Question

A patient comes to your ER very confused, he doesn't speak English and has no insurance. Initial blood work comes back showing some of his blood chemistry is at extremely high levels - he is in kidney failure, needs dialysis and you suspect he has been off and on hemodialysis for several years. As a hospital, you realize this patient is likely to have a long and expensive stay. Can you refer him to the outpatient dialysis unit down the street or do you have to admit the patient?

His neighbor brought him to the ER and brought the patient's pit bull along. The neighbor tells staff that the pit bull, Spot, helps the patient know when he is so sick he needs to go to the hospital, either because of his blood sugar or other blood levels.

What regulates service animals? what rights to healthcare facilities have to limit service animals? what rights to hospital staff have in refusing to care for the patient and/or service animal?

Be sure to provide your references as you discuss the answers to these questions.

Answer 1

Almost every hospital in the U.S. is required by law to provide necessary emergency medical treatment to anyone - with or without insurance coverage.A federal law called the Emergency Medical Treatment and Active Labor Act (EMTALA) requires almost all hospitals to provide treatment to all patients who need emergency medical treatment regardless of whether the patients have health insurance.For any patient that comes onto the hospital’s premises seeking emergency medical care, or who appears to require emergency care, the hospital must conduct a medical screening examination to determine whether or not the patient has an emergency medical condition. If the hospital screener determines that the patient does not have an emergency medical condition, the hospital has no further obligation to the patient if the patient does not have medical insurance.If the patient is deemed to have an emergency medical condition, the hospital then must either provide what is called necessary stabilizing treatment or, in certain circumstances, transfer the patient to another hospital, or both. Stabilizing treatment is defined as whatever medical treatment is necessary to assure that no material deterioration of the patient’s condition is likely to result from or occur during the transfer of the patient to another hospital.A non-stabilized patient may only be transferred if the patient makes a written request for transfer after being informed of the risks, or if a physician certifies that the benefits of the transfer to the patient outweigh the risks.The hospital must first attempt to stabilize the patient as much as possible within the limits of its capabilities, and then may only transfer the patient, along with the patient’s medical records, to another hospital that has agreed to take the patient.(Berg,2018).So the patient should be admitted and to be provided with treatment to stabilize him.

In case of service animals , a public accommodation shall modify policies, practices, or procedures to permit the use of a service animal by an individual with a disability.Public accommodation may ask an individual with a disability to remove a service animal from the premises if:(i) The animal is out of control and the animal's handler does not take effective action to control it; or(ii) The animal is not housebroken.Individuals with disabilities shall be permitted to be accompanied by their service animals in all areas of a place of public accommodation where members of the public, program participants, clients, customers, patrons, or invitees, as relevant, are allowed to .(2)

When it comes to hospital access rights for Service Dogs, United States federal law permits Service Dogs to accompany their disabled handler into in non-sterile, public areas.Service Dogs are allowed in hospitals, doctor’s offices, patient rooms, and other health care facilities as long as their presence doesn’t pose a threat or danger to standard medical practices and doesn’t impede operations of fundamental services and functions.If a Service Dog handler requires admission to the hospital, there’s likely something wrong, either medically or psychiatrically, that requires medical attention, intervention or assistance.If a handler can’t move around effectively or is too sick or too unaware or otherwise unable to care for their Service Dog (feeding, exercising, taking out, cleaning up after), then, under federal law, there’s an issue.In a hospital, that means the presence of the Service Dog can’t violate standards that are in place for patient or staff safety and are medically necessary(Grace,2013)

Ref:

1. David Berg, 2018,Can an Uninsured Patient Be Denied Emergency Treatment?, Retrieved from www.alllaw.com/articles/nolo/medical-malpractice/uninsured-patient-denied-emergency-treatment.html.

2. Code of Federal Regulations,Title 28 - Judicial Administration

   Volume: 1Date: 2012-07-01Original Date: 2012-07-01Title: Section 36.302 - Modifications in policies, practices, or procedures.Context: Title 28 - Judicial Administration. CHAPTER I - DEPARTMENT OF JUSTICE. PART 36 - NONDISCRIMINATION ON THE BASIS OF DISABILITY BY PUBLIC ACCOMMODATIONS AND IN COMMERCIAL FACILITIES. Subpart C - Specific Requirements.

3. Kea Grace,2013,Hospital Access Rights for Service Dog Teams,Laws and legalities,public Access, retrieved from www.anythingpawsable.com/hospital-access-rights-service-dogs/