EMTALA

The important law that will come to bear on our discussions this week is the Emergency Medical Treatment and Active Labor Act (EMTALA). This is a Federal law that places restrictions on medical care from hospitals that receive Medicare money. As with all legislation of this type, a majority of the written law addresses how it is to be enforced. This is definitely not breakfast table reading. If you are up to the task, visit the Health and Human Services web page to read the whole thing. (I did, and I still don't understand some of it.) I've included some choice snippets from the law that should help you understand the EMTALA basics. If you are not in the mood to be an EMTALA gunner, the American College of Emergency Physicians (ACEP) has some good resources, including an EMTALA Q&A, guidelines for appropriate interhospital patient transfer, and practice guidelines regarding taking blood alcohol levels in the ED.

I. General Information. EMTALA requires hospitals with emergency departments to provide a medical screening examination to any individual who comes to the emergency department and requests such an examination, and prohibits hospitals with emergency departments from refusing to examine or treat individuals with an emergency medical condition. The term “hospital” includes critical access hospitals. The provisions of EMTALA apply to all individuals (not just Medicare beneficiaries) who attempt to gain access to a hospital for emergency care. The regulations define “hospital with an emergency department” to mean a hospital with a dedicated emergency department. In turn, the regulation defines “dedicated emergency department” as any department or facility of the hospital that either (1) is licensed by the state as an emergency department; (2) held out to the public as providing treatment for emergency medical conditions; or (3) on one-third of the visits to the department in the preceding calendar year actually provided treatment for emergency medical conditions on an urgent basis.

You're going to see a couple of potentially confusing abbreviations. Here's a key:

MSE: Medical Screening Examination
EMC: Emergency Medical Condition

Follow this link for the really juicy sections of the law. (Be sure to read them!) They are the sub-categories of 489.24. (Use the Table of Contents at the left of the .pdf when you link there, or just scroll down to the end of the document.) This section includes lay-person's language for how the law is to be interpreted. Here is the overview from the law.

489.24
Hospitals with an emergency department are required under EMTALA to do the following:

• To provide an appropriate MSE to any individual who comes to the emergency department;
• Provide necessary stabilizing treatment to an individual with an EMC or an individual in labor;
• Provide for an appropriate transfer of the individual if either the individual requests the transfer or the hospital does not have the capability or capacity to provide the treatment necessary to stabilize the EMC (or the capability or capacity to admit the individual);
• Not delay examination and/or treatment in order to inquire about the individual’s insurance or payment status;
• Accept appropriate transfers of individuals with emergency medical conditions if the hospital has the specialized capabilities not available at the transferring hospital and has the capacity to treat those individuals;
• Obtain or attempt to obtain written and informed refusal of examination, treatment or an appropriate transfer in the case of an individual who refuses examination, treatment or transfer; and
• Not take adverse action against a physician or qualified medical personnel who refuses to transfer an individual with an emergency medical condition, or against an employee who reports a violation of these requirements.

The remainder of 489.24 includes details relevant to the exam the patient is asking for [489.24(a)] whether the patient's presentation is emergent [489.24(c)] or when is an appropriate time to transfer a patient to another hospital [489.24(e)]. The law even accounts for whether the patient needs to present anywhere on hospital property or in the ED [489.24(a)]. (It is anywhere on hospital property.)