Case Study #2 will use the case “EMTALA Case” Chapter 6 of

Case Study #2 will use the case “EMTALA Case” Chapter 6 of the text, pages 164-165.

After reading the case write an essay [ 1,400 – 1,750 words —- 350 words = 1 page ] that addresses — What actions should Ms. Alexander take in order to minimize any probability of EMTALA lawsuits at her hospital.

As the basis of your analysis and recommendations address the following prompts/questions – do not look at the case questions on p165

What are the key issues Alexander likely sees in relation to concepts from Chapter 6 ( Legal & Regulatory) ?

Motivation is obviously a factor in this case – what did she see related to the motivation of staff at the other hospital and what should she be sure to do

Are there Structural / Staffing issues?

In what ways should she involve the Governing Board?

Now – Remember –

There are always multiple sides to every scenario. Try not to jump to conclusions. Instead, think critically about the scenario and what they see and should / could be doing in light of course ideas. You must provide justification – substantive support – for your thinking, i.e. What are the course concepts or ideas, other research findings, etc. that you can point to that strongly indicate ‘ the reader of your work should reasonably believe your position / assertions.’

Students often run with the seemingly more immediately interesting ‘legal’ issues @ hospital ‘A’. Yet, the legal issues are plain and really point to the Risk Mgmt issues that Alexander and the Board must be attuned to addressing at their hospital. And that is Alexander’s focus – Risk Mgmt – NOT legal issues that will have to be handled by the other HSO. In this vein consider the following diagram.

To EMPHASIZE — you have just studied a Module on RISK MANAGEMENT — CONSIDER THIS AS IF A TEST RE: YOUR ABILITY TO WORK WITH Risk Mgmt CONCEPTS. THE LEGAL ISSUES IN THE CASE JUST PROVIDE THE CONTEXT TO WORK WITH THESE CONCEPTS. The legal concepts ARE NOT THE FOCUS OF THE CASE. DON’T FOCUS MUCH ATTENTION ON THE ‘EASY’ LEGAL ASPECTS — IMPLEMENT CONCEPTS & IDEAS FROM CHAPTER 6.

Case Study 2 EMTALA CASE

A month after Olivia Alexander began her tenure as CEO of the Dallas, Texas, JLV Community Medical Center she learned from front-page articles in the local and regional newspapers of a new lawsuit that was filed against a Houston area community hospital and its neurosurgi-cal group. The legal basis of the suit was a violation of the Federal Emergency Medical Treatment and Assisted Labor Act (EMTALA). Having been in hospital manage-ment for a decade, Ms. Alexander was quite familiar with other EMTALA cases. She knew that the law was an anti–patient-dumping act, which has as its focus the require-ment that all patients seeking care in an emergency room, regardless of their financial situation, receive appropriate medical care and be stabilized before they are transferred to another facility. In the newspaper articles Ms. Alexander read the story

presented was of a woman, Mrs. Sally Altman, who was taken by her husband to the hospital’s emergency room. Mrs. Altman came in complaining of nausea, and an “unbe-lievable splitting headache.” She was poorly oriented and her speech was slurred. The ER triage nurse’s notes indi-cated an intake blood pressure of 199/125. In response to her situation the emergency room physician performed an examination of her major systems and ordered lab tests and placed her on a stretcher where her heart, blood pressure, oxygenation, and respiration were continuously monitored. Additionally, suspecting some degree of dehydration, the ER physician ordered a saline IV drip as well as an anti-emetic for Mrs. Altman. At some point within an hour of her admission to the ER Mrs. Altman needed to use the toilet. An internal hospital incident report investigation indicated that Mrs. Altman had pressed her call bell at least once and apparently, because the response from nursing was not immediate, she decided to

Case Study 2

climb over the rails of her stretcher, tripped on the IV line, and banged her head on the side of a cabinet. The noise attracted the staff who found Altman on the floor bleed-ing from a large gash on the forehead. The ER physician immediately brought her into the surgical procedure room, ordered sedation, and sutured the gash. Her husband asked what specialist had been consulted and was told none. He asked specifically that a neurosurgery consultant be called in and was told by the nurse that the neurosurgeons could only seen by appointment because they refused to be on the on-call list. When asked about her blood pressure the nurse said that it was still as it was and that there was nothing more they were going to do for her. The ER administrator then came over to Mr. Altman and suggested that he take his wife to the University Hospital where she might get more special-ized care. Worried about his wife’s unstable situation, but fearful that nothing was going to change at the local hospital, he agreed to the discharge but requested an ambulance take them to the University Hospital. The ER administrator said they could not do that so Mr. Altman drove his wife to the ER at the University. Once there a CT scan and an MRI were done that found a massive stroke that had likely been developing for hours. Mrs. Altman died later that night. Mr. Altman, on behalf of the estate of his late wife, has instituted the lawsuit.