EMTALA Question

Throwaway account.

Today I had a call that (I feel) violated EMTALA in a BIG way.

My unit gets called to one of our city's hospitals for a psych. This hospital doesn't offer psych or trauma services. We arrive and find four cops and a bunch of security guards in front of the ED entrance with a guy who is absolutely shitfaced. PD tells me that he drove his wife (while drunk) to this hospital to get seen for her pseudo seizures. The ED staff, for obvious reasons, didn't make it a big priority (primarily because she walked in to the ED and said "I'm having a seizure right now"). Guy became belligerent and security made him wait outside. While outside, guy lit up a cigarette. A security guard told him that smoking was not allowed, and he attacked the security guard. Security guard tazed him and called PD. PD arrived and gave the guy a ticket for assault, and called us when he said his back hurt after getting tazed.

I get there and the guy is being a drunk douche bag. First he doesn't want to be seen, but changes his mind when PD tells him "Get in the ambulance or I'm taking you to jail" (A common tactic used by this police department when they don't want to deal with someone). Guy then says he wants to be seen at the hospital that he just acted like a complete asshat in, and both PD and the security guards tell him (and me) that they will not let him be seen inside there. I have a supervisor on scene who tells me to take him to the nearest hospital.

Long story shorter, guy gets in my bus, continues being an asshat, and ends up in restraints. PD & security both tell me they will not let me bring him into this hospital, so I take him to the next nearest hospital. The ED staff there was less than pleased, but accepted the pt without hesitation.

So, I know that the system failed several ways here.

  • PD should've just arrested this asshat for the numerous crimes he committed, but they didn't (and usually don't). I obviously have no control over that.

  • The hospital security and police could've just cuffed asshat and escorted him into the hospital to make sure he didn't hurt anyone else.

  • Asshat obviously did not have decision-making capacity, so his preference was irrelevant.

  • The receiving hospital did not raise a stink about it, and I documented the shit out of why I took him to another hospital, so I'm not worried about getting in trouble, I'm just curious.

So, I'll finally ask my question- did I totally violate EMTALA here, since asshat was on one hospital's property, and I transported him to another hospital? I've been told so many different interpretations of EMTALA that I don't know which to believe, and all of the literature that I've found online deals with transfers, not "emergency" calls.

Thanks in advance.


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