Want to have an intelligent discussion on a point of disagreement? Fine. Whan to act like an idiot and hurl insults needlessly? Get your own blog and reign like an anal sphincter.

EMTALA is really specific and, as you have found out, rarely applied except when it comes to things that your hinder care and slow you down. The, as Dr Leap says, it grows fangs, claws, develops bad breath and reached 20 stories in height. One day soon hospitals will realize that if they drop Medicare, the all this crap goes away (a whole other topic, but mark my words, hospitals will start dropping Medicare…)

So, let’s deal with the real world.

The risk today is that if you push the issue, the specialist may balk and cease taking call, which in a smaller hospital could cripple the ER. The ramifications to you, in the mecca, are obvious. You will be getting all my ortho (for example) patients if my one ortho guy stops taking call, instead of the occasional “comfort level” patient. OTOH, if this situation is allowed to occur and goes unchecked then the specialist comfort level rapidly deteriorates after midnight, only to return at 7am.

What I do in the sending hospital is notify our (useless) hospital administrator to expect an EMTALA call from the mecca. They usually will have a talk with the offending specialist (along the “why are you turning away cash” discussions… something hospital administrators understand).
If I am working at the mecca, I usually get the name and number of the sending hospital specialist and give the name to our forced accepting specialist, and let those two hash it out. I also give the mecca (even more useless) administration a heads up call.

Reporting docs to their boards becomes a slippery slope, and should be reserved as a nuclear option. And remember Newton’s law: For every action there will be a reaction. I have seen stuff like this in up in court.

In the old days, when docs were allowed to decide what they wanted to do and when they thought it best to do it, it was rare for anyone to die in the streets for lack of medical attention. Now, with government, administrators, bureaucrats, lawyers, and various other regulators telling us what to do, where and when to do it, and whether and how much we’ll be paid to do it, it’s only a matter of time before people start dying, not in the streets, but in the ER, where they can force a facility to do the precious screening exam, but then only hope that there is a gullible specialist around who will subject himself to the stress, liability, and general unpleasantness of serving on an ER panel. It’s terrible that it has come to this, but, as they said in the movie, “Who you gonna get?”

So for these questionable cases I’d ask the sending ED doc to get the sending specialists to talk to the receiving specialist prior to accepting transfer. Personally I’d be hesitant to file a complaint to their board, I’d rather put the onus on the accepting specialists to determine if the sending specialist’s transfers are inappropriate.

No one in my administration ER or hospital nor the medical staff offered any support in the problem. I guess nothing has changed. That is one of the reasons I no longer practice hosptial based emergency medicine.