This document discusses a case study involving two paramedics, Robert and Roy, who transported two critically injured patients from an automobile accident to the nearby city hospital without checking the hospital's divert status. Upon arrival, they discovered the hospital was on divert for the emergency department and pediatrics. A verbal altercation ensued over admitting the patients, resulting in further delays to care. The young girl went into cardiac arrest and died. The document then provides discussion questions on liability and responsibilities of various parties under the Emergency Medical Treatment and Active Labor Act (EMTALA). It also summarizes EMTALA and discusses issues around its implementation regarding costs, screening exams, and limitations.

1. (Mt) – Management Emergency Divert Status Report
Supporting Lectures: Review the following lecture: o The Emergency Medical Treatment
Active Labor Act (EMTALA) Introduction: Robert and Roy, emergency medical technician
paramedics (EMT-P), were back on the streets after a slow afternoon of handling
administrative tasks in the office. Neither paramedic had checked the divert status board
before heading out , so they were unaware that numerous hospitals in the city were on
emergency department (ED) divert. Tasks: Case Study Eighty-Three: Emergency Divert
Status Read the above case study; your task would be to evaluate this case study utilizing
the format below. Make sure to include at least two scholarly/peer-reviewed articles to help
support your evaluation. Case Study Evaluation o o Prepare a written report of the case
Summarize the scenario in
your own words—do not simply regurgitate the case. Briefly describe the organization,
setting, situation, who is involved, who decides what, etc. Specifically identify the major
ssues? What are the differences? Can
secondary issues become major problems? Present an analysis of the causes and effects. 1
Fully explain your reasoning. Declare your role in a sentence or a short paragraph
explaining from which role you will address the major problem and whether you are the
your choice, you must justify in writing as to why you chose that role. What are the
advantages and disadvantages of your selected role? Be specific. Recognize the strengths
relation to the major problem. Again, your focus here should be in describing what the
organization is capable of doing (and not capable of doing) with respect to addressing the
major problem. Thus, the identified strengths and weaknesses should include those at the
managerial level of the problem. For example, if you have chosen to address the problem
from the departmental perspective and the department is understaffed, that is a weakness
worthy of mentioning. Be sure to remember to include any strengths/weaknesses that may
the two to three alternative solutions you came up with. What feasible strategies would you
recommend? What are the pros and cons? State what should be done—why, how, and by
whom. Be specific. Evaluate how you would know when you’ve gotten there. There must be
measurable goals put in place with the recommendations. Money is easiest to measure;

2. what else can be measured? What evaluation plan would you put in place to assess whether
ll” your
proposed solution to the organization. Convince the reader that your proposed solution is
the best available and that it will work as planned. Make sure that the goals you identify are
ignments, cite your sources in
your work and provide references for the citations in APA format. 2 Submission Details: o
Your assignment should be addressed in a 4to 6-page document. 3 CASE 83 Emergency
Divert Status Kevin D. Zeiler Robert and Roy, emergency medical technician paramedics
(EMT-P) were back on the streets after a slow afternoon of handling administrative tasks in
the office. Neither paramedic had checked the divert status board before heading out, so
they were unaware that numerous hospitals in the city were on Emergency Department
(ED) divert.* After having worked 18 hours with only 3 hours off, they were hoping to settle
into a quiet shift that would allow them an opportunity to get some rest. Within 30 minutes
of getting to their first assigned post, the radio call came through that an adult and child
were injured in an automobile accident. Robert and Roy headed to the scene to find that a
father and daughter had been riding a bicycle when they were struck at high speed by an
automobile. The injuries were serious and both needed emergency treatment. The
paramedics decided to take both patients to the nearby city hospital for treatment. Robert
rode in the back and was in charge of caring for the patients, while Roy drove. On the way to
the facility the young girl quit breathing and required intubation to sustain her airway.
Because of the time required to intubate and stabilize the patient, Robert never notified the
receiving facility that they were coming with two critical emergent patients. In addition,
Roy, as the driver, never contacted the facility and also never contacted dispatch to see if the
facility was on divert. Upon their arrival at the city hospital, Robert and Roy found out that
the hospital was on ED divert as well as pediatric trauma divert. In other words, they were
not accepting any patients to the ED and they were not accepting any children. Because
Robert and Roy felt that they could not support the pediatric patient any longer in the back
of an ambulance, they wheeled both patients into an unprepared Emergency Department. A
verbal battle ensued between the emergency room physician and the paramedics, which led
to a further delay in care for the injured trauma patients. Ultimately, the hospital agreed to
care for the patients, but soon realized that the young girl had gone into cardiac arrest and
died. She could not be resuscitated. 1 Discussion Questions 1. Who is at fault in the above
scenario? Why? 2. As an emergency department supervisor, what legal principle would you
rely on to make your case about the divert status of your facility? 3. As a health
administrator in charge of ambulance operations, what issues must you address with your
ambulance crew? How would you frame your argument concerning legislation that has been
enacted to protect patients from hospital divert situations? 4. Is there any issue with the
paramedics concerning the amount of time they recently worked? 5. Finally, explain the
liability issues for all participants, i.e., the receiving hospital, the ambulance service,
physicians, paramedics, supervisors, etc. ADDITIONAL RESOURCES Buchbinder, S. B., &
Shanks, N. H. (Eds.). (2012). Introduction to health care management (2nd ed.). Burlington,
MA: Jones & Bartlett. EMTALA.com. Retrieved from http://www.emtala.com/ Furrow, B. R.,
Greaney, T. L., Johnson, S. H., Jost, T. S., & Schwartz, R. L. (2008). Health law: Cases, material

3. and problems (6th ed.). St. Paul, MN: Thomson-West. Moy, M. M. (2012). EMTALA answer
book (2012 ed.). New York, NY: Aspen. * Diversion or divert status is a “temporary status
for a health care facility, where its administration informs its emergency medical services
that the hospital is full” (Diversion status. (n.d.). In The free dictionary. Retrieved from
http://medicaldictionary.thefreedictionary.com/Diversion+Status). 2 The Emergency
Medical Treatment and Active Labor Act (EMTALA) The purpose of the Emergency Medical
Treatment and Active Labor Act (EMTALA) is to ensure that any individual who comes to a
hospital, through the ER, is cared for, even if he or she does not have insurance. The ability
to give this care may be threatened by insufficient capacity, inadequate community
resources, and the uninsured and underinsured who have no other resource. Now, some
patients, who do not have insurance, have taken to use the ER as their primary care
physician (The Ethics Committee, 2005). This is one of the things the Affordable Care Act
addressed by expanding the coverage for patients under the Medicaid program. The Act
stops hospitals from financially screening patients, but there is still the practice of “triaging
out” patients and treating patients with true emergencies first (Moffat, 2017). So it’s
difficult for an ER physician to resolve the conflicting obligations of the patient, the hospital,
and the payments that will be incurred by treating someone without insurance, which is
commonly filtered into the bad debt budget for the hospital. Those costs can filter out
among the rest of the hospital with increased cost to those who do have insurance (The
Ethics Committee, 2005). Another ethical question is how financing medical care should
influence individual medical decision making (The Ethics Committee, 2005). This is when
the third parties get involved. Many times, a physician will want a specific scan done, e.g.,
computed tomography (CT) scan and magnetic resonance imaging (MRI). Many times, the
insurance company won’t allow it until other steps or scans have been done (The Ethics
Committee, 2005) even if the Doctor has documented that the MRI with contrast will show
the possible sign of a liver lesion while the CT scan will show only an unclear view. Though
many times, the insurance will state that the CT scan should be done, even though it’s
inadequate, before they will approve the MRI. It’s a difficult issue for the ER physicians as
they are ethically bound to help everyone that comes through the ER doors, but the cost can
sometimes be overwhelming for the institution. Limitations of the EMTALA Law Ant-
Dumping Example Designed to prevent private hospitals from transferring uninsured or
underinsured patients to public hospitals, enforcement and fines seem to come in waves. In
2000, Congress made EMTALA enforcement a priority with nearly as much in penalties in
that year as in the previous ten years. EMTALA made national headlines again in 2013 when
a Nevada psychiatric hospital was accused of sending patients to California by bus without
making arrangements for their care. EMTALA Law Misinterpretation 1 Example Some
groups are proactive and require all of their physicians to undergo an annual EMTALA
continuing medical education (CME) course. On the other end of the spectrum, some
emergency room (ER) groups have no written policy about EMTALA and leave it to the
medical director to educate their staff. Medical Screening Exams Example Under EMTALA,
everyone who comes to the emergency department (ED) and requests medical care has a
right to a medical screening exam. This screening examination should be reasonably
calculated to uncover any emergency medical condition. The screening examination must

4. also be nondiscriminatory, meaning that all patients with similar complaints must receive
similar screening exams and/or testing (Silverman, 2015). Who Pays the Cost for EMTALA?
EMTALA is, indeed, the central factor in the “free-rider” phenomenon. The government
forces hospitals to care for these individuals, without financially compensating hospitals for
the cost of doing so. Hospitals in areas with a high indigent population must shift more of
the cost of unreimbursed care than those in areas of low unreimbursed care. It’s like
increasing the taxes in poor areas and lowering taxes in affluent areas. Furthermore, since
the bills are different with each patient, some will receive a higher proportion of shift than
others. It’s like raising taxes on the sickest patients just because they have the ability to pay.
Who Pays the Cost for EMTALA? EMTALA is, indeed, the central factor in the “free-rider”
phenomenon. The government forces hospitals to care for these individuals, without
financially compensating hospitals for the cost of doing so. Recent bills that offer to reform
the Affordable Care Act have included provisions for a partial tax credit to emergency
physicians who provide unreimbursed EMTALA mandated care. The important feature of
this provision is that these are tax credits, not reductions to income such as those received
for charitable giving. Why? Again it goes to treating everyone equally. If a wealthy tax payer
who pays a higher proportion of this income gives to charity, his or her benefit from
charitable donation is proportionally higher (Plaster, 2015). Thus, lower income or even
taxpayers who already lower their taxable income through charity will feel a smaller effect
from the reduction of income. 2