85 Obstetrical-Related Civil Monetary Penalties Resulting From Violation of Emergency Medical Treatment and Labor Act, 2002-2018

Abstract

To describe characteristics of obstetrical-related civil monetary penalty (CMP) settlements levied by the Office of the Inspector General (OIG) related to violation of the Emergency Medical Treatment and Labor Act (EMTALA). Descriptions of all CMP settlements from 2002 to April 2018 related to EMTALA violations were obtained from the OIG. Characteristics of settlements including settlement date, location, amount, whether the settlement was against a hospital or individual physician, and nature of the allegation were described. Obstetrical-related cases were identified in settlement descriptions using keywords: pregnant, pregnancy, birth, and labor. Cases where the term “labor” was included in the CMP description as part of the acronym for EMTALA without relevance to an obstetrical context were not included. Of 229 total CMPs levied by the OIG during the study period, 38 (17%) were related to obstetrical emergencies. Three (8%) of the CMP settlements related to obstetrical emergencies were levied against individual physicians and the remaining 35 (92%) were levied against hospitals. Of 8 total CMPs levied against individual physicians during the study period, 3 (37.5%) were related to obstetrical cases, including 2 against obstetricians, 1 of whom failed to respond to a request to evaluate and treat a pregnant patient with preeclampsia, and another who failed to provide appropriate medical screening examination, stabilizing treatment, and appropriate transfer for a pregnant woman in labor. The third case involved an emergency physician who repeatedly failed to provide medical screening exam and stabilizing treatment to a pregnant minor with vaginal bleeding. Of 38 penalties related to obstetrical emergencies, 15 (40%) occurred in CMS region IV, and 8 (21%) in CMS region VI. Eight of 15 (53%) settlements in CMS region IV occurred in Florida, and 5 of 8 (63%) in CMS region VI occurred in Texas. The average CMP settlement amount for obstetrical-related cases ($35,908) was not significantly different than the average amount for non-obstetrical cases ($43,585)(p=0.63). While ages of patients involved in cases resulting in CMP settlements are not systematically reported, 7 (18%) of CMP settlements related to obstetrical emergencies were specifically noted to involve a pregnant minor. We found that approximately 1 in 6 CMPs related to EMTALA violations were related to obstetrical emergencies. CMP settlements related to obstetrical conditions concentrate in 2 of the 10 CMS regions - with 3 of 5 settlements occurring in CMS regions IV and VI. Further research is needed to determine if the high rates of CMPs in these regions reflect inadequate obstetrical emergency care or enhanced enforcement in these regions. Of note, nearly 1 in 5 cases was specifically noted to involve a pregnant minor indicating that emergency physicians and obstetricians may benefit from education regarding obligations to evaluate, stabilize, and when necessary arrange for appropriate transfer of pregnant minors with active labor or other obstetrical emergencies even absent parental consent.