EMTALA prohibits “patient dumping”

The Emergency Medical Treatment and Active Labor Act (EMTALA), also known as the “Patient Anti-Dumping” statute, is a federal law enacted in 1986 in response to concerns that hospitals were denying care to indigent or uninsured patients, transferring them to other hospitals to avoid caring for them, or discharging them without adequate medical treatment. EMTALA sought to remedy this problem by imposing three general requirements upon Medicare-participating hospitals, and EMTALA compliance has become a considerable focus of healthcare compliance attorneys.

  1. The hospital must provide all individuals presenting in the ER with an appropriate medical screening to determine whether an emergency medical condition (EMC) exists. The hospital cannot delay examination or treatment to inquire about the patient’s payment or insurance, and the ER must display signage that informs patients of their right to receive examination and treatment for emergencies.
  2. If an EMC exists, the hospital must provide treatment to stabilize the condition, or transfer the patient to another hospital. The hospital’s EMTALA obligation ends if the patient is admitted as an inpatient for continuing treatment.
  3. The hospital may only transfer an unstable patient under EMTALA if it constitutes an “appropriate transfer” under the law. An “appropriate transfer” is one that satisfies several requirements and depends upon the medical staff’s evaluation of numerous factors – including whether the medical benefits of transfer outweigh the risks. A physician must certify this evaluation in writing. If the receiving hospital believes that the transfer was not appropriate, it must report that potential EMTALA violation to CMS.

Non-compliance with EMTALA carries potentially grave consequences.

The consequences of an EMTALA violation can be grave and might include:

  • Termination of the hospital’s Medicare participation
  • Monetary penalties levied against the hospital and/or physician(s)
  • Lawsuits by the patient and other hospitals which suffer financially because of another hospital’s EMTALA violation

Understanding your legal obligations under EMTALA is key.

Jackson LLP will help your facility and physicians understand the legal obligations, likely sources of confusion, and day-to-day problems that might arise. Because we work primarily with smaller entities, we are familiar with the concerns faced by ambulatory surgery centers or urgent care clinics. Our work to ensure your EMTALA compliance might include the following:

  • Establish comprehensive policies and procedures to govern EMTALA compliance
  • Identify your facility’s scope of available emergency services
  • Define your ASC’s transfer requirements and establish transfer agreements with a local hospital
  • Understand your self-reporting obligations
  • Clarify the definition of an “appropriate transfer”
  • Implement a Quality Improvement Organization’s correction plan
  • Clarify your responsibilities under EMTALA if your facility’s services or situation are unique or unusual
  • Review physician contracts to provide call coverage

For small hospitals or non-hospital facilities, these are the questions that might arise:

  • Can an on-call physician “respond” via telehealth mediums, rather than presenting in-person to the hospital?
  • Does an ambulatory surgery center satisfy its obligations by calling 911?
  • What are my call coverage obligations under my managed care contract through which I receive hospital privileges?
  • What are my call obligations if I know that the patient will be transferred for our hospital’s inability to address this patient’s type of emergency?
  • How can we modify our medical staff bylaws to better articulate our clinical privileges?
  • What are my obligations to a patient after I treated him or her emergently in the ER? 
  • Does my urgent care center constitute an emergency department under EMTALA?
  • How does EMTALA apply to mental health emergencies?

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