DUTIES, RESPONSIBILITIES AND RIGHTS OF A PROVIDER AND THE PROVIDERS’ PATIENT UNDER THE EMTALA AND HIPAA STATUTES

DUTIES, RESPONSIBILITIES AND RIGHTS OF A PROVIDER AND THE PROVIDERS’ PATIENT UNDER THE EMTALA AND HIPAA STATUTES

            EMTALA was enacted in 1986 by the United States Congress as a section of the COBRA, which deals with the Medicare matters. The prime purpose of the law or the Act was to ensure that patients have right of entry to emergency health services as well as stop the practice of patient abandoning, where the patients who are uninsured are moved from private health facilities to community health facilities because of the financial reasons. The law (EMTALA) is one of the most inclusive laws assuring nondiscriminatory access to emergency medical service and the system of the health care. [1]This law applies to nearly all elements of patient care in the hospital environment. On the other hand, HIPAA was passed in 1996 with a mandate of making sure that the Secretary of Department of Health and Human Service publicizes standards for security, privacy, and electronic transfer of health information. [2]HIPAA ensures that the health care provider is a covered entity, the one who transmit electronic health information concerning particular connections.  The main emphasis on the effect of these laws is not only in the emergency medical care of the patients but also for the medical care staffs and hospital. This paper looks at the responsibilities, duties and the rights of the provider as well as the providers’ patient under these two statutes and relating to the issues of patients at the emergency department.

If the patient presents to an emergency department conscious, but with extreme chest pain, and requests assistance, the health provider at the department have a responsibility under the EMTALA to initiate the sought care that is within the capabilities of the department. At the same time, the provider has a duty of making contact with maintaining a unit of the hospital for the assistance of the staff with deciding on which option is the best interest of the patient.  In this case, the on-call physicians have a role, where when they are on call they do represent not only their department but also the hospital.   Therefore, in the case of the above problem and for which it is beyond their coverage, but it is a condition cared for at the health facility, it is their responsibility to look for somebody to care for the patient.  It is the duty of the health care provider makes a medical screening check-up to determine if an emergency medical problem of the chest pain exist. The patient has a right to treatment because the treatment or examination cannot be made to delay for examining about insurance coverage or the method of payment.

It is the responsibility of the health provider to notify the patient of his or her rights to medical treatment or medical screening examination.  If the screening is carried out and shows that chest pain exists, it is the duty of the provider to give treatment until the chest pain is stabilized or resolved. If the emergency department and the entire hospital do not have the capacity to make the treatment of the severe chest pain, it is the duty of the provider to make an appropriate transfer of the patient of another health care facility. The latter must be carried out by the provision of ETMALA. [3]The health provider with specialized capabilities has an obligation to accept transfer request made by the hospital regarding the patient with severe chest pain, and who lacks the capacity to treat the pain with the emergency medical conditions of severe chest pain.

The patient requesting for emergency medical treatment but has severe chest pain has the right to be evaluated by a competent professional at the emergency department and has the right to treatment until the chest pain has stabilized. Under ETMALA, the patient has the right to be accepted to the hospital he being transferred to if the hospital he presented does not have the capacity to treat him. The patient has a right to agree to the transfer. The patient also has a right to be accompanied by enough medical records under the protected health information. The patient with the chest problem has the right to access his or her health information.  The patient under this condition has the right for requesting to a change of his or her Protected Health Information if he feels the information is inadequate or incorrect.

Emergency room personnel can converse with the patient, but the patient is in pain. Since the patient is conversing with staff in the emergency room, and refuses to sign the EMTALA form of transfer (in case he request a transfer), then the physician has the responsibility of informing the patient of the benefits as well as the risks of the desired transfer that must be certified on the transfer form of the EMTALA. [4]The physician has the duty of determining whether the patient can make the decision of signing or not signing the transfer form by examining the medical condition of the patient and recording the findings. The patient should not be forced or given authority information of his request for a transfer. Under no circumstance that the provider should force any transfer that is made illogically or by any form of discrimination. In the case of refusal to transfer to another hospital after being informed of the benefits and risk of transfer, it is the responsibility of the provider to make all logical determinations to get an informed written refusal to agree to transfer the patient.

The service provider at the emergency department has no obligation under the EMTALA statute to threaten patient or scare patient who does not have money or insurance cover. It is the mandate of the provider to protect the patient under the requirements of CMS. If the patient converse and give false information, he or she can be prosecuted under the prevailing federal, local, or state laws, especially when giving false information to dodge payment. It is a duty of the provider not to deny the patient or give the substandard patient services because of an outstanding balance at the hospital. [5]The provider should not withhold records, belongings, or other needed services until the patient pays. The provider has the duty to maintain a list of doctors who are on call for the obligation after the early check up to give advanced treatment or evaluation needed to stabilize the patient in pain. The doctor on call has the duty of responding to the patient in pain after as per the set out by laws and policies in the hospital.

The provider has a duty not to delay the provision of relevant medical screening checkup or advanced stabilizing treatment and checkup to determine. The provider should not delay by inquiring the insurance of the payment method of the patient. The provider has a duty of not seeking or asking the patient in pain to look for permission of his or her insurance for screening or treatment services to be carried out by Qualified Medical Practitioner. This should be done after the provider has provided a correct Medical Screening Examination and started any advanced alleviating treatment that may be required. It is a duty of the provider to contact the physician of the patient on issues concerning the medical past records of the patient, which relate to the treatment or screening as it is under the HIPAA.

It is the obligation of the hospital’s physicians to make a follow up after a patient represents himself in the emergency room. This is a crucial part of the treatment.  If the patient undergoes any form of surgery because of pain indicated by the screening examination, the provider is obliged to make a follow up for the removal of suture and dressing of the wound. The provider is needed to ensure the patient has stabilized by having satisfactory results from follow-ups.

Emergency room physicians have access to the patient’s records through a Regional Health Information Exchange. T[6]he physicians in the Emergency room having access to the records of a patient from the regional health exchange of information should always adhere to the rules and guideline stipulated by HIPAA.  The providers should make the protected health information of the patient is available but is should make sure that it is secured and private for enhancing quality treatment as well as care.

If even the physician has accessed the confidential information concerning the patient health record, it is their responsibility to make sure that the information is not transferred from, to or put within any technology, such as cell phones or personal computer, because it can jeopardize the privacy of patient health record. It is the duty of the physician not to share the information of the patient on social media, and they have a responsibility to adhere to the cell phone using rule at the hospital.

It rests with the provider to ensure that the security rule as per HIPAA is adhered to, which requires it to ensure health information is available when necessary and ensure there is the integrity of the patient’s information.  It is the responsibility of the provider to ensure that the patient’s records are not altered or changed by someone who does not have permission to do that. It is the requirement of the HIPPA to have distinctive identifiers to access the electronic records of the patient that contain patient personal information, such as contact, address among others. It the obligation of the physicians accesses information of the patient from the regional health information exchange but has the duty to keep the protected health information secure, confidential and private.

However, under the HIPAA, the patient has right to access his health information. The right to request for changes of the protected health information if he feels the information in inadequate or inaccurate. The right to ask a place to get the protected health information and the right to request a limitation on what should be disclosed by the Protected Health Information.

Bibliography

Adams, James. Emergency Medicine: Clinical Essentials, 157-160. Philadelphia, Pa: Elsevier/       Saunders, 2012.

Luband, Charles. “EMERGENCY PREPAREDNESS FOR HOSPITALS AND THE      HEALTHCARE MARKETPLACE.” Administrative Law Review 58, no. 3 (2006): 575-       85.

Morganti, Kristy Gonzalez, Sebastian Bauhoff, Janice C. Blanchard, Mahshid Abir, Neema Iyer, Alexandria C. Smith, Joseph V. Vesely, Edward N. Okeke, and Arthur L. Kellermann.     “Conceptual Model of ED Use.” In The Evolving Role of Emergency Departments in the        United States, 7-12. RAND Corporation, 2013.

Peden, Ann H. Comparative Health Information Management, 59-62. Boston, MA : Cengage       Learning, 2017

            [1] Peden, Ann H, Comparative Health Information Management (Boston, MA: Cengage Learning, 2017), 59-62.

            [2] Adams, James, Emergency Medicine: Clinical Essentials (Philadelphia, Pa: Elsevier/ Saunders, 2012), 157-160.

 

            [3] Morganti, Kristy Gonzalez, Sebastian Bauhoff, Janice C. Blanchard, Mahshid Abir, Neema Iyer, Alexandria C. Smith, Joseph V. Vesely, Edward N. Okeke, and Arthur L. Kellermann. “Conceptual Model of ED Use.” In The Evolving Role of Emergency Departments in the United States (RAND Corporation, 2013), 7-12.

 

            [4] Morganti, Kristy Gonzalez, Sebastian Bauhoff, Janice C. Blanchard, Mahshid Abir, Neema Iyer, Alexandria C. Smith, Joseph V. Vesely, Edward N. Okeke, and Arthur L. Kellermann. “Conceptual Model of ED Use.” In The Evolving Role of Emergency Departments in the United States (RAND Corporation, 2013), 7-12.

            [5] Luband, Charles. “EMERGENCY PREPAREDNESS FOR HOSPITALS AND THE HEALTHCARE MARKETPLACE.” Administrative Law Review 58, no. 3 (2006): 575-85.

 

            [6] Luband, Charles. “EMERGENCY PREPAREDNESS FOR HOSPITALS AND THE HEALTHCARE MARKETPLACE.” Administrative Law Review 58, no. 3 (2006): 575-85.