EMTALA – Understand the Basics of the Emergency Medical Treatment and Active Labor Act

• Patients have rights to emergency medical care despite capacity or resources of the hospital under the Emergency Medical Treatment and Active Labor Act (EMTALA). 
• EMTALA was passed under the Regan administration over 35 years ago. 
• Learn how EMTALA impacts our hospital emergency departments today. 

Spend any time in the emergency room and you have crossed paths with the Emergency Medical Treatment and Active Labor Act (EMTALA) and the complexities of the law.  

What was the impetus that drove the law into existence? President Ronald Reagan signed the anti-dumping law (EMTALA) passed by congress over 35 years ago in response to an epidemic of small local hospitals failing to screen, treat and then transfer unstable emergency patients and women in labor—to nearby public hospitals and academic medical centers, often for financial reasons.  

In short, EMTALA ensures the public access to emergency services regardless of their financial status.  

What Makes an EMTALA Violation?

Mr. Quartermain arrived at General Hospital after receiving a gunshot wound to the leg during a domestic dispute. General Hospitals’ on-call specialist declined to come in and evaluate the patient and transferred Mr. Quartermain to another hospital.  

Is this an EMTALA  violation? The on-call specialist refused to come in and evaluate the patient, so General Hospital did not offer stabilizing treatment.  

Under EMTALA, this is a violation. General Hospital transferred the patient before stabilization. In this scenario, General Hospital violated the Federal Emergency Medical Treatment and Active Labor Act (EMTALA) secondary to the improper transfer of Mr. Quartermain, even though General Hospital could treat Mr. Quartermain.  

In this scenario, the benefits of the transfer did not outweigh the risks of transfer, jeopardizing Mr. Quartermain’s health. General Hospital violated Federal law and faces stiff penalties from the regulatory federal agencies, including the Office of the Inspector General (OIG).  

General Hospital received a $50,000 civil fine, and a potential exclusion from the Medicare and Medicaid programs. Mr. Quartermain, the transferred gunshot victim, later sued General Hospital and received an award of $100,000 through civil litigation for the improper and unsafe transfer. 

The Three EMTALA Components

There are specific obligations on Medicare-participating hospitals. Institutions taking part in Medicare reimbursement are bound to:  

• Offer patients a medical screening examination (MSE) 
• Require emergency departments to stabilize patients who arrive with an emergency medical condition 
• Require hospitals to transfer and / or accept patients as needed / required 

Medical Screening Exam

As defined by EMTALA, regardless of insurance status, nation of origin, race, religion, EMTALA entitles patients to an MSE when they arrive within 250 yards of a hospital building or are on the hospital’s campus. The MSE determines whether an underlying emergency medical condition exists. 

What Constitutes as “Stabilization” Under EMTALA?

If an emergent condition exists, EMTALA mandates that the hospital stabilize the patient. A stabilized patient is the definition as someone, within reasonable medical certainty, will not deteriorate from or during transfer.  

Transfers

If the patient’s condition requires a higher level of care, EMTALA mandates hospitals start the process for a “suitable transfer” to a higher level of care if required by the patient’s condition.  

To meet the conditions of EMTALA, the transferring facility must fully treat and stabilize the patient within the capacity of their available resources.  

Transfer documents, including medical records and imaging must accompany the patient during transfer. EMTALA mandates the receiving hospital accept the patient, having the proper resources to care for the patient. 

Enforcement 

Two regulatory bodies enforce EMTALA. The Department of Health and Human Services which authorizes investigations on violations of patient dumping and the Office of Inspector General, which assesses the monetary penalties to hospitals and doctors. 

Results of EMTALA

Does EMTALA cause unnecessary regulatory burden on the overwhelmed hospitals and physicians? Do lack of resources make it more difficult for smaller hospitals to comply?  

EMTALA is a paradox which requires hospital emergency departments to offer care to every patient, though it does not guarantee payment for the medical services provided. 

There are those who consider EMTALA an unfunded mandate, meaning hospitals and physicians pay for the uncompensated care of patients, and the law does little to confront the underlying problem of ED overcrowding, and instead relies on systems of enforcement and redressing violations. 

 In smaller, resource-burdened hospitals, the cost of uncompensated care has crippled emergency care nationwide, causing the closure of emergency departments. With ED overcrowding in low-income communities at a tipping point, components of EMTALA may cause more harm to the patients than the law protects.  

EMTALA disadvantages these smaller hospitals in low-income and underserved communities secondary to lack of resources. After providing care, low-resource hospitals end up transferring patients to outlying facilities that have capacity and resources.  

Unsafe transfer prior to stabilization place patients at risk. Smaller hospitals around the country have shouldered the financial burden of uncompensated care, while struggling with the number of patients above their financial and physical capacities.

The Bottom Line

Patients have rights despite the capacity or resources of the hospital at which the patient arrives. Any patient injured because of a hospital’s failure to offer care under EMTALA can start a claim against the hospital and/or emergency room under state medical malpractice laws.

Since EMTALA, emergency department visits in the United States have soared from 85 million visits per year to 130 million visits per year. During this period, over 550 hospitals and 1,100 emergency departments have closed, further burdening at-capacity hospitals.  

Despite the EMTALA mandate that every patient receive stabilizing care, portions of the United States have become more perilous than ever for patients seeking care.  

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