Send in the JV

(Junior Varsity) Despite my best efforts, I am still on the medical center's quality review committee. At our latest meeting we discussed the problem of transfers that are coming from outlying hospitals that turn out to have a totally different diagnosis than what the transferring ED said they have. An example of this is when the outside ED calls and says they have a patient with a bad pneumonia and when they get to us we find that they are actually in cardiogenic shock from a massive MI, not pneumonia and the TPA window is passed. Our physicians are irate with these transfers but because of EMTALA they cant refuse them so they are stuck with the misdiagnoses and mismanaged train wrecks. So anyway, we looked into the issue. What we found was that these EDs have independent practicing ARNPs not docs. This was not the first time this issue has come up in the quality meeting, so the medical centers attorney was there to explain again how under EMTALA we just had to accept the patients and suck it up no matter what. Fuming at the the bad care that these patients were getting at the outside EDs I blurted out, "if we mismanaged and misdiagnosed patients like that we would get our a++ sued off!". To this the medial center's attorney explained that the ARNPs are held to a different standard. A lesser standard. I had to ask for clarification " so, if you come in to the ED and are seen by an ARNP there is a different standard than if you are seen by a MD or DO? Why isn't there just a standard for what problem that you came in to the ED with?" I didn't get an answer. I guess what I learned is that if you go to the ED with shortness of breath a DOC is held accountable for making the right diagnosis and performing the correct treatment, where a ARNP is not.