Penalties for Emergency Medical Treatment and Labor Act Violations Involving Obstetrical Emergencies

Introduction: The Emergency Medical Treatment and Labor Act (EMTALA) was intended to prevent inadequate, delayed, or denied treatment of emergent conditions by emergency departments (ED). While controversies exist regarding the scope of the law, there is no question that EMTALA applies to active labor, a key tenet of the statute and the only medical condition – labor – specifically included in the title of the law. In light of rising maternal mortality rates in the United States, further exploration into the state of emergency obstetrical (OB) care is warranted. Understanding civil monetary penalty settlements levied by the Office of the Inspector General (OIG) related to EMTALA violations involving labor and other OB emergencies will help to inform the current state of access to and quality of OB emergency care.Methods: We reviewed descriptions of all EMTALA-related OIG civil monetary penalty settlements from 2002-2018. OB-related cases were identified using keywords in settlement descriptions. We described characteristics of settlements including the nature of the allegation and compared them with non-OB settlements.Results: Of 232 EMTALA-related OIG settlements during the study period, 39 (17%) involved active labor and other OB emergencies. Between 2002 and 2018 the proportion of settlements involving OB emergencies increased from 17% to 40%. Seven (18%) of these settlements involved a pregnant minor. Most OB cases involved failure to provide screening exam (82%) and/or stabilizing treatment (51%). Failure to arrange appropriate transfer was more common for OB  (36%) compared with non-OB settlements (21%) (p = 0.041). Fifteen (38%) involved a provider specifically directing a pregnant woman to proceed to another hospital, typically by private vehicle.Conclusion: Despite inclusion of the term “labor” in the law’s title, one in six settlements related to EMTALA violations involved OB emergencies. One in five settlements involved a pregnant minor, indicating that providers may benefit from education regarding obligations to evaluate and stabilize minors absent parental consent. Failure to arrange appropriate transfer was more common among OB settlements. Findings suggesting need for providers to understand EMTALA-specific requirements for appropriate transfer and for EDs at hospitals without dedicated OB services to implement policies for evaluation of active labor and protocols for transfer when indicated

Concert recording 2013-03-10

[Track 01]. Cello suite no. 5 in C minor, BWV 101. Prelude / Johann Sebastian Bach ; translated by Ralph Sauer -- [Track 02]. Du bist die ruh, op. 59, no. 3, D776 / Franz Schubert ; translated by Andrew Jones -- [Track 03]. Capriccio for solo tuba / Krzysztof Penderecki -- [Track 04]. Etre ou ne pa etre: Monologue d\u27Hamlet / Henri Tomasi -- [Track 05]. Concerto for bass tuba and orchestra in F minor / Ralph Vaughn William

Concert recording 2013-04-18a

[Track 01]. Concerto for trombone, I. Moderato assai ma molto maestoso, II. Quasi una leggenda / Launy Grondahl -- [Track 02]. Conversation for tenor and bass trombone / Charlie Small -- [Track 03]. Elegie op. 3, no. 1 / Sergei Rachmaninoff -- [Track 04]. Marietta\u27s Lied from Die tote Stadt / Erich Wolfgang Korngold -- [Track 05]. Concerto for trombone, I. Adagio ; [Track 06]. II. Allegro assai / Georg Christoph Wagenseil

Concert recording 2013-04-14a

[Track 01]. Moving air / Nigel Westlake -- [Track 02]. New York counterpoint / Steve Reich -- [Track 03]. In motion hand covers bruise / Trent Reznor ; Atticus Ross -- [Track 04]. When it rains / Brad Mehldau -- [Track 05]. Born to be wild / David Lang -- [Track 06]. Cheating, lying, stealing / David Lang -- [Track 07]. Two instrumental rounds in snaketime / Moondog -- [Track 08]. Motown metal / Michael Daughterty

Concert recording 2013-04-25

[Track 01]. Excerpts from The water music / G.F. Handel, transcribed by L. Martinet -- [Track 02]. Villanelle / Paul Dukas -- [Track 03]. Nocturne / Reinhold Gliere -- [Track 04]. Concerto no. 1. Allegro moderato / Franz Strauss -- [Track 05]. Horn-lokk (1972) / Sigurd Berge -- [Track 06]. Sonata for horn in F. Massig bewegt / Paul Hindemith -- [Track 07]. Killer tango / Sonny Kompanek -- [Track 08]. Fantasy (1979) / Ronald LoPresti -- [Track 09]. Sextet for horns (1967) / Gregory Kerkorian

American political affiliation, 2003–43: a cohort component projection

The recent rise and stability in American party identification has focused interest on the long-term dynamics of party bases. Liberal commentators cite immigration and youth as forces which will produce a natural Democratic advantage in the future while conservative writers highlight the importance of high Republican fertility in securing Republican growth. These concerns foreground the neglect of demography within political science. This paper addresses this omission by conducting the first ever cohort component projection of American partisan populations to 2043 based on survey and census data. A number of scenarios are modeled, but, on current trends, we predict that American partisanship will shift much less than the nation’s ethnic composition because the parties’ age structures are similar. Still, our projections find that the Democrats gain two to three percentage points from the Republicans by 2043, mainly through immigration, though Republican fertility may redress the balance in the very long term

Concert recording 2013-04-14b

[Track 01]. Winter spirits for solo flute / Katherine Hoover -- [Track 02]. Il bacio / Luigi Arditi -- [Track 03]. Sonata for flute and piano. First movement / Otar Taktakishvili -- [Track 04]. Euphonium Concerto. Andante ; [Track 05]. Finale-Giocoso / Vladimir Cosma -- [Track 06]. Flute concerto in D, op. 283. Allegro molto moderato / Carl Reinecke -- [Track 07]. White knuckle stroll / Casey Cangelosi -- [Track 08]. Into the air / Ivan Trevino -- [Track 09]. Horn concerto no. 1 in E♭ major. Allegro / Richard Strauss -- [Track 10]. Pulsar / Augusta Read Thomas -- [Track 11]. Concerto in F minor. Movement one / Oskar Bohme -- [Track 12]. Fugue in G minor, Little Fugue / J.S. Bach

Concert recording 2013-03-28

[Track 01]. Fanfares liturgiques. Procession du Vendredi-Saint / Henri Tomasi -- [Track 02]. The good soldier Schweik suite. Overture / Robert Kurka -- [Track 03]. The good soldier Schweik suite. Lament / Robert Kurka -- [Track 04]. The good soldier Schweik suite. March / Robert Kurka -- [Track 05]. The good soldier Schweik suite. War Dance / Robert Kurka -- [Track 06]. The good soldier Schweik suite. Pastoral / Robert Kurka -- [Track 07]. The good soldier Schweik suite. Finale / Robert Kurka -- [Track 08]. Serenade no. 11 in E flat major, KV 375. Allegro maestoso / Wolfgang Amadeus Mozart -- [Track 09]. Prelude, fugue and riffs / Leonard Bernstein

The Time Is Now to Use Clinical Outcomes as Quality Indicators for Effective Leadership in Trauma

Not applicable (Letter to the Editor

Penalties for Emergency Medical Treatment and Labor Act Violations Involving Obstetrical Emergencies

Introduction: The Emergency Medical Treatment and Labor Act (EMTALA) was intended to prevent inadequate, delayed, or denied treatment of emergent conditions by emergency departments (ED). While controversies exist regarding the scope of the law, there is no question that EMTALA applies to active labor, a key tenet of the statute and the only medical condition – labor – specifically included in the title of the law. In light of rising maternal mortality rates in the United States, further exploration into the state of emergency obstetrical (OB) care is warranted. Understanding civil monetary penalty settlements levied by the Office of the Inspector General (OIG) related to EMTALA violations involving labor and other OB emergencies will help to inform the current state of access to and quality of OB emergency care.Methods: We reviewed descriptions of all EMTALA-related OIG civil monetary penalty settlements from 2002-2018. OB-related cases were identified using keywords in settlement descriptions. We described characteristics of settlements including the nature of the allegation and compared them with non-OB settlements.Results: Of 232 EMTALA-related OIG settlements during the study period, 39 (17%) involved active labor and other OB emergencies. Between 2002 and 2018 the proportion of settlements involving OB emergencies increased from 17% to 40%. Seven (18%) of these settlements involved a pregnant minor. Most OB cases involved failure to provide screening exam (82%) and/or stabilizing treatment (51%). Failure to arrange appropriate transfer was more common for OB  (36%) compared with non-OB settlements (21%) (p = 0.041). Fifteen (38%) involved a provider specifically directing a pregnant woman to proceed to another hospital, typically by private vehicle.Conclusion: Despite inclusion of the term “labor” in the law’s title, one in six settlements related to EMTALA violations involved OB emergencies. One in five settlements involved a pregnant minor, indicating that providers may benefit from education regarding obligations to evaluate and stabilize minors absent parental consent. Failure to arrange appropriate transfer was more common among OB settlements. Findings suggesting need for providers to understand EMTALA-specific requirements for appropriate transfer and for EDs at hospitals without dedicated OB services to implement policies for evaluation of active labor and protocols for transfer when indicated