What Is the Emergency Medical Treatment and Labor Act (EMTALA)?

The Emergency Medical Treatment and Active Labor Act, EMTALA, is a federal law that regulates emergency treatment at hospitals. EMTALA requires emergency departments to treat or stabilize patients regardless of their ability to pay. This law is also known as the "anti-dumping" statute and mandates select hospitals to give emergency medical screening examinations (MSE) or treatment for an emergency medical condition (EMC).

EMTALA History

Initially, EMTALA only applied to Medicare-participating hospitals. However, under EMTALA expanded hospital obligations to the indigents and uninsured. EMTALA also guarantees protection to pregnant women, as active labor is an emergency medical condition.

Congress passed EMTALA in 1986 as part of the Consolidated Omnibus Budget Reconciliation Act (COBRA) of 1985. EMTALA-mandated regulations supersede any conflicting state laws.

EMTALA is overseen by the Centers for Medicare and Medicaid Services (C.M.S.), an agency under the U.S. Department of Health and Human Services (H.H.S.).

EMTALA Provisions

Congress enacted EMTALA in response to several reports about emergency departments turning away ill or injured patients because of their health insurance status. Often, these patients had no money to pay for treatment.

Denying emergency services can have devastating consequences, including serious impairment and death. Today, medical care is not limited to those with health insurance. EMTALA ensures that everyone, including non-citizens, has access to emergency care.

EMTALA provisions include the following:

• Conduct a medical screening exam (M.S.E.) on every patient seeking emergency care.

• If the M.S.E. reveals an emergency condition the hospital must provide all necessary stabilizing treatment. An emergency condition includes serious dysfunction of any organ or active labor.

• Medical facilities with specialized capabilities, such as a burn unit, must accept transfers of persons in need of these capabilities.

Patient Dumping

Patient dumping occurs when a hospital sends uninsured patients to a public hospital. Often, private hospitals would transfer poor and uninsured patients to public hospitals. Before EMTALA, hospital emergency departments were not required to treat everyone who came to the emergency room. In many states, hospitals were not held responsible for damages caused by their refusal to treat patients.

EMTALA Obligations

By law, hospitals must conduct adequate medical screening examinations by qualified personnel. These screenings help determine if a patient has an emergency medical condition and often include a review of the patient’s medical records.

If the hospital cannot provide the essential treatment, they must arrange an appropriate transfer to another facility to meet the patient's needs.

The EMTALA requirements imposes two essential obligations on transferring hospitals. Before a hospital can make an appropriate transfer, they must screen the patient. They must also stabilize the patient before transferring them to a receiving hospital.

Hospitals must assess the risks of transfers and have the appropriate transportation equipment. Improperly transferring patients could lead to serious jeopardy.

Appropriate Medical Screening Examination

Hospitals must provide an appropriate MSE to determine whether an emergency medical condition exists.

An EMC is a medical condition where failure to provide immediate medical attention could result in serious dysfunction of any bodily organ. Specifically, harm to:

• Bodily functions
• Serious damage to an organ or body part
• Serious risk to the health of an individual and/or unborn child

The hospital is not obligated under EMTALA to treat the patient if, after the M.S.E., the hospital determines there is no E.M.C. to deal with.

Stabilization of Any Emergency Medical Condition

If the screening reveals an E.M.C., the hospital must treat and stabilize the patient's medical condition. Then, they can transfer the patient to another hospital or discharge the patient from the emergency room. Under EMTALA, stabilized means that no significant worsening of the patient's medical condition will likely result from a transfer or discharge.

In the circumstance of a woman in active labor, stabilization means the woman has delivered the child and placenta. A non-stabilized patient may be eligible for transfer if the hospital cannot further stabilize the patient and a different facility has the necessary treatment. Hospitals must follow very specific procedures for such transfers.

Applying EMTALA

EMTALA applies to all hospitals with emergency rooms that provide emergency medical services and participate in the Medicare program.

Almost all public and private hospitals receive Medicare funds. So, EMTALA governs most hospitals. In some instances, EMTALA also applies to outpatient facilities, such as

• Outpatient surgical practice
• Urgent care facilities
• Inpatient hospital wards

EMTALA Violations

Suing a hospital under EMTALA is different than suing under state medical malpractice laws. EMTALA is not a substitute for suing for a wrong diagnosis or improper performance of a medical procedure.

Misdiagnosis

If a patient receives an M.S.E. but is misdiagnosed, the hospital may be responsible for damages under state malpractice law. An inadequate M.S.E. may still violate EMTALA. Courts decided that a good M.S.E. is when a hospital gives the same checkup to all patients with the same problems, regardless of whether or not they have insurance or money. A hospital breaks the M.S.E. rule of EMTALA only when people who seem to have the same sickness receive different treatment.

Stabilization Rule

EMTALA's stabilization rule regulates a hospital's care of a patient immediately after admitting the patient for emergency care. Once a patient goes to the hospital and is placed under the care of physicians, their state medical malpractice law applies. EMTALA covers the actions of the hospital and doctors.

What Does a Patient Have To Prove in a Lawsuit?

Lawsuits brought under EMTALA must establish that the hospital treated the patient differently. Some courts have determined that to prove they did not receive an appropriate M.S.E., the patient must show there was an improper motive of the hospital. This means the choice about what kind of checkup to give is driven by wrong reasons like:

• Inability to pay
• Race
• Sex/Gender of the patient

Is There a Penalty for Violating EMTALA?

Depending on the facts of the case, hospitals or physicians that violate EMTALA are subject to fines and may lose Medicare provider agreements.

Failure to follow EMTALA can result in penalties, such as loss of reimbursement from programs like Medicaid. The U.S. Department of Health and Human Services (HHS) and The Office of the Inspector General enforce penalties and citations.

Other EMTALA Facts to Keep in Mind

• The American College of Emergency Physicians (ACEP) supports EMTALA's principles to ensure patients receive the necessary care they deserve.

• State survey agencies authorized by C.M.S track Hospitals' compliance with EMTALA.

• It's important to note that EMTALA's principles are consistent across all patients, regardless of age. Ensuring pediatric patients receive appropriate and timely medical care is fundamental to EMTALA's mission.

• Hospitals must remain knowledgeable about the provisions outlined in the Code of Federal Regulations (C.F.R.) Title 42 (U.S.C.).

Protect Your EMTALA Rights

The EMTALA protects your right to receive emergency care regardless of your ability to pay. If you're concerned about treatment, seek the advice of an experienced healthcare law attorney.