June Spotlight — Emergency Medicine: EMTALA, A Federal law that may affect your area of practice


Submitted by Steven Gamburg, MD, Chair, Emergency Medicine


The Emergency Medical Treatment and Active Labor Act (EMTALA) is a federal law that has tentacles reaching into many physician areas of practice, not just the Emergency Department. Initiated in response to transfer of under-insured patients with emergency conditions and originally known as the “anti-dumping” law, it has transformed into something far broader.


If a person “comes to the emergency department” seeking emergency care, emergency physicians (or other specific qualified medical personnel) are obligated to perform an evaluation in the form of a Medical Screening Exam (MSE) to rule out an emergency medical condition, and it cannot be delayed to obtain insurance or other undue information. The MSE must be performed uniformly and include all tests that would be considered typically needed to make the determination of whether an emergency medical condition exists.  If it is determined that the patient has an emergency medical condition, then the hospital must provide necessary stabilizing treatment prior to discharge or transfer of the patient.


EMTALA does NOT apply to private physician offices but it DOES apply to hospital buildings, parking lots, sidewalks, driveways and areas within 250 yards of the main hospital building.  It also applies to off-campus provider-based departments. And if you are the On-Call physician, then EMTALA applies to you. You must be available in a timely fashion to present to care for a patient who has an emergency condition when called to do so.


EMTALA addresses transfers for those with an emergency condition. Patient transfers must be performed in a manner which attempts to ensure the patient’s best outcome.  Transfer of a patient with an emergency medical condition that has not been stabilized is only permissible if the patient/family requests a transfer in writing after being told of the risks, or if the hospital cannot stabilize the patient and a physician has signed a certification that the benefits of transfer outweigh the risks.


Qualified personnel and records must accompany the patient on transfers and, again, the stability of the patient is of paramount importance. There are many other rules outlined in EMTALA that are crucial to follow if one is to maintain compliance with the transfer process. For example, the receiving facility must have adequate space, equipment and qualified personnel to care for the patient and must accept the patient in transfer. And, hospitals with specialized capabilities, such as trauma or NICU that have available capacity, may not refuse the transfer of a patient with an emergency medical condition.


Hospitals are obligated to report an improper transfer when it is felt that there has been an EMTALA violation.


Civil monetary penalties for an EMTALA violation, which may not be covered by your malpractice policy, include fines up to $50,000.


For more information on EMTALA, refer to the EMTALA Policy or contact the MLH Legal or Compliance Departments.


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