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AU Effective Evaluation of Hospitals Compliance to EMTALA Memorandum

Bounce-Back Problem

Bill Howell does not have health insurance and has been experiencing homelessness for at least one year. Two days ago, Howell walked into the emergency department at the Waverly Medical Center (WMC) complaining of shortness of breath. A triage nurse determined that he had a fever. After being screened by a physician in the emergency department, Howell was diagnosed with severe dehydration. After approximately eight hours in the emergency room, during which time Howell’s dehydration was treated with intravenous fluids and his fever was reduced using ibuprofen, Dr. Arjun Roy certified Howell as stable for discharge. Staff at WMC called a ride-share service to pick up Howell and take him back to the shelter for the homeless where he had stayed most recently prior to his hospitalization. In the car on the way to the homeless shelter, Howell went into cardiac arrest. The driver immediately returned him to WMC’s emergency department, where doctors resuscitated him but not before he experienced brain damage resulting in permanent neurological deficits. He has now been admitted to the ICU at WMC, but administrators would like to transfer him to CGH for further care as soon as possible. Upon admission, doctors performed additional tests that were not performed during Howell’s time in the emergency department, including a chest X-ray. These results indicated a diagnosis of bilateral pneumonia, which was almost certainly present when Howell first arrived in the emergency department.

Part a: You are an investigator with the state health department. Please draft a memo for your supervisor outlining the factual and legal questions you will need to answer as part of your investigation to determine whether the Waverly Medical Center and/or Dr. Roy violated EMTALA, and explain the significance of these questions to your investigation.

Part b: You are a compliance officer at Waverly Medical Center. Please draft a memo for your supervisor explaining how you would evaluate the effectiveness of the Hospital’s EMTALA

compliance utilizing the “seven effective elements” framework and making specific recommendations to enhance EMTALA compliance following the incident described above.


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