The Emergency Medical Treatment and Active Labor Act

The Emergency Medical Treatment and Active Labor Act (EMTALA) is a federal law enacted in 1986 to stop the practice of “patient dumping,” or turning patients away from emergency rooms based on their lack of ability to pay. Under EMTALA, any hospital that has an emergency room and that receives federal funding must provide any individual coming to its premises with a medical screening examination to determine if an emergency condition or active pregnancy labor exists. If so, the hospital is required to stabilize the patient’s condition prior to transferring the patient to another facility, subject to a few narrowly defined exemptions. The transfer must be appropriate and meet certain conditions.

The purpose of EMTALA is to require any hospital receiving federal Medicare funding to provide the initial medical screening examination regardless of diagnosis, financial status, race, color national origin, or handicap. Under the law, the hospital in not permitted to delay the initial medical screening to even ask about a patient’s insurance status. While the law applies only to hospitals receiving Medicare funding, it protects all individuals who appear in an emergency room, not just those receiving Medicare benefits.

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Both hospitals and physicians may be subject to substantial penalties for violating provisions of EMTALA. The maximum civil fines for hospitals range from $25,000 to $50,000 for each violation. Physicians who participate in the wrongful transfer of an unstable patient may be fined up to $50,000, and they may be excluded from federal and state medical reimbursement programs if the violations of EMTALA are gross and flagrant or repeated. In addition, EMTALA grants a private right of action against hospitals to patients who were harmed by a wrongful transfer or to hospitals forced to bear the cost of a wrongful transfer. Claims under EMTALA must be filed within two years from the date of the violation.

Although EMTALA is broad and ambitious in its coverage, it is vague in many areas. It is unclear whether EMTALA’s obligations apply only to hospitals or if they extend to off-campus hospital facilities such as physician’s offices, clinics, or outpatient departments affiliated with a hospital subject to EMTALA. Due to the vague nature of the statute, the Department of Health and Human Services has issued regulations with interpretative guidelines in an attempt to clarify the law. These guidelines provide details to help hospitals in precisely complying with the statute and address the responsibility of hospitals when dealing with managed care patients. Under the regulations, hospitals subject to EMTALA must treat any person who presents to an emergency room regardless of any participating provider agreements that they might have with managed care organizations, and they may not delay treatment to consider the reimbursement issues.

In the almost 20 years since the enactment of EMTALA, a hospital’s legal obligations under the saw have been narrowed by various courts and federal agencies in order to focus more closely on its original goal of preventing “patient dumping.” Recent court decisions and new regulations have attempted to clarify a hospital’s duties while avoiding the federalization of medical malpractice law.