Please help me respond to this discussion post...Thank you!

1. Why do you suppose the hospital in Childs did not have a physician present or immediately available to assist in its emergency department?

Given that this happened around twenty years before EMTALA was enacted, the lack of regulations and standards surrounding emergent quality of care proved detrimental for some patients. This particular hospital did not require the on-call physicians to see and examine all emergency patients. Nowadays, a requirement for participation in the Medicare program, hospitals must maintain a list of physicians who are on-call for duty after the initial examination to provide treatment necessary to stabilize an individual with an emergency medical condition. Written on-call policies and procedures must clearly define the responsibilities of the on-call physician to respond, examine and treat patients. The policies and procedures must also ensure that the hospital provides emergency services that meet the needs of an individual with an EMC if the hospital chooses to employ any of the on-call options permitted under the regulations, i.e., community call, simultaneous call, or elective procedures while on-call. If a physician who is on-call, refuses or fails to appear at the hospital where he/she is directly on call in a reasonable period of time, then that physician as well as the hospital may be found to be in violation of EMTALA. [1]

2. Why would a physician not come to the hospital and personally examine a woman in labor?

A physician has no common-law responsibility to respond to a call for help when they have no preexisting relationship with the patient (under early-common law). The court's decision held that the doctor's duty depended on the existence of a contract with the patient, and because Dr. Weis and Mrs. Childs had no such contract, he had no duty to treat her. Having given the nurse information for Mrs. Childs to consult with her personal OB about her next steps, Dr. Weis felt that he had fulfilled his part in the situation. There was a dispute surrounding the nurse's comprehension and communication of Dr. Weis' instruction. Federal law now requires ED personnel to stabilize emergency conditions irrespective of whether a provider-patient relationship exists. Regarding transfers while in labor, regardless of practices within a state, a woman in labor may be transferred only if she or her representative requests the transfer or if a physician or other qualified medical personnel signs a certification that the benefits outweigh the risks.[1]

3. What were the motives of the parties involved?

Dr. Weis- prove that he had not established a provider-patient relationship with Mrs. Childs and was not required to treat her.

Mrs. Childs- prove that Dr. Weis conducted negligence by refusing to treat her in the ED, causing her to seek care elsewhere which resulted in the death of her child.

[1] Centers for Medicare & Medicaid Services. (CMS) State Operations Manual. Appendix V-Interpretive Guidelines-Responsibilities of Medicare Participating Hospitals in Emergency Cases. (Rev. 191, 07-19-19) July 2019. https://www.cms.gov/Regulations-andGuidance/Guidance/Manuals/downloads /som107ap_v_emerg .pdf