EMERGENCY CARE: Dodging Calls Puts Specialists At Risk
Specialists frustrated with managed care organization's low reimbursement are becoming more reluctant to respond to emergency calls, but they do so at an increased risk of liability, according to a recent article in American Medical News. Health care lawyers report they are starting to see malpractice suits alleging that physicians violated the Emergency Medical Treatment and Active Labor Act (EMTALA) by refusing on- call assignments. Hospitals that don't enforce those assignments may also be liable.
A Missouri case exemplifies physicians' growing liability risks in emergency coverage. At issue is whether on-call general surgeon Dr. Joseph Corrado was legally bound to notify Audrain Medical Center that he was unavailable to take assignments. Although Corrado arranged for an orthopedic surgeon to cover his shift, a former trauma patient alleges Corrado failed to alert the hospital to the change. Lacking a general surgeon, Audrain transferred the patient to a trauma center; she survived, but claims the delay caused several injuries, including the loss of a kidney. Corrado was initially dismissed from the case because he had no formal relationship with the patient -- a requirement of the state's malpractice law -- but an appeals court overturned that ruling, finding that Corrado's on-call status "created a duty to provide reasonable notice to appropriate hospital personnel" that he was unavailable for calls. Corrado plans to appeal, but legal experts contend his argument is shaky, as federal EMTALA requirements can be applied despite state law.
Health care lawyers warn that hospitals are obligated to ensure compliance with EMTALA requirements, which may mean revoking privileges for physicians who refuse assignments. Several industry groups have also said that if a specialist's failure or refusal to take call results in a patient transfer, the hospital must provide the receiving facility with the offending physician's name and address, or risks an EMTALA violation (Klein, 1/24).