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Report No. 201

Regulation 489.24 (Special responsibility of Medicare hospitals in emergency cases):

Section (c) "Necessary stabilized treatment for emerging medical conditions:- (1) If any individual (whether or not eligible for Medicare benefits) comes to a hospital and the hospital determines that the individual has an emergency medical condition, the hospital must provide either -

(i) Within the capabilities of the staff and facilities available at the hospital, for further medical examination and treatment as required to stabilize the medical condition; or

(ii) for transfer of the individual to another medical facility in accordance with para (d) (below) of this section."

(2) Refusal (by victim) to consent to treatment: This provision states that after the hospital with an emergency department informs the patient or person acting on his behalf, of the risks and benefits to the individual of the examination and treatment, but the individual (or person acting on his behalf) refuses consent to the examination and treatment, the medical record of the hospital must record the refusal and take all reasonable steps to secure the individual's written informed consent (or that of the person acting on his or her behalf). The written document must indicate that the person has been informed of the risks and benefits of the examination or treatment.

"(3) Delay in examination or treatment (not permissible): A particular hospital (i.e. that has entered into a Medicare provider agreement under section 18.66 of the Act) may not delay providing an appropriate medical screening examination or further medical examination and treatment required in order to inquire about the individual's method of payment or insurance status.

(4) This clause deals with refusal by the victim or the person acting on his behalf, for transfer to another medical facility having required facilities. Written refusal must be obtained."

Section (d) Restricting transfer until the individual is stabilized: (1) If an individual at a hospital has an emergency medical condition that has not been stabilized, the hospital may not transfer the individual unless -

(i) the transfer is an appropriate transfer as stated in section (d)(2), and

(ii) (A) the individual (or a legally responsible person acting on his behalf) requests the transfer, after being informed of the hospital's obligation under this section and of the risk of transfer. The request must be in writing and indicate the reasons for the request as well as indicate that he or she is aware of the risks and benefits of the transfer.

(B) a physician has signed a certificate that, based upon the information available at the time of transfer, the medical benefits reasonably expected from the provision of appropriate medical treatment at another medical facility outweigh the increased risks to the individual or, in the case of a woman in labour, to the woman or the unborn child, from being transferred. The certification must contain a summary of the risk and benefits upon which it is based; or

(C) if a physician is not physically present in the emergency department at the time an individual is transferred, a qualified medical person (as determined by the hospital in its bye laws and regulations) has signed a certificate described in clause B above after a physician in consultation with the qualified medical person, agrees with the certification and subsequently countersigns the certificate. The certificate must contain a summary of the risks and benefits upon which it is based.

(2) A transfer to another medical facility will be appropriate only in those cases in which -

(i) the transferring hospital provides medical treatment within its capacity that minimizes the risk to the individual's health and, in the case of a woman in labour, the health of the unborn child;

(ii) The receiving facility -

(A) has available space and qualified personnel for the treatment of the individual; and

(B) has agreed to accept transfer of the individual and to provide appropriate medical treatment;

(iii) the transferring hospital sends to the receiving facility, all medical records (or copies thereof) related to the emergency condition which the individual has presented that are available at the time of transfer) including available history, records related to the individual's emergency medical condition, observations of signs or symptoms, preliminary diagnosis, results of diagnostic studies or telephone reports of the studies, treatment provided, results of any tests and the informed written consent or certification (or copy thereof) required under this section, and the name and address of any on-call physician who has refused or failed to appear within reasonable time to provide necessary stabilizing treatment. Other records (e.g. test results not yet available or historical records not readily available from the hospital's files) must be sent as soon as practicable after transfer, and

(iv) the transfer is effected through qualified personnel and transportation equipment as required, including the use of necessary and medically appropriate life support measures during the transfer.

(3) a participatory hospital may not initize do take adverse action against a physician or a qualified medical person described in para D(1)(ii)(C) above because the physician or qualified person refuses to authorize the transfer of an individual with an emergency medical condition that has not been stabilized, or against any hospital employee because the employee reports a violation of a requirement of this section.

Emergency Medical Care to Victims of Accidents and during Emergency Medical Condition and Women under Labour Back

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