The document discusses EMTALA (Emergency Medical Treatment and Active Labor Act), which requires hospitals with emergency departments to provide medical screening exams and stabilizing treatment to anyone who requests it, regardless of ability to pay. Key points include: - Hospitals with emergency departments must provide a medical screening exam to anyone who requests one to determine if an emergency medical condition exists. - If an emergency condition exists, the hospital must stabilize the patient or appropriately transfer them. - EMTALA applies to any individual on hospital property, including ambulances and areas within 250 yards, and certain off-campus facilities like urgent cares. - Hospitals cannot delay care, transfer unstable patients, or discourage patients from treatment based on insurance status

1. EMTALA:
Things You Don’t Know
Elizabeth Davlantes, MD

2. History
 Emergency Medical Treatment and Active
Labor Act enacted by Congress in 1985
 “Patient dumping”
 Part of Medicare, but applies to all patients
 Updated 5 times- last in 2003
 Established ER as safety net

3. Key Points
 Any ER that accepts Medicare or Medicaid
payments must participate
 Must offer a medical screening exam (MSE) to
anyone who asks for one OR looks like they
need one
 If an emergency medical condition (EMC)
present, stabilize or transfer

4. 42 U.S. Code §1395dd
In the case of a hospital that has a hospital emergency
department, if any individual (whether or not eligible for
benefits under this subchapter) comes to the emergency
department and a request is made on the individual’s
behalf for examination or treatment for a medical
condition, the hospital must provide for an appropriate
medical screening examination within the capability of the
hospital’s emergency department, including ancillary
services routinely available to the emergency department,
to determine whether or not an emergency medical
condition exists.

5. “Any Individual”
 Word choice- not “patient”
 Anyone on ANY hospital property who requests
medical attention
 Prudent layperson- new from 2003
 If a patient does not ask for emergency care but a
“prudent layperson” could see that they need it
 Must register EVERYONE

6. “The Hospital Campus”
 Anywhere on hospital property
 OR within 250 yards of hospital property
 Including hospital-owned ambulances (with
some exceptions)
 Exempt:
 Hospitals without ERs
 VA hospitals, military hospitals
 Non-hospital-owned urgent care centers

7. What Counts as an ER?
 “Dedicated Emergency Department”
 Meets 1 of 3 requirements:
 Licensed by the state as an ER
 Advertised to the public as providing unscheduled
emergency or urgent care visits
 1/3 of visits are for treatment of medical conditions
on an urgent basis without an appointment

8. Who Can Perform MSE?
 “Qualified medical professional”
 Designated in hospital bylaws
 Attending physicians
 NP/PA/CNM if supervised
 Residents?
 NOT nurses

9. Registration
 Must register all people who come to your ED,
even if they later decide not to be seen
 Registration/insurance checking may not delay
MSE

10. Screened, Now What?
 EMC: the absence of immediate medical
attention will result in serious injury
 If no EMC present, EMTALA obligation ends
 Insurance pre-authorization
 State and local laws may apply
 Or once you admit to inpatient
 But really… keep treating the patient

11. When to Transfer?
 Hospital has used all available resources to
provide all the care within its capability
 Receiving hospital has space and qualified
personnel
 Receiving hospital has agreed to transfer
 Transfer performed by qualified personnel with
appropriate equipment
 Enclose relevant medical records

12. When to Transfer?
 If pt unstable, CANNOT transfer
 Unless:
 Pt requests transfer in writing and understands risks
and benefits
 Physician certifies that benefits outweigh risks
 Active labor not stable until baby and placenta
are delivered
 Receiving hospital must report bad transfers

14. Consultants
 If it’s available at your hospital, it needs to be
available to the ER
 Telemedicine doesn’t count
 Must maintain on call lists
 If the ER calls, consultant must see the patient
in a timely fashion
 Must provide timely outpatient follow up,
regardless of ability to pay

15. Costs
 No funding attached to EMTALA mandate
 Uncompensated care

16. Penalties for Violations
 $50,000 per violation
 Excluded from Medicare
 Victims of dumping can recover all costs of care
 Patient sues you
 Loss of federal grants
 Civil rights violations
 Injunction

17. Cases

18. Case 1
 I work at a children’s hospital across the street
from an adult hospital, and a patient’s
grandmother just fainted in the cafeteria. Can I
roll her in a stretcher in across the street to the
adult ED? They will have better expertise to
care for her…

19. Case 2
 I am a neurologist in a small, hospital-based
practice (4 neurologists in total). Two of our
neurologists are leaving town for a week for a
conference. It’s no problem to cover their clinic
patients, but do the two of us left have to take
q2 ER call?!?

20. Case 3
 My ER is overcrowded with low-acuity patients,
so we have initiated a process to divert some of
them to our walk-in primary care clinic on the
hospital campus. Is this EMTALA-compliant?
 What about sending needlestick patients to
occupational health?

21. Case 4
 I work at a hospital-owned urgent care center in
Rural, Georgia. Our center is located three
hours away from the parent hospital in Atlanta,
and across the street from Rural Regional
Hospital here in town. If I identify a patient with
an EMC at my urgent care center, can I transfer
them to Rural Regional Hospital?

22. Case 5
 To beat the EMTALA obligations, our hospital
has organized our urgent care centers under a
separate LLC from the one the hospital is under.
The same people administer both companies,
but since they are legally separate, now our
urgent care centers can reject uninsured patients.
Right?

24. Take Home Points
 Take care of the patient
 Work together
 Document everything!

27. Thank you!