On-Call Responsibilities for Hospitals and Physicians

Quality Advisory

This Quality Advisory, a service to members of the American Hospital Association (AHA), the American College of Emergency Physicians (ACEP) and the American Society for Healthcare Risk Management (ASHRM), provides guidance to institutions in ensuring quality health care for the patients and communities they serve.

On-Call Responsibilities for Hospitals and Physicians

A Message to AHA, ACEP, and ASHRM Members:

USA Today and the Los Angeles Times recently reported on the refusal of specialists to come to the hospital when called to care for emergency room patients. The newspapers alleged that specialized treatment sometimes isn't available because doctors won't come in when called, won't volunteer to be on call in the first place, or simply are not available.

While these cases appear to be isolated, they strike at the heart of the public's confidence in what hospitals do. They are part of a larger concern about both caring for and being accountable to our communities. That's why it's important to continue to make sure your organization is doing everything it can to provide all patients with the care they need when they need it.

Make sure you're following the 1986 Emergency Medical Treatment and Active Labor Act (EMTALA) and its regulations. Be aware that a number of jurisdictions have state-based EMTALA laws that should be followed with the same rigorous attention to detail. EMTALA is intended to ensure that all patients who come to the emergency department receive appropriate care, regardless of their insurance or ability to pay. Hospitals are required to provide patients with a medical screening examination to determine if they have an emergency medical condition and, if so, to stabilize their condition. The law prevents hospitals from transferring patients until they're stable, unless the expected benefits of transfer outweigh the risks or the patient has made a request to be transferred. Violations carry penalties of up to $50,000 per incident and possible exclusion from Medicare and Medicaid.

After reviewing this advisory, check off the following items from your to-do list:

  • Make sure your hospital's medical staff bylaws and emergency department policies regarding on-call physician responsibilities are consistent with EMTALA's requirements.
  • Review EMTALA with your medical staff (including residents and interns), governing boards, senior managers, nurses and key personnel. Share copies of hospital emergency department policies and procedures with them. Determine when medical staff had its last training session on EMTALA. Consider whether it's time for a "refresher" course.
  • Engage your community on this issue. Have your community and media relations' teams speak candidly to community leaders and local media about your policies...your procedures...your commitment to ensuring quality care.
  • Encourage your medical staff, nurses, and other health care professionals to consult your hospital's risk manager for assistance and advice on EMTALA and its on-call requirements.

Jonathan T. Lord, MD
Chief Operating Officer
American Hospital Association
John C. Moorhead, MD
President
American College of Emergency Physicians
Grena Porto
President
American Society for Healthcare Risk Management




Background

In the vast majority of communities, the "on-call" system works well. It's largely invisible to the public, but is one of the cornerstones of good hospital care. Physicians respond night and day - take time from family and other activities - to be there for patients who are brought to their community hospital.

"On-call" duties come with the privilege of practicing in a hospital. They are a covenant between physician and hospital as part of their mutual responsibility to all patients who come to the hospital door. Physicians who break that covenant call into question their medical staff privileges. Every hospital should have policies to ensure appropriate "on-call" coverage of the emergency department by specialists and sub-specialists.

Hospital and Physician Requirements

Hospitals and physicians, including on-call physicians, who violate EMTALA may face stiff penalties. They could include civil fines of up to $50,000 per violation or exclusion from participating in the Medicare and Medicaid programs. Specifically:

  • § Hospitals must maintain a list of physicians, including specialists and sub-specialists, who are on call to evaluate and treat patients in the emergency department.

  • Hospitals are responsible for ensuring that on-call physicians respond within a reasonable period of time.
  • The medical staff bylaws or policies and procedures must define the responsibility of on-call physicians to respond, examine, and treat patients with emergency medical conditions.
  • Although physicians are not required to be on call at all times, hospitals must have policies and procedures that are followed when a particular specialty is not available or on-call physicians cannot respond because of situations beyond their control (for example, if the physician is performing another surgery).
  • In most cases, on-call physicians must come to the hospital to examine the patient when a request is made for their services. If, however, their offices are located in a hospital-owned facility on contiguous land or on the hospital campus, the patient may be seen in the physician's office.
  • If a hospital transfers a patient to another facility because an on-call physician fails or refuses to appear, it must give the on-call physician's name and address to the receiving hospital. Failure to provide this information would violate EMTALA.

If you have questions regarding the advisory, please contact Roslyne Schulman, AHA's senior associate director of policy, at (202) 626-2273, or rschulm1@aha.org; ACEP's federal affairs director, at (800) 320-0610, ext. 3014; or David Strickland, ASHRM's executive director, at (312) 422-3989, or dstrickland@aha.org.

Additional EMTALA information can be found on AHA's Web site at www.aha.org, ACEP's Web site at www.acep.org, and ASHRM's Web site at www.ashrm.org

 
 
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