EMTALA

What is EMTALA?

 

The Emergency Medical Treatment and Labor Act is a statute which governs when and how a patient must be (1) examined and offered treatment or (2) transferred from one hospital to another when he is in an unstable medical condition.

EMTALA was passed as part of the Consolidated Omnibus Budget Reconciliation Act of 1986, and for that reason it is sometimes referred to as "the COBRA law". In fact, a number of different laws come under that general name. Another very familiar provision, also referred to under the COBRA name, is the statute governing continuation of medical insurance benefits after termination of employment.

EMTALA applies only to "participating hospitals" under Medicare — i.e., to hospitals which have entered into "provider agreements" under which they will accept payment from the Department of Health and Human Services, Centers for Medicare and Medicaid Services (CMS) under the Medicare program for services provided to beneficiaries of that program. In practical terms, this means that it applies to virtually all hospitals in the U.S., with the exception of the Shriners' Hospital for Crippled Children and many military hospitals. Its provisions apply to all patients, and not just to Medicare patients.

The avowed purpose of the statute is to prevent hospitals from rejecting patients, refusing to treat them, or transferring them to "charity hospitals" or "county hospitals" because they are unable to pay or are covered under the Medicare or Medicaid programs. This purpose, however, does not limit the coverage of its provisions.

 

What are the provisions of EMTALA?

 

Any patient who "comes to the emergency department" requesting "examination or treatment for a medical condition" must be provided with "an appropriate medical screening examination" to determine if he is suffering from an "emergency medical condition". If he is, then the hospital is obligated to either provide him with treatment until he is stable or to transfer him to another hospital in conformance with the statute's directives.

In essence, then, the statute:

  • imposes an affirmative obligation on the part of the hospital to provide a medical screening examination to determine whether an "emergency medical condition" exists;
  • imposes restrictions on transfers of persons who exhibit an "emergency medical condition" or are in labor, which restrictions may or may not be limited to transfers made for economic reasons;
  • imposes an affirmative duty to institute treatment if an "emergency medical condition" does exist.

 

What is an emergency medical condition?

 

A medical condition manifesting itself by acute symptoms of sufficient severity (including severe pain) such that the absence of immediate medical attention could reasonably be expected to result in —

  • placing the health of the individual (or, with respect to a pregnant woman, the health of the woman or her unborn child) in serious jeopardy,
  • serious impairment to bodily functions, or
  • serious dysfunction of any bodily organ

 

Is a psychiatric crisis an emergency medical condition?

 

Yes

 

Does a law enforcement officer have to return to a hospital to transfer the person once he/she has been medically cleared?

 

No. Once the person is taken to the hospital, federal EMTALA law requires the hospital to arrange for appropriate transfer, when necessary. EMTALA preempts any state law with which it is in conflict. EMTALA requires that a hospital accept any person who presents or is brought to the emergency room for the purpose of performing a medical screening. If the ED staff determine the person has an emergency medical condition (including psychiatric and substance abuse emergencies), the hospital is then responsible for the person until the emergency has been stabilized, including the person’s discharge or transfer from the hospital to another facility that has the capability and capacity to manage the person’s condition. This includes, among other responsibilities, the duty to arrange a safe and appropriate method of transportation to the destination facility.

 

Are there penalties for violating these requirements?

 

Yes. A hospital which negligently violates the statute may be subject to a civil money penalty (i.e., a fine, but without criminal implications) of up to $50,000 per violation. If the hospital has fewer than 100 beds, the maximum penalty is $25,000 per violation.

A physician who is responsible for providing an examination or treatment, including but not limited to an on-call physician, may be liable for a civil money penalty for signing the medical certificate if he knew or should have known that the benefits of transfer did not in fact outweigh the risks of transfer, or if he misrepresents the patient's condition or the hospital's obligations under the statute.

A physician who is on call and who fails or refuses to appear after being called by an E.R. physician (or other physician) may be subject to a penalty under the statute, or may subject his hospital to a penalty.

 

Is there a phone number to call to make a complaint against a hospital for an EMTALA violation?

 

Yes. 1-888-973-0022

 

In Summary

 

A person entering a hospital emergency department (ED) in a medical emergency, either by him/herself or brought in by another, must be evaluated, treated, and stabilized by the hospital ED. The hospital cannot release an unstable patient. If the hospital does hot have the expertise to treat the person, it is the hospital's responsibility to transfer the patient to a hospital/facility with that expertise. The hospital must treat an individual whether the person has insurance or not. It is not a law enforcement officer's duty/job to transfer a person from a hospital ED to another facility. It is the hospital's responsibility to make that transfer via appropriate means, e.g., medical ambulance. There are civil monetary penalties for violations of EMTALA. The phone number for making complaints is 1-888-973-0022.