Implications of the consolidated Omnibus Budget Reconciliation "antidumping" legislation for emergency nurses

Although the original intent of the law is to protect the indigent, the statute applies to any situation in which a patient is denied care or transferred to another facility before being medically stabilized. The data thus far indicate that financial motives may be only partially responsible for alleged COBRA violations and that other health care system issues are involved. Patient "dumping" may become better camouflaged against federal and state scrutiny, but until these other issues are identified and addressed dumping may continue to occur for a variety of reasons. To avoid the appearance of dumping, the emergency nurse and physician should meticulously record all aspects of every patient transfer. Particular attention should be given to documenting patient stability at the time of transfer, the risks versus benefits of the transfer, and the communication with and acceptance of the patient by the receiving facility. Emergency nurses, directors of nursing, and nursing quality assurance or risk managers should all be familiar with the COBRA requirements. For further information on the interpretation and application of COBRA, contact your state's acute care facility licensing authority or one of the HCFA Regional Offices listed in the Appendix.