By: Karina Gonzalez
With the opioid epidemic in South Florida at crisis levels, there is an increasing demand on local hospital emergency departments for screening and evaluations of drug overdoses, considered a medical emergency. Addiction treatment law evolves with EMTALA updates. Many patients receiving substance abuse treatment in this community are coming from out-of-state. Many are young, under 35 years and a majority receive outpatient services. Overdoses are occurring more frequently as patients deliberately misuse opioid prescriptions such as Fentanyl or an illicit drugs such as heroin. If the patient possesses and or uses an illicit drug while in treatment, the policy in many facilities is to terminate treatment and discharge the patient. But if the patient has overdosed, the facility will place a call to 911 and that patient will end up with a visit to a local emergency department. A discharged patient will often continue using and end up in the emergency department, taken there by paramedics or some other individual.
Evolution of EMTALA
Local emergency departments now play a pivotal role in the next steps that an overdosed patient may take. Is the patient receiving their EMTALA rights (Emergency Medical Treatment and Labor Act), a federal law requiring anyone coming to a hospital emergency department to be screened and examined? If an emergency medical condition exists, treatment is provided to relieve or eliminate the emergency medical condition within the service capability of the hospital, a difficult task with substance abuse.
Many patients are being kept in the ER less than 24 hours before being discharged. Are the discharges appropriate? The out-of-state patients may have nowhere to go and end up in the streets. They have been discharged from both treatment because of drug abuse and from their emergency visit because presumably they are considered stabilized.
Hospitals may want to consider putting consenting patients on medication assistant therapies. Referrals to licensed treatment facilities, communication with patient’s family should be part of responsible discharges when the patient is voluntary. Patients that are discharged to temporary hotel rooms or to the street end up in the cycle of addiction and death. Emergency departments can only retain persons who meet voluntary criteria for services. Involuntary admission falls under Florida’s Substance Abuse Impairment Act. There are different procedures for involuntary admissions, some involve direct petitions to the court, but admission can be done with a certificate of a physician. A law enforcement officer through protective custody can also initiate an involuntary admission if this is the intervention necessary for a specific patient.
Florida Legislature Backs House Bill 61
The Florida legislature recently considered House Bill 61 “Emergency Services for an Unintentional Drug Overdose” which required hospital emergency departments to develop best practices to promote the prevention of unintentional drug overdoses but it did not pass this 2017 session, a step back from needed clarity in the addiction treatment law space.
The bill allowed hospitals to determine what should be included in best practices but authorized several items in light of this new area of addiction treatment law, such as
- Obtaining patient consent to disclose to the patient’s next of kin and primary care physician or practitioner who prescribed the controlled substance of the patient’s overdose, location and nature of substance involved in the overdose;
- A process for providing information to the patient or next of kin regarding licensed substance abuse treatment providers and voluntary and involuntary commitment procedures;
- Controlled substance prescribing guidelines for emergency department practitioners; and
- Use of licensed or certified behavioral health professionals or peer specialist in emergency department to encourage the patient to voluntarily seek substance abuse treatment.
It seems that, at least in South Florida, practices to promote better discharges, more involvement of the patient’s families and family practitioners and use of better treatment protocols in the emergency department will be left to the hospitals, substance abuse treatment facilities and the community to explore and implement better practices.