PRESENTED BY:   Robert W. Monteiro, MD, President

REFERRED TO:     Reference Committee No. 1 – Timothy M. Beittel, MD, Chair

Resolution 6-2011–EMTALA was introduced at the 2011 Annual Meeting of the House of Delegates, by the New Hanover Pender County Medical Society.  The Resolution contained the following Resolves:

RESOLVED, That the NCMS supports an amendment to EMTALA requiring that all patients transferred for emergency specialty care be transported to the nearest hospital able to provide that care without regard to alliances or contracts (policy); and be it further

 RESOLVED, That the NCMS delegation to the AMA submit a resolution calling upon the AMA to seek an amendment to EMTALA requiring that all patients transferred for emergency specialty care be transported to the nearest hospital able to provide that care without regard to alliances or contracts. (action)

 The House of Delegates referred Resolution 6-2011 for study and report back. The NCMS Board of Directors subsequently referred it to the Physician Hospital Relations Task Force. 

The Task Force discussed Resolution 6 (2011) EMTALA at its meeting on August 16, 2012. Mr. Keene provided some background on the structure in place today in NC to address choice of hospital issues under EMTALA. In brief, the State of NC has adopted four statewide Triage and Destination Plans, generally referred to as bypass protocols, which are in force across the state. These protocols were developed by the NC Chapter of the American College of Emergency Physicians to address STEMI, pediatric, burn and stroke cases. In addition, each county may adopt policies to address local circumstances. The CMS interpretive guidance on EMTALA permits EMS providers to follow community-wide EMS protocols addressing choice of hospitals. The Task Force expressed some concern that a nationwide mandate dictating that the nearest hospital able to provide necessary care receive all emergency transfers would lead to significant unintended consequences and that a more tailored solution to the specific problem that gave rise to the resolution might be preferred.

The NCMS Board of Directors at its meeting on September 8, 2012, approved the following recommendation from the Physician Hospital Relations Task Force which is hereby submitted to the House of Delegates for action.

 RECOMMENDATION

That the following be adopted and the remainder of the report be filed:

1.   That Resolution 6-2011—EMTALA be filed;  and

2.   That the North Carolina Medical Society staff further research the circumstances that led to the  introduction of Resolution 6 and explore alternative solutions to that specific problem.  (action)

Fiscal Note:  Estimated additional budget impact:  $2,000.  Current resources will be allocated based on the priorities of the Society and the NCMS budget.

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