (as already mentioned). That said, there are a number of private urgent cares in the area that require a down-payment after the MSE if it is deemed that the patient is not experiencing a medical emergency.

Sounds like in your case the hospital should have bit their tongue and gone a step further from the last visit and involved a mental health officer or longer-term facility.
 

Akulahawk

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But then that means that they must accept and triage the patient from EMS as opposed to just refusing to do any of the above, correct?
In short, yes. However that doesn't mean that accepting report, doing triage, an MSE and subsequent dispo can't happen very, very quickly. Typically a triage nurse isn't doing the MSE as they're typically not qualified to perform one. I have seen patients brought in, triaged at bedside, an MSE done by the EDMD, and dispo'd as discharged within a few minutes as nothing has changed since the patient's previous discharge minutes or hours ago. That being said, often there's a conversation that's had with Security after the discharge stating, in essence, next time you come back, you need to have an actual problem not related to simply wanting a meal and a warm bed or we'll trespass you after we determine you have no medical emergency...
 

Akulahawk

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TransportJockey

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Only hospital I have been to that could flat out refuse patients was the VA system

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Summit

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Were they on divert?
 

NPO

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Has anyone ever had a hospital refuse a patient for reasons other than the patient meets trauma criteria and wasn't brought to a trauma center etc...
The VA hospitals. But I suspect that's not relevant to your overall question.



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Tigger

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Our hospitals can and will get restraining orders against patients but they still have to provide the MSE.
 

VFlutter

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Is there any consideration for patient's whom return after signing out AMA? I thought the hospital can refuse but I still think they get a MSE.
 

NPO

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Our hospitals can and will get restraining orders against patients but they still have to provide the MSE.
How's this work?
Asking for a friend.

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Bullets

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We have a few patients who have active restraining orders. We can still bring them in but they are immediately placed under watch by security and arrested upon discharge
 

Handsome Robb

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Alright I'm gonna be that guy.... what's MSE?




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Tigger

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How's this work?
Asking for a friend.

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I have no idea how they are able to do this. The patient can still show up, but once the hospital does the Medical Screening Exam and decides there is nothing life threatening...out they go.
 

NPO

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I have no idea how they are able to do this. The patient can still show up, but once the hospital does the Medical Screening Exam and decides there is nothing life threatening...out they go.
One of our hospitals has wanted to do this for a psych patient with a history of assaulting staff.

Too bad we can't do that. We remain assaulted.

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Dennhop

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Can someone explain to me the process of a hospital trespassing someone off the property? I've seen it happen before, but never understood how it really works, and what happens to the individual after the fact...so they deem them physically ok, trespass them off...but if that person shows up a few hours or a day later, what exactly does that mean for future pt care?
 

Akulahawk

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Can someone explain to me the process of a hospital trespassing someone off the property? I've seen it happen before, but never understood how it really works, and what happens to the individual after the fact...so they deem them physically ok, trespass them off...but if that person shows up a few hours or a day later, what exactly does that mean for future pt care?
Basically what happens is after the hospital has determined that the patient doesn't have a medical or psychiatric emergency (doesn't mean the patient doesn't have a medical or psychiatric condition, just not an emergent one right then), the Hospital no longer has an EMTALA duty to care for the patient. This cannot be determined until the patient has had an MSE done by someone qualified to perform the MSE. (This is very important, BTW.) Since the Hospital no longer is required by EMTALA to treat the patient, the Hospital ED can discharge the patient. At that time the patient is considered to be just like any other person and the Hospital does not have to allow the person to remain on Hospital grounds. If the person refuses to leave, that person can be arrested/charged with trespassing. Here's the wrinkle: person comes back to the ED claiming to have a medical or psychiatric emergency, the Hospital then is required by EMTALA to perform another MSE. If no emergent condition is found, the cycle continues. If the person does this enough times, the Hospital may attempt to have a restraining order placed and violation of said order results in arrest. In that instance, the person had better truly have a medical or psychiatric emergency if they present themselves to the ED or they'll be in violation of the restraining order. If that happens and the patient is stabilized and can be discharged, the person must leave immediately or be subject to the RO.

Here's an interesting twist as well: if someone keeps returning to the ED, the Hospital may try to have that person arrested/charged with (basically) abuse of the emergency system.

In short, read up on EMTALA. It's a very big hammer that Hospitals do NOT want to get hit with and it's easy to violate this law. EMTALA does have its limits and that is once the patient's emergency condition is stabilized, EMTALA no longer applies. Under EMTALA, the Hospital doesn't have to treat or stabilize all of the patient's conditions, only their emergent ones. Patients often don't understand this...
 

Jim37F

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Basically what happens is after the hospital has determined that the patient doesn't have a medical or psychiatric emergency (doesn't mean the patient doesn't have a medical or psychiatric condition, just not an emergent one right then), the Hospital no longer has an EMTALA duty to care for the patient. This cannot be determined until the patient has had an MSE done by someone qualified to perform the MSE. (This is very important, BTW.) Since the Hospital no longer is required by EMTALA to treat the patient, the Hospital ED can discharge the patient. At that time the patient is considered to be just like any other person and the Hospital does not have to allow the person to remain on Hospital grounds. If the person refuses to leave, that person can be arrested/charged with trespassing. Here's the wrinkle: person comes back to the ED claiming to have a medical or psychiatric emergency, the Hospital then is required by EMTALA to perform another MSE. If no emergent condition is found, the cycle continues. If the person does this enough times, the Hospital may attempt to have a restraining order placed and violation of said order results in arrest. In that instance, the person had better truly have a medical or psychiatric emergency if they present themselves to the ED or they'll be in violation of the restraining order. If that happens and the patient is stabilized and can be discharged, the person must leave immediately or be subject to the RO.

Here's an interesting twist as well: if someone keeps returning to the ED, the Hospital may try to have that person arrested/charged with (basically) abuse of the emergency system.

In short, read up on EMTALA. It's a very big hammer that Hospitals do NOT want to get hit with and it's easy to violate this law. EMTALA does have its limits and that is once the patient's emergency condition is stabilized, EMTALA no longer applies. Under EMTALA, the Hospital doesn't have to treat or stabilize all of the patient's conditions, only their emergent ones. Patients often don't understand this...
interesting and good to know! Explains how a frequent flyer we had once said he couldn't go to the hospital a couple blocks away from where we normally pick him up because they had a restraining order against him, no one actually knew how that was supposed to work.....or how the other we picked up last shift explained both of the two closer hospitals keep calling the Sheriffs Dept on him every time he shows up, this explains both those situations rather nicely...
 

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