2002 年至 2018 年违反《紧急医疗治疗与劳动法》（EMTALA）涉及精神科急症的民事罚款情况。
Civil Monetary Penalties Resulting From Violations of the Emergency Medical Treatment and Labor Act (EMTALA) Involving Psychiatric Emergencies, 2002 to 2018.
机构信息
Keck School of Medicine, University of Southern California, Los Angeles, CA.
Schaeffer Center for Health Policy & Economics, University of Southern California, Los Angeles, CA.
出版信息
Acad Emerg Med. 2019 May;26(5):470-478. doi: 10.1111/acem.13710. Epub 2019 Apr 17.
OBJECTIVE
The objective was to describe characteristics of civil monetary penalties levied by the Office of the Inspector General (OIG) related to violations of the Emergency Medical Treatment and Labor Act (EMTALA) involving psychiatric emergencies.
METHODS
Descriptions of EMTALA-related civil monetary penalty settlements from 2002 to 2018 were obtained from the OIG. Cases related to psychiatric emergencies were identified by inclusion of key words in settlement descriptions. Characteristics of settlements involving EMTALA violations related to psychiatric emergencies including date, amount, and nature of the allegation were described and compared with settlements not involving psychiatric emergencies.
RESULTS
Of 230 civil monetary penalty settlements related to EMTALA during the study period, 44 (19%) were related to psychiatric emergencies. The average settlement for psychiatric-related cases was $85,488, compared with $32,004 for non-psychiatric-related cases (p < 0.001). Five (83%) of the six largest settlements during the study period were related to cases involving psychiatric emergencies. The most commonly cited deficiencies for settlements involving psychiatric patients were failure to provide appropriate medical screening examination (84%) or stabilizing treatment (68%) or arrange appropriate transfer (30%). Failure to provide stabilizing treatment was more common among cases involving psychiatric emergencies (68% vs. 51%, p = 0.041). Among psychiatric-related settlements, 18 (41%) occurred in CMS Region IV (Southeast) and nine (20%) in Region VII (Central).
CONCLUSIONS
Nearly one in five civil monetary penalty settlements related to EMTALA violations involved psychiatric emergencies. Settlements related to psychiatric emergencies were more costly and more often associated with failure to stabilize than for nonpsychiatric emergencies. Administrators should evaluate and strengthen policies and procedures related to psychiatric screening examinations, stabilizing care of psychiatric patients boarding in EDs, and transfer policies. Recent large, notable settlements related to EMTALA violations suggest that there is considerable room to improve access to and quality of care for patients with psychiatric emergencies.
目的
描述监察长办公室（OIG）因违反《紧急医疗治疗和劳动法》（EMTALA）而对涉及精神科急症的违规行为处以民事罚款的特征。
方法
从 OIG 获得了 2002 年至 2018 年与 EMTALA 相关的民事罚款和解的描述。通过在和解描述中包含关键词，确定与精神科急症相关的案例。描述并比较了与精神科急症相关的 EMTALA 违规行为和解的特征，包括日期、金额和指控性质，以及与非精神科急症相关的和解。
结果
在研究期间，有 230 项与 EMTALA 相关的民事罚款和解中，有 44 项（19%）与精神科急症有关。精神科相关病例的平均和解金额为 85488 美元，而非精神科相关病例为 32004 美元（p<0.001）。在研究期间的六个最大和解中，有五个（83%）与涉及精神科急症的案例有关。涉及精神科患者的和解中最常被引用的缺陷是未能提供适当的医疗筛查检查（84%）或稳定治疗（68%）或安排适当的转移（30%）。未提供稳定治疗在涉及精神科急症的病例中更为常见（68%比 51%，p=0.041）。在与精神科相关的和解中，有 18 项（41%）发生在 CMS 地区 IV（东南部），9 项（20%）发生在地区 VII（中部）。
结论
近五分之一与 EMTALA 违规相关的民事罚款和解涉及精神科急症。与精神科急症相关的和解费用更高，并且更常因未能稳定病情而不是非精神科急症而被和解。管理人员应评估和加强与精神科筛查检查、急诊科住院患者的稳定护理以及转移政策相关的政策和程序。最近与 EMTALA 违规相关的巨额和解表明，在改善精神科急症患者的获得和护理质量方面还有很大的改进空间。
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