Reform of Tort Law

Reform of Tort Law

Policy Statements services is ensured through appropriate public policy initiatives and health care reimbursement system reform. The development of de...

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Policy Statements services is ensured through appropriate public policy initiatives and health care reimbursement system reform. The development of dedicated clinical service lines in specialty hospitals (defined as stand-alone, single-specialty facilities not within the walls of a full-service hospital), although having potential benefits, can lead to a number of untoward and sometimes adverse health system consequences. These consequences may vary with location and include: ● Exacerbating the loss of on-call, specialty physician coverage for emergency department (ED) patients. ● The dual financial drains on full-service hospitals of “siphoning” paying patients, as well as the loss of more highly compensated procedural services. Arguably, these financial drains could precipitate additional full-service hospital closures. Efforts have been undertaken to help mitigate some of the untoward effects. Specialty hospital construction has been limited by several moratoriums created by Congress during the past several years. The Patient Protection and Affordable Care Act of 2010 prohibits expansion of existing physician-owned hospitals and bans any new physician-owned hospitals not built and Medicare certified by December 31, 2010.1 Additional measures are needed to preserve patient care and safety in full service hospitals, including the following: ● The federal Emergency Medical Treatment and Labor Act (EMTALA) currently places certain obligations on Medicareparticipating hospitals with EDs for medical screening and treatment,2 as well as maintenance of on-call specialty services.3 EMTALA places additional obligations on Medicare-participating hospitals (regardless of presence of an ED) with “specialized services” with regard to accepting the transfer of patients in need of such services.4 Appropriate enforcement of current federal law (or additional EMTALAlike mandates) obligates specialty hospitals to provide specialty-appropriate emergency evaluation and treatment, irrespective of a patient’s ability to pay, including the obligation to always have at least 1 physician available or on call to accept specialty-appropriate referrals from full-service hospitals. ● Full-service hospitals should not be economically disadvantaged or deprived of specialty physician coverage to ensure that all patients retain timely access to specialty services without disruption. Revised and approved by the ACEP Board of Directors April 2011 Originally approved by the ACEP Board of Directors October 2004 REFERENCES 1. Patient Protection and Affordable Care Act. (H.R. 3590); Section 6001. 2. 42 USC 1395 dd (a), (b), & (c); 42 CFR 489.24 (a), (d), & (e). 3. 42 USC 1395 cc (a) (1) (I) (iii). 4. 42USC 1395 dd (g); 42 CFR 489.24 (f). doi:10.1016/j.annemergmed.2011.04.025

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Reform of Tort Law [Ann Emerg Med. 2011;58:111.] ACEP endorses in principle federal laws, state legislation, or constitutional amendments to implement tort legal reforms, including but not limited to the following: ● limitation of liability for noneconomic damages; ● holding judges accountable for the quality of scientific evidence presented in medical malpractice litigation; ● joint and several liability; ● recognition of collateral sources of compensation in granting awards; ● structured payment systems for damage awards; ● reduction of term length in statutes of limitation; ● controls on attorneys’ contingency fees; ● qualifications for expert witnesses; ● apologies without admissibility; ● sovereign immunity for Emergency Medical Treatment and Labor Act–required services; ● recognition of local standards of care in rural areas; ● immunity for following guidelines; and ● pilot programs to study innovation such as health care courts and publishing expert witness opinions. Approved April 2011 Revised and approved by the ACEP Board of Directors August 2009 and April 2011 Reaffirmed by the ACEP Board of Directors October 1998 Originally approved as Council Resolution CR027, titled “Reform of Tort Law” September 1985 doi:10.1016/j.annemergmed.2011.04.029

Blood-Borne Infections in Emergency Medicine [Ann Emerg Med. 2011;58:111-112.] HIV, hepatitis, and other blood-borne infections affect increasing numbers of people, leaving emergency health care workers (HCWs) to confront a 2-fold challenge: ensuring that all individuals have access to emergency care and treatment regardless of HIV or other infectious disease status, and preventing exposure to and nosocomial transmission of those blood-borne infections. The risk of accidental transmission of HIV from infected HCWs to patients appears to be remote. However, there is greater evidence of the transmission of hepatitis B (HBV) and hepatitis C (HCV) from HCWs with active disease to patients. In light of this challenge, the American College of Emergency Physicians (ACEP) endorses the following principles and recommendations.

PRINCIPLES ●

Appropriate care should be provided to all patients who seek emergency care regardless of risk factors for or known infections with HIV or other blood-borne infections. Annals of Emergency Medicine 111