Episode #47
When "Stable" Becomes the Wrong Finish Line with Dr. Nicholas Cozzi
Watch the video: https://youtu.be/NJ0Pmyc-z_g "Stabilization, to me, is the wrong word." In this Team Summit Special Edition of The Leadership Lab, recorded in Chicago, Asbel Montes sits down with returning guest Dr. Nicholas Cozzi, emergency physician and EMS Medical Director at Rush University Medical Center, for a conversation about a question that sounds simple and isn't: what actually counts as an emergency, and when is a patient truly safe? Dr. Cozzi starts at the bedside. He walks through a shift where he saw 70 to 80 patients in eight hours, a patient he heard wheezing before he ever saw her, and why a final diagnosis can't decide after the fact whether someone was having an emergency. Then the conversation turns personal for both of them: behavioral health patients waiting hours, days, even weeks in the ER for a bed, a 22-year-old who was stable at hour 11 and in restraints by hour 30, and why Asbel wants to retire the "cage car" for good. You'll Learn: ✅ Why EMTALA was written in 1986, and why the ER looks very different almost 40 years later ✅ What a medical screening exam is, and how an emergency physician sorts dozens of patients an hour ✅ The prudent layperson standard, and why insurance can't use a final diagnosis to deny an emergency ✅ Why "stable" doesn't mean safe, and how your zip code can decide where you get transferred ✅ What happens when behavioral health patients have nowhere to go but the emergency department ✅ Why transportation is part of treatment, from psychiatric care to dialysis This conversation isn't finished. Asbel and Dr. Cozzi are planning a round two on behavioral health, and Dr. Cozzi invited Asbel to shadow him in the ER to see it firsthand. If this episode made you think, subscribe to The Leadership Lab and share it with someone who needs to hear it. About Dr. Nicholas Cozzi: Dr. Cozzi is a board-certified Emergency Medicine and EMS physician with an MBA. He is EMS and Disaster Medicine Medical Director at Rush University Medical Center, Assistant Professor of Emergency Medicine at Rush Medical College, and a physician medical consultant for the Chicago Fire Department. He completed his EMS fellowship with FDNY and Northwell Health. Chapters: 00:00 Cold open 01:03 Welcome back to Chicago, Dr. Nicholas Cozzi 01:45 What counts as an emergency? 03:36 Dr. Cozzi's background 04:41 Why EMTALA exists 06:03 80 patients in 8 hours: the medical screening exam 10:12 When minutes mean life or death 12:47 The prudent layperson standard 15:00 When the ER can't provide the care 17:15 Your zip code can change your care 18:40 Why "stable" is the wrong word 21:31 Sponsor: Solutions Group Services 22:41 Behavioral health transfers and state law 24:37 The mental health access failure 28:49 Cage cars and the humanity of transport 34:01 Rethinking behavioral health transportation 35:54 Why "get them out of the ED" is the wrong goal 36:44 A 22-year-old, 30 hours in the ER 38:16 Transportation is part of treatment 39:32 Round two, and an invitation to the ER 40:47 Closing thoughts Links: Asbel Montes LinkedIn - https://www.linkedin.com/in/asbel-montes-31027634 Asbel Montes Book (In Plain Sight) - https://asbelmontes.com/store/ Asbel Montes Website - https://asbelmontes.com Dr. Nicholas Cozzi LinkedIn - https://www.linkedin.com/in/nicholaspcozzi/ Dr. Nicholas Cozzi at Rush - https://doctors.rush.edu/details/19379 Dr. Cozzi's first episode, The Economics of Care - https://youtu.be/s1zuc-Rb4yU The Leadership Lab: X - https://x.com/leadershiplabam Instagram - https://www.instagram.com/leadershiplabam/ Sponsored by: Solutions Group Services - https://www.solutionsgroup.com/?utm_source=podcast&utm_medium=audio&utm_campaign=ll-ep47-nicholas-cozzi Black Ink - https://www.discoverblackink.com
