Compliance Operations: What is the Emergency Medical Treatment and Labor Act (EMTALA)?

Compliance Operations: What is the Emergency Medical Treatment and Labor Act (EMTALA)?

The Emergency Medical Treatment and Labor Act (EMTALA), also known as the “anti- patient dumping” statute, is a federal law that applies to Medicare-participating hospitals with emergency departments.

What is Required Under EMTALA?

EMTALA requires that anyone, regardless of insurance status or ability to pay, who comes to a hospital emergency department requesting examination or treatment be given an appropriate medical screening examination to determine if an emergency medical condition exists.

What is an Emergency Medical Condition?

An emergency medical condition (EMC) is one in which acute symptoms are sufficiently severe that, without immediate medical attention, the individual’s health would likely be placed in serious jeopardy, or result in serious impairment to bodily functions or serious dysfunction of bodily organs or parts.

For pregnant women in active labor, an EMC exists when there is not enough time to transfer the woman before delivery, or when transfer may pose a threat to the woman’s or unborn child’s health or safety.

What Must a Hospital Do if it Determines an Emergency Medical Condition Exists?

The hospital must provide stabilizing treatment within its capability and capacity, or arrange an appropriate transfer to a facility that can provide the necessary stabilizing treatment.

What is Stabilizing Treatment?

Stabilizing treatment is care needed to assure, within reasonable medical probability, that the patient’s condition will not materially worsen during or as a result of a transfer. “Stabilization” is not the same as “cure” — EMTALA requires only that the patient’s condition reach a point where transfer or discharge will not likely cause material deterioration.

Women in active labor are considered stabilized only upon delivery of the child and placenta.

What if an Individual’s Medical Condition Does Not Constitute an Emergency?

If the nature of an individual’s request makes clear that the condition is not an emergency, the hospital need only perform screening sufficient to determine that no emergency medical condition exists. EMTALA does not require stabilization of individuals without an emergency medical condition.

What if an Individual Refuses to Consent to Treatment?

An individual may refuse further examination or stabilizing treatment. The hospital must document in writing: the risks and benefits of the examination or treatment; the reasons for refusal; a description of what was refused; and the steps taken to obtain a written, informed refusal.

What Must a Hospital Do if an Individual Refuses to Consent to Transfer?

If an individual refuses a proposed transfer, staff must inform the individual of the risks and benefits and document the refusal. The hospital should obtain a signed statement of refusal and place it in the medical record. If the individual also refuses to sign, the hospital should document that refusal as well.

May a Hospital Delay Examination or Treatment to Inquire about Insurance or Payment?

Neither the medical screening examination nor stabilizing treatment may be delayed by inquiries about payment method or insurance status. However, EMTALA permits a “reasonable registration process,” which may include asking about insurance, provided those inquiries do not delay screening or treatment or unduly discourage individuals from remaining for evaluation.

What is an Appropriate Transfer?

An unstabilized patient may be transferred only if the transfer is “appropriate.” An appropriate transfer requires that:

1. The transferring hospital provides treatment to minimize risks to the individual’s or unborn child’s health.
2. The receiving hospital has space, qualified personnel, and has agreed to accept the patient.
3. The transferring hospital sends all available documents related to the patient’s condition to the receiving facility.
4. The transfer occurs with qualified personnel and appropriate transportation equipment.

A medically unstable patient may not be transferred unless the patient requests it and a physician certifies that the benefits outweigh the risks.

When Do a Hospital’s EMTALA Obligations End?

EMTALA is generally considered satisfied once the hospital stabilizes the patient, arranges an appropriate transfer, or admits the patient as an inpatient in good faith.

What are the Obligations of a Receiving Hospital?

A Medicare-participating hospital with specialized capabilities or facilities (e.g., burn units, shock trauma units, neonatal intensive care units) may not refuse an appropriate transfer of a patient who needs those capabilities, if the hospital has the capacity to treat the patient. This obligation applies even if the hospital does not have an emergency department.

Does EMTALA Impose Additional Obligations on Hospitals?

Hospitals must maintain an on-call physician list to ensure stabilizing treatment is available following the medical screening examination. A physician who is on call and fails or refuses to appear within a reasonable time may be personally liable for an EMTALA violation.

What Happens When EMTALA Is Violated?

Hospitals and physicians who violate EMTALA may face civil monetary penalties. A hospital that violates EMTALA is also subject to termination of its Medicare provider agreement.

Individuals harmed by a hospital’s EMTALA violation may bring a civil action in federal court for money damages under applicable state personal injury law. Medical facilities that suffer a financial loss as a direct result of another hospital’s EMTALA violation, such as a receiving hospital that absorbs the cost of treating an improperly transferred patient, may also bring a federal lawsuit.

Conclusion

EMTALA requires Medicare-participating hospitals with emergency departments to screen any individual who presents requesting examination or treatment, regardless of insurance status or ability to pay, and to provide stabilizing treatment if an emergency medical condition is found, or arrange an appropriate transfer if they cannot.

Transfers must meet specific requirements: the transferring hospital must minimize transfer risks; the receiving hospital must have agreed to accept the patient and have the capacity to treat them; all relevant records must accompany the patient; and qualified personnel and equipment must be used. An unstabilized patient may be transferred only at the patient’s request and upon physician certification that the benefits outweigh the risks.

Patients may refuse treatment or transfer. Hospitals must document refusals in writing, inform patients of the risks and benefits, and seek written acknowledgment. Medicare-participating hospitals with specialized capabilities may not refuse appropriate transfers of patients needing those capabilities, even without an emergency department.

Hospitals must also maintain on-call physician lists. Violations may result in civil monetary penalties for hospitals and physicians, termination of Medicare participation, and civil lawsuits in federal court by patients or facilities harmed by the violation.