What On-Call Physicians Should Know About EMTALA

Every physician knows that being on-call is sometimes just a part of the job. But the need for hospitals to provide round-the-clock specialized care is a legal one, too.

Two physicians walking down a hospital corridor.

You may be familiar with EMTALA, the Emergency Medical Treatment and Labor Act, at least by name. EMTALA is a federal law that requires anyone coming to an emergency department to be stabilized and treated. It’s sometimes referred to as the “patient anti-dumping” law.

EMTALA may sound broad, and it is. Not all adverse patient outcomes, inadequate screening exams, or malpractice actions indicate an EMTALA violation. Still, a hospital or physician can violate EMTALA by procedurally mishandling a patient’s emergency, even if it doesn’t result in an adverse medical outcome. 

Essentially, EMTALA requires hospitals that accept federal funds to stabilize and treat anyone who comes into the emergency department, regardless of their ability to pay. To comply with EMTALA, hospitals need to maintain staff onsite who can handle a wide variety of emergency conditions.

In short, if you’re a physician, both you and the hospitals in which you work have large incentives to comply with the law. 

Physician Obligations Under EMTALA

Say that you are an on-call physician and fail to respond appropriately to a request from the emergency department to further evaluate or help stabilize a patient with an emergency medical condition. In such a situation, you and the hospital might be risking an EMTALA violation.

Hospitals maintain comprehensive policies and procedures to ensure their ongoing EMTALA compliance. These procedures — on which all physicians and emergency staff should be trained — will shape your response to the emergency department’s call when you’re on call. 

What’s In Your Contract?

Private practice physicians often overlook one important detail when signing contracts with hospitals for hospital privileges. That is, they might have on-call obligations imposed upon them by those agreements. These provisions exist, in part, to help the hospital meet its own EMTALA obligations. 

Do you have EMTALA-based obligations written into your agreement? If so, and you fail to respond appropriately when you’re on-call, you may also be breaching your hospital contract. This kind of breach could result in the loss of hospital privileges and the ability to work out of that hospital. You may also face significant monetary penalties, as we will discuss later.

Specific Services and Procedures

If you are credentialed to provide a specific service or procedure, you will be expected to provide that service or procedure as an on-call physician under EMTALA. Even if you practice a highly specialized type of medicine through your private practice, the hospital may want you to be on-call in case your type of expertise is needed in an emergency. 

As such, you should continually assess your capabilities and what services you’ve agreed to provide. If there are procedures you have stopped performing or medical services that you no longer offer, consider relinquishing those privileges so that the hospital will not expect you to execute those responsibilities when you’re on call. The hospital should be aware of your capabilities and the situations in which you’ll be able to provide emergency care. 

Keep in mind that sometimes, hospitals may require more from physicians than EMTALA mandates. This is a way for hospitals to conservatively plan for emergencies and demonstrate their generous interpretation of EMTALA’s obligations.

Penalties For EMTALA Violations

The penalties for hospitals that don’t comply with EMTALA can be heavy. Both CMS and OIG have administrative enforcement powers to investigate and penalize EMTALA violations.  Severe violations of EMTALA can cause the government to terminate the hospital or provider’s Medicare Provider Agreement. Fines can reach $100,000 per violation. In addition, hospitals may be held liable in civil lawsuits brought either by patients or by other hospitals that received improper patient transfers.

Physicians can also have individual responsibility for EMTALA violations. For physicians alone, individual fines can reach $50,000, and malpractice insurance policies may not cover such monetary penalties. Between the fines and the potential loss of privileges discussed above, the personal stakes can be high.

Know the Expectations Before You Sign

The bottom line: understand the terms that you’re accepting as you move through a hospital’s credentialing and privileging process. Read the hospital’s policies and bylaws carefully. These documents can include helpful details about your obligations and the procedures for meeting them.

The experienced healthcare attorneys at Jackson LLP want to help you ensure that you fully understand the terms of your contract. If you’re looking at an employer in any state where we have licensed attorneys, book a free consultation to see if we fit your needs.

This blog is made for educational purposes and is not intended to be specific legal advice to any particular person. It does not create an attorney-client relationship between our firm and the reader. It should not be used as a substitute for competent legal advice from a licensed attorney in your jurisdiction.

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