Understanding the Emergency Medical Treatment and Active Labor Act

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An Important and Contemporary Issue – Once Again

[By Patricia Trites; MPA, CHBC, CMP™ (Hon) with Staff Reporters]

tritesThe Emergency Medical Treatment and Active Labor Act (EMTALA) is receiving increasing scrutiny from prosecutors during these times of financials stress and credit tightening. The statute is intended to ensure that all patients who come to the emergency department of a hospital receive care, regardless of their insurance or ability to pay. Both hospitals and physicians need to work together to ensure compliance with the provisions of this law.

Triad of Requirements

EMTALA imposes three fundamental requirements upon hospitals that participate in the Medicare program with regard to patients requesting emergency care.

First, the hospital must conduct an appropriate medical screening examination to determine if an emergency medical condition exists.

Second, if the hospital determines that an emergency medical condition exists, it must either provide the treatment necessary to stabilize the emergency medical condition or comply with the statute’s requirements to affect a proper transfer of a patient whose condition has not been stabilized. A hospital is considered to have met this second requirement if an individual refuses the hospital’s offer of additional examination or treatment, or refuses to consent to a transfer, after having been informed of the risks and benefits of treatment.

Third, EMTALA’s requirement is activated if an individual’s emergency medical condition has not been stabilized.

Hospital Transfers

A hospital may not transfer an individual with an unstable emergency medical condition unless:

(1) the individual or his or her representative makes a written request for transfer to another medical facility after being informed of the risk of transfer and the transferring hospital’s obligation under the statute to provide additional examination or treatment;

(2) a physician has signed a certification summarizing the medical risks and benefits of a transfer and certifying that, based upon the information available at the time of transfer, the medical benefits reasonably expected from the transfer outweigh the increased risks; or

(3) a qualified medical person signs the certification after the physician, in consultation with the qualified medical person, has made the determination that the benefits of transfer outweigh the increased risks, if a physician is not physically present when the transfer decision is made. The physician must later countersign the certification.dhimc-book21

On-Call Responsibilities

One area of particular concern is physician on-call responsibilities. Physician practices whose members serve as on-call hospital emergency room physicians are advised to familiarize themselves with the hospital’s policies regarding on-call physicians. This can be done by reviewing the medical staff bylaws or policies and procedures of the hospital that must define the responsibility of on-call physicians to respond to, examine, and treat patients with emergency medical conditions. Physicians should also be aware of the requirement that, when medically indicated, on-call physicians must generally come to the hospital to examine the patient. Patients may be sent to see the on-call physician at a hospital-owned contiguous or on-campus facility to conduct or complete the medical screening examination due to the following reasons:

  • all persons with the same medical condition are moved to this location;
  • there is a bona fide medical reason to move the patient;
  • qualified medical personnel accompany the patient; and
  • teaching physicians may participate.

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9 Responses

  1. EMTALA and National Healthcare

    EMTALA is the flawed, unfunded, mandate forcing hospitals to provide a medical exam to anyone who presents to a hospital emergency room.

    Now, can’t one imagine a scenario where a family who is denied care, is uninsured or can’t afford it, simply calls emergency services or shows-up in the hospital ER to get the care they need [want]?

    Don’t we have socialized medicine already; given Medicare, Medicaid, the Indian Health and Prison Systems, SHIPS, etc?



  2. Gary,

    Agree with you.

    Let’sget rid of EMTALA. If everyone is required to purchase their own insurance, there is no justification for hospital systems to be required to absorb the cost of providing care for those who choose not to purchase their own policies.

    For those who choose not to purchase their own policies and find themselves sick and in need of help, they have the right to seek out care from organizations who provide that carry voluntarily from any government mandate.



  3. EMTALA is the unfunded, mandate forcing emergency departments to provide a medical examinations and stabilization treatments to anyone who presents to a hospital emergency room. It is a very fine part of the medical market.

    Of course, EMTALA stops way short of what other first world industrialized nations provide; yet, given the me-first screw everyone else ideologies of many in the USA, EMTALA is the best we can do for now.

    It is a sad state of affairs that in America some think that the Greedy are Needy while the Needy are Greedy. This nation has been turned on top of its head going back the Reagan. Sigh …



  4. Health overhaul may mean longer ER waits, crowding

    Emergency rooms, the only choice for patients who can’t find care elsewhere, may grow even more crowded with longer wait times under the nation’s new health law. People without insurance aren’t the ones filling up the nation’s emergency rooms. Far from it. The biggest users of emergency rooms by far are Medicaid recipients. And the new health insurance law will increase their ranks by about 16 million.




  5. EMTALA and why this emergency physician is against it


  6. Emergency Care, But Not at a Hospital

    Emergency departments are struggling to keep up with demand, serving a growing number of people at the same time that their numbers are shrinking.

    One increasingly popular option, discussed on the ME-P, is to improve access to services is the freestanding emergency department, a facility that, as its name suggests, isn’t physically located with a hospital.

    Services at these facilities get high marks, but questions remain about whether they’re the best choice for some serious medical problems, such as heart attacks. And, some policy experts say the facilities may not be serving the people who need them most.


    Ann Miller RN MHA
    [Managing Editor]


  7. MetroAtlanta Ambulance to offer Georgia’s first free EMT program

    MetroAtlanta Ambulance Service will offer the first free emergency medical technician’s program in Georgia.


    The program, to be offered at the MetroAtlanta EMS Academy with help from Kennesaw State University’s nursing school, provides entry-level education to help students prepare for the state’s licensing examination.

    Ann Miller RN MHA


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