QUESTION:
We are in a two-hospital town and our neighbors across town have become lax with their on-call schedule.  Even though this other hospital has numerous physicians in certain specialties, it keeps transferring ED patients to us because it doesn’t have anyone on call in that specialty who can treat the patient.  Our physicians feel like they’re on call for the other hospital as well as our own.  Do we have to accept these transfers?

ANSWER FROM HORTYSPRINGER ATTORNEY IAN DONALDSON:

Unfortunately, the answer is yes.  While a receiving hospital has the right to refuse a request for a “lateral” transfer, if the receiving hospital has “specialized capabilities” (and capacity), then the receiving hospital must accept the patient.

EMTALA itself lists burn units, shock trauma units and neonatal units as examples of “specialized capabilities.”  However, courts and CMS have taken the position that an on-call physician also constitutes a “specialized capability.”  Thus, if your hospital has an on-call physician available, and the hospital proposing the transfer doesn’t have an on-call physician available, your hospital must accept the transfer if it has the capacity to take care of the patient.  This is true even if the sending hospital has specialists on its staff who could treat the patient if they were on call (but who are not actually on call).  This requirement has put hospitals and on-call physicians in a difficult position and continues to make EMTALA compliance a challenge.

If you have a quick question about this, e-mail Ian Donaldson at IDonaldson@hortyspringer.com.