Current regulations under the Emergency Medical Treatment and Active Labor Act (EMTALA) require the certification of a physician as evidence that a pregnant patient is in "false labor" to rule out an emergency medical condition as defined under EMTALA, thus eliminating any further EMTALA obligations. However, effective October 1, 2006, the EMTALA regulations will be revised to permit a "certified nurse midwife...or other qualified medical person" acting within the scope of his or her practice to certify as to a patient’s false labor for EMTALA purposes. This change, part of the changes to the Hospital Inpatient Prospective Payment System regulations released by the Centers for Medicare & Medicaid Services (CMS) on August 1, 2006, comes after a lengthy battle on the part of hospitals and nurse midwives to expand the list of appropriate personnel to certify false labor.
Pursuant to EMTALA’s requirements, a determination as to whether or not an emergency medical condition exists is made by the physician or other qualified medical person. For a woman in labor presenting to a hospital emergency department, the change will permit a certified nurse midwife (CNM) or other qualified medical person to certify false labor so long as such a determination is not outside of the scope of practice of that professional, necessitating a review of state practice acts for CNMs and others.
In light of this regulatory change, hospitals may wish to:
- Review EMTALA policies and procedures to ensure they are consistent with current EMTALA regulations, including EMTALA policies specific to the hospital's Obstetrics Department/Labor & Delivery
- Determine which categories of health care professionals the hospital would like to authorize as "qualified medical persons" for purposes of diagnosing false labor of pregnant patients
- Confirm that the diagnosis of false labor is within the scope of practice of such health care professionals as defined by the medical staff bylaws and state law
- Discuss liability concerns related to any changes in policy with the hospital’s risk manager and its hospital counsel