EMTALA Prepared by: Sarah Axler, MD University of Connecticut
Dec 31, 2015
EMTALA
Prepared by:Sarah Axler, MD
University of Connecticut
Introduction
• Emergency Medical Treatment & Active Labor Act
• Federally-mandated requirement
• Patient anti-dumping law
Objectives
• EMTALA: When? What? Whom?
• EMTALA requirements
• EMTALA exceptions
• Violations
When does EMTALA apply?
1. Individual comes to E.D. & requests treatment
– Regardless of ability to pay, insurance status, citizenship, ethnicity, …
2. ‘Prudent Layperson’ Standard: Individual’s appearance or behavior would cause a prudent layperson to believe that examination or treatment is needed
What constitutes an ‘E.D.’?
• Dedicated emergency department
• Hospital property
• Ambulances
Photo Courtesy of U.S. Army
To whom does EMTALA apply?
• All Medicare-participating hospitals
• Any physician responsible for examination, treatment, or transfer of patient in an ED– Including physician-on-call
EMTALA Requirements
1. A hospital must perform a medical screening exam to any person coming to ED seeking care
2. A hospital must treat any patient with an emergency medical condition until stable, or must transfer the patient
3. A hospital may not transfer an unstable patient
MSE: Medical Screening Exam
• Performed by a ‘qualified medical person’ (QMP)– MD, DO, PA, NP, midwife– Anyone defined by hospital privileges as QMP
• MSE cannot be delayed to inquire about payment or insurance status
• Triage ≠ MSE
EMC: Emergency Medical Condition
• Definition: When absence of immediate medical attention could result in:– Placing health of a person or unborn child in
serious jeopardy– Serious impairment to bodily function– Serious dysfunction of part of the body– Severe pain
• No EMC found?– Hospital has no further legal obligation to treat
Pregnancy
• Pregnant women with contractions are considered to be medically unstable (active labor)
• QMP must certify that the patient is in false labor
US Air Force / 445th Airlift Wing Maj. Ted Theopolos
Stabilization
• Definition: Medical treatment of an EMC within the capabilities of the facility & staff
• After stabilization, there are no further EMTALA obligations
Patient Refusal of MSE or Treatment
• Inform patient of risks of refusal
• Document this conversation in the medical record
• Attempt to obtain patient’s written refusal
On-call Physicians
• Must respond within ‘a reasonable amount of time’ when requested
• Hospital must have policy in place for back-up or transfer if on-call physician cannot respond
Picture: Ed Edahl, Federal Emergency Management Agency
Transfer
• Reasons for transfer:1. Appropriate care is not available at the
current facility
2. Patient requests transfer
• Hospital discharge is considered a ‘transfer’
Before Transfer …
1. Treat & stabilize patient as far as possible
2. Patient must sign certification / informed consent for transfer
3. Contact receiving hospital
4. Receiving hospital must accept transfer
5. Send copies of medical records & test results
6. Arrange necessary personnel & equipment for transfer
Transfer: Receiving Hospital
• Must accept transfer if hospital’s capabilities to treat the patient exceeds risks of transfer
• Not obligated to conduct another MSE
• Snitch Rule: Receiving hospital must report cases of inappropriate transfers
Patient Refusing Transfer
• Inform patient of risks & benefits of transfer– Document conversation in medical record
• Attempt to obtain patient’s written refusal of transfer & reason for refusal
• Continue to treat patient until stable
EMTALA Sign
• Must be posted in all public entrances, registration areas & ED waiting areas
Enforcement
• Maximum fine per violation: $50,000 – $25,000 for hospitals with <100 beds
• Gross violations can lead to termination of Medicare funding
• Individual doctors CAN be fined!
Take Home Points: EMTALA
• Every patient presenting to any ED must have a medical screening exam
• Every patient with an emergency medical condition must be stabilized and/or transferred
• Before hospital transfer, a patient must be stabilized as far as possible
• EMTALA is enforced with hefty fines
Conclusion
• Treat EVERY patient that comes to the ED to the best of your ability without regard to their ability to pay