Harbor:Legal

Risk Management

  • RM is automatically notified when SI is placed
  • For any adverse events that warrant family/patient notification, the physician needs to do it
  • RM at HUMC: Lan Soeur or Haya Nemtzov
    • x66330 or pgr x1277

EMTALA Concerns

Law Enforcement in the ED

  • County Counsel designated the ED as a "safe space"
  • ICE is not welcome in any treatment space without a law enforcement warrant
  • Any outside police agency can be directed to the HUMC Sheriffs for questions
  • In the event of a large law enforcement presence due to an officer involved incident, the HUMC Sheriffs Sergeant should be involved to direct vehicle and personnel traffic and keep the treatment areas clear


  • HUMC Policy 451
    • Securitas provides orientation informational pamphlet, get visitor sticker (to differentiate from Harbor LASD staff)
      • Securitas calls HUMC LASD to check in outside LEP
      • Outside LEP then directed to OCN or Area Charge
      • OCN/Area Charge checks with physician if patient is stable for LEP interview
      • If patient it is not medically appropriate to have LEP interview the patient, please document in your note, communicate to LEP.
    • Patients NOT in custody
      • Patients who are NOT in LE custody have a right to refuse interviews and/or photographing by law-enforcement agencies.  (This policy does NOT apply to psychiatric patients on a hold; they are covered by different laws.)
    • Patients in custody
      • Harbor will provide emergency and stabilizing care to in-custody patients; when these patients are stable for transport, in accordance with EMTALA, they should be transferred to the LAC+USC Medical Center Jail Ward for continued care/treatment.
      • For critical patients who require emergent medical intervention and stabilization, law enforcement will remove the patient’s handcuffs, at the request of the attending physician.
      • Outside LE may be asked to leave the patient’s room during the patient care to ensure patient privacy and confidentiality, unless doing so would cause an unsafe situation.  The officer must remain in the immediate vicinity and keep the patient in view throughout the provision of medical care or treatment. 
      • Any requests by the patient’s family/friends to the clinical staff for contact with an in-custody patient shall be directed to the involved LE agency and/or Harbor Sheriff.
      • If any issues arise related to the presence and/or behavior of outside LE, staff should contact Harbor Sheriff for assistance. 
      • If outside LE fails to comply after discussion with Harbor Sheriff, the issue should be referred to Risk Management.
    • LE will be cleared to detain the patient once the full evaluation and urgent treatment of the patient are complete, and at the discretion of the ED or admitting attending physician.


Law Enforcement Escorting Patients Out Of the Emergency Department

Because of the potential conflicts with EMTALA law, it is important that a physician be involved in any decision to remove any patient or potential patient from the emergency department. For this reason, any time law enforcement is either requested by nursing staff, or decides on its own, to escort a patient from the emergency department (including the waiting room), an attending physician should be notified and agree with (and document) the decision. The House Supervisor should also be notified (x3434) before involving law enforcement. Documentation should specifically state that the patient has had a medical screening exam and does not have an emergency medical condition, or if there is an emergency medical condition that it has been appropriately stabilized. Obviously, it should also be safe for the patient to be removed from the emergency department.

Dir AED 5/26/16

Weapons in ED

  • As a general rule, no patients should have weapons on them (INCLUDING PEACE OFFICERS), even if they have concealed weapons permit.
  • No visitors should have weapons. The only exception to visitors carrying weapons are active peace officers.
  • We are working with hospital administration to make this hospital policy for campus grounds.
  • If you encounter issues, call the Sheriffs Department for assistance.

A.Wu, Dir AAED, LASD, Dir OPs 12/9/16

ILLICIT DRUGS/MARIJUANA IN ED

  • Marijuana less than an ounce (plant) or 8 gms (concentrate) and patient at least 21 years old - keep with patient belongings
  • Marijuana quantity more than above (or not sure), or possessed by person under 21 - Call Sheriff
  • All other illicit drugs (or suspect as illicit) - Call Sheriff


AB 2760: Naloxone for patients at risk for opioid overdose

Requires providers to offer a prescription for naloxone (or other reversal agent) when

  1. Prescribing ≥90 morphine milligram equivalents/day (for example, 9 Norco 10/325 tabs/day) Here is a link to the CDC tool for daily opioid dose calculations: https://www.cdc.gov/drugoverdose/pdf/calculating_total_daily_dose-a.pdf, or
  2. When co-prescribing an opiate with a benzodiazepine.
  3. 'Even when not prescribing opioids if the patient just has a history of overdose or substance use disorder', or if the patient is at risk for returning to a high dose of opioid medication to which he or she is no longer tolerant. Cal/ACEP is looking further into this latter provision but for now, it’s the law.
  • At Harbor, we have naloxone intranasal on formulary. Further, if a prescription for naloxone (or other reversal agent) is given, the provider must educate the patient (or someone designated by the patient) on overdose prevention and how to use naloxone (or other reversal agent). To help you with that requirement, below is a link to a sample patient education handout, which includes naloxone information. Patient Handout. We are working making this flyer available at each clerk’s station and in the doc boxes, and there are similar naloxone instructions in ORCHID.
  • .ednaloxoneEDdistribution - when given home packet from ED
  • .ednaloxoneprescribed - when given Rx
  • .ednaloxonedeclined - when pt declines

SB 1152 - 2019 California homeless patient discharge planning law

Bottom line,

  1. Consult social work as early as possible once you have identified a homeless patient ("HL" icon). Social work wants to be consulted for EVERY homeless patient.
  2. Infectious disease (ID) screening and vaccinations are now mandated by law, so based on current ID concerns, please document that you offered Hep A vaccine to those that qualify since there is an ongoing Hep A outbreak.
  3. If medically appropriate, please order a meal prior to discharge.

Details:

  • New definition of homeless:
    • Lack fixed and regular nighttime residence
    • Primary nighttime residence in supervised area or area not designed for living/sleeping
    • Examples: Car, shelters, tent, hotel, street, beach, park, abandoned building, bus/train station, etc.
  • Offer meal - please order of medically appropriate: Provider and RN
  • Offer weather appropriate clothing - SW and RN
  • Discharge meds or prescriptions - Provider
  • Referral for follow up care - Provider
  • Offer infectious disease screening and vaccinations: Currently, Hep A vaccine to address local outbreak. Provider and RN.
  • Offer transportation: bus tokens from social work, House Supervisor, Registration
  • Screening for affordable healthcare coverage: Patient Financial Services (PFS), Registration
  • Identify post-discharge destination: SW
  • Communicate discharge needs to receiving entity: SW

More info: https://californiaacep.site-ym.com/page/Legislation_Implementation

Involuntary holds

Adverse event mandatory reporting

Prescribing

Template:Harbor follow up

Family Viewing of Deceased Patients

If you have a death in the ED, please don't direct family to the morgue and don't promise body viewing. If the death is potentially a coroner's case, with an unclear cause of death or concerns for possible criminal activity (violence, hit and run, etc.), the family may not be allowed near the body for concerns of evidentiary integrity. For any death that we will be disclosing to the family, the ED social worker should be present to handle the details of discussing body and funeral preparations with the family.

Family Bereavement Resources

How to access the bereavement packet if needed.

  • Go to home page for Harbor/UCLA and click on Departments/Site pages
  • Once the page comes up, look in the second column for Patient Education
  • Click on Patient Education
  • Once the page comes up, look for Patient Handouts
  • Click on Patient Handouts
  • Once page comes up, scroll down to Bereavement packet; it is available in English, Spanish, and Korean.




OBSERVERS IN THE ED

  • There can never be an observer of any type in the ED without the prior permission of hospital administration or the chair, or one of the vice-chairs in the department.
  • Observers must be introduced to any patient whose care they observe and the patient must be given the opportunity, in a non-coercive and open manner, to not have the observer present during their care.
  • Observers must never be present during sensitive parts of medical care (e.g., genital exams, during history taking regarding abuse or sexual assault, etc.).
  • Observers must wear a clearly visible name tag that provides their first and last name and identifies them as an “Observer” or using a more descriptive label (e.g., “Medical Student” or “Residency Candidate”).

Chair, EM 9/2017

See Also