Reprinted with Permission from the Birmingham Medical News.

On June 2, 2017, Anderson, S.C.-based AnMed Health and the Department of Health and Human Services Office of Inspector General entered into the largest settlement under the Emergency Medical Treatment and Labor Act ("EMTALA"). AnMed agreed to pay $1,295,000.00 to settle allegations that AnMed involuntarily held behavioral health patients in its emergency department for multiple days on numerous occasions. Specifically, the allegations were that AnMed kept 35 individuals in its emergency department, pursuant to a longstanding policy of not admitting involuntary patients to its psychiatric unit. AnMed's policies provided that if an individual should be involuntarily committed and did not have financial resources, the attending physician could write an order for the local mental health center to evaluate the patient for commitment to the state mental health system after the patient is medically stable. These individuals were kept in AnMed's emergency department for 6-38 days until they were discharged or transferred to another medical facility. These individuals ranged in age from young adults to elderly adults. Most of them were suicidal and/or homicidal and suffered from depression, schizophrenia, bipolar disorder, drug abuse, psychosis, personality disorders or other serious psychiatric disorders. AnMed strongly denied that it ever considered an individual's ability to pay when providing care.

Under Section 1867(d)(l)(A) of the Social Security Act, "[a] participating hospital that negligently violates a requirement of that section is subject to a civil money penalty of not more than $50,000 (or not more than $25,000 in the case of a hospital with less than 100 beds) for each such violation." The fine was calculated based on the OIG's investigation into individuals who presented to AnMed's emergency department with unstable psychiatric emergency medical conditions. Instead of being examined and treated by on-call psychiatrists, patients were involuntarily committed, treated by emergency department physicians and kept in AnMed' s emergency department for days or weeks instead of being admitted to AnMed' s psychiatric unit for stabilizing treatment.

The settlement is a disturbing development for hospitals and emergency room physicians because of the frequency of how often involuntarily committed behavioral health patients are brought to hospitals' emergency departments. Additionally, there are often shortages of appropriate psychiatric beds or behavioral health facilities to treat the individuals, and a shortage of psychiatrists on-call to determine if the individuals are experiencing a true emergency medical condition as defined by EMTALA.

Download the full article, "The Largest EMTALA Settlement Underscores the Difficulty of Treating Behavioral Health Patients in the Emergency Room" written by James A. Hoover.