EMTALA: The Emergency Medical Treatment and Labor Act

The Emergency Medical Treatment and Labor Act (EMTALA) is legislation approved by Congress that requires any hospital that accepts payments from Medicare to provide care to any person who arrives for emergency treatment, irrespective of their citizenship or ability to pay. The law also applies to ambulance services.

EMTALA was designed to combat “patient dumping,” the practice of transferring uninsured patients from one hospital to another for financial reasons. Most hospitals in the United States participate in Medicare so the law in effect covers virtually all hospitals.

This article describes the emergency services hospitals are required to provide under EMTALA and what constitutes a violation of the law. It also explains how to file a complaint or legal action if you or a loved one has been denied emergency care.

Legal Duties of Hospitals Under the EMTALA Law

The Emergency Medical Treatment and Labor Act (EMTALA) is regulated by the Centers for Medicare and Medicaid Services (CMS). According to CMS, there are three conditions a hospital must meet under EMTALA if any person arrives seeking emergency care:

Appropriate Medical Screening

Anyone arriving at a hospital emergency room must receive appropriate and prompt examination and medical screenings to determine whether or not they are experiencing a medical emergency. The law applies to any facility that provides emergency services, not just to designated emergency rooms.

The determination of what is appropriate is based on a preliminary medical evaluation, known as triage, by an emergency care nurse and/or attending physician.

Based on the triage findings, additional tests may be ordered, including but not limited to:

• Imaging studies, like X-rays
• Blood tests
• Electrocardiogram (ECG)
• Pulse oximetry

The appropriate tests must be performed regardless of the financial or insurance status of the patient.

If the medical screening exam finds no emergency medical condition, the hospital is not required to provide further treatment. Even so, they must direct the individual to facilities or providers who can offer the appropriate non-emergency treatments they need.

Stabilization of the Patient

If an emergency medical condition exists, treatment must be delivered without delay to stabilize the patient to where they can either be safely discharged or safely transferred to another hospital better equipped to handle the emergency.

Under EMTALA, a person is stabilized when their condition, or that of their unborn baby, will not worsen upon leaving. A transfer to another hospital can only be made if there is reasonable medical certainty that “no material deterioration” will occur from or during the transfer.

Transfers, When Needed

Under EMTALA, a transfer can be made if the hospital lacks the capabilities to treat the emergency. Even so, the transfer from one hospital to another can be made if:

• The treatment provided minimizes the risks to the patient or unborn child.
• The receiving hospital has space available, agrees to the transfer, and has qualified personnel on hand to treat the patient.

On the other hand, a medically unstable patient cannot be transferred unless they specifically request the transfer and a physician certifies that the benefits outweigh the risks.

“Reverse-Dumping”

Reverse-dumping is the practice in which a hospital with specialized units (such as burn units) refuses the transfer of a patient who requires their specific services and sends them back to the transferring hospital.

Under EMTALA, a hospital with specialist units must take appropriate transfers. Refusal can only be made if the hospital doesn’t have any open beds or the emergency room is suddenly overwhelmed and lacks the medical capability (such as not having enough ER physicians or medical equipment).

Even so, if a patient is transferred to a specialized hospital with no beds, the hospital must still treat them. They can then report the transferring hospital for an EMTALA violation.

What Is an EMTALA Violation?

EMTALA violations are surprisingly uncommon, but they do occur. According to research from the Milken Institute School of Public Health at George Washington University, EMTALA violations dropped from a high of 46 in 2002 to a low of six in 2015 (a decline of 87%).

A violation occurs when any of the three fundamental conditions of EMTALA are not adhered to.

Examples of EMTALA violations include the following:

• You arrive at an emergency room that does not accept your insurance. The ER staff directs you to a nearby hospital that does and orders an ambulance without performing triage.
• You have been stabilized and informed that you need to be transferred to another hospital that can better treat you. When you arrive, the receiving hospital has no beds and has not been informed of the transfer.

EMTALA violations by hospitals with over 100 beds may result in civil penalties of $119,942 per infraction, while hospitals with under 100 beds may be subject to civil penalties of $59,973 per infraction. Physicians may also be subject to civil penalties of $199,942 per infraction.

On top of this, violating hospitals or physicians could be sued for damages and/or excluded from Medicare.

How Is an EMTALA Violation Reported?

Anyone can report a suspected EMTALA violation to their state survey agency. You can file a complaint without providing your name and remain anonymous throughout the investigation.

A state survey agency is the office that determines whether healthcare providers meet federal certification standards to participate in Medicare or Medicaid programs.

Complaints may be filed online or by mail. Be sure to include:

• The hospital name
• The patient’s name
• What happened, including the date of the incident
• Your name and contact information (unless you file anonymously)

Civil monetary penalties (CMPs) may be imposed against hospitals or individual physicians for EMTALA violations. Physicians may also be subject to exclusion from the Medicare and Medicaid programs.

If you were denied treatment based on race, ethnicity, sexual orientation, or any other form of discrimination, you can file a civil rights complaint with the Department of Health and Human Services if the incident happened within the past six months.

If an EMTALA violation resulted in the death or disability of a loved one or unborn baby, contact a medical malpractice attorney to file legal action against the hospital and responsible individuals.

Summary

The Emergency Medical Treatment and Labor Act (EMTALA) protects patients from being turned away from emergency rooms based on their citizenship state or inability to pay.

Under EMTALA, emergency rooms are required to perform medical screenings to determine if there is a medical emergency. If there is, the patient must be stabilized or safely transferred to a hospital capable of treating their emergency medical condition.