Obstetrical Stabilization and Transfer Issues Under EMTALA

IN GENERAL …
The appropriateness of a transfer depends upon the clinical condition of the patient. For example, sending a pediatric code requiring IV pressors to a tertiary care center via BLS ambulance probably wouldn’t be considered appropriate. I’m not aware of any statute or CMS opinion that prevents transfers by private vehicle and I have personally transferred patients to tertiary care facilities by private vehicle. Most recent one I recall was a traumatic globe rupture with eye shield applied. Of course, even if a private vehicle is used, that doesn’t absolve the transferring facility from complying with all of the other EMTALA requirements.
In the situation you describe, there are several considerations, but again they focus on the clinical condition of the patient and the potential for decompensation during transport. Consider the globe rupture example above. The patient and family didn’t want to pay for an ambulance transport and agreed to go directly to the tertiary care center. The ophthalmologist accepted transfer. All of the medical records and transfer documents were sent with patient. Even though this is a serious injury, what is the likelihood of decompensation during transport? I judged it to be small enough that transfer by family vehicle was appropriate.
With respect to psych patients, here are a few considerations:
Has the patient been calm and cooperative throughout the ED visit? If so, transfer via private vehicle may be appropriate. Is the patient agitated, combative, threatening, or actively hallucinating? Probably not.
How far is the patient being transferred? A 15 minute trip gives less time for a psych patient to decompensate in route as opposed to 90+ minute transfers.
Will the transfer personnel be able to manage a patient who decompensates? This gets back to issue over whether to transport using BLS/medic/nurse with the resuscitated pediatric code. I recall reading about a case in which a transferring facility was sued because it transferred a suicidal patient using a petite woman as a driver and an elderly male as the chaperone for the patient. The patient decompensated and overpowered both of them. I’ll see if I can find the case and if so, I’ll post a link here.
Finally, consider how a bad outcome during transfer might appear based on the transfer method and personnel. If a bad outcome is viewed in retrospect, will the mode of transport and personnel seem reasonable to a CMS field investigator? If not, reconsider the personnel and or transportation decision.
Keep in mind that these are just general considerations – not a legal opinion.
Hopefully they help give you some additional perspective.