Outcomes of Medical Malpractice Litigation Against US Physicians

crease in the number of inpatient endoscopic procedures performed per year starting in 2004 compared with 2000-2003 (Figure 2) despite nearly all of their transfers under EMTALA citing lack of gastroenterology coverage as the reason for transfer.Comment.Our data suggest that the Final Rule may facilitate legal selective transfer of patients with emergency medical conditions based on insurance status.In the case of Hospital J, there was an increase following the Final Rule in the number of patients transferred to our center from their ED for GI hemorrhage, citing lack of gastroenterologist coverage despite an increase in the number of endoscopic procedures performed at their institution over the same period.Elimination of mandatory ED coverage for specialty providers allows hospitals to legally justify an EMTALA transfer request by saying they do not have guaranteed coverage in certain situations even when the facility has the capability to provide those services.Consequently, a selective coverage policy allowing specialists not to take call for the ED or to take only "elective" call (where the specialist is not obliged to see ED patients) is permissible under the Final Rule.6]78 The absence of any formal requirement for record keeping of EMTALA requests makes estimating the scope and prevalence of these practices difficult even though such behavior would clearly violate the intent of EMTALA.