Medical Emergencies and the Law
by: Iowa Legal Aid
In 1986, concerns about "patient dumping" by hospitals led Congress to adopt a new law. Patient dumping refers to when a hospital denies care to patients or transfers patients to other hospitals without providing any medical treatment. "Dumped" patients were uninsured or under-insured. Some believed other discriminatory reasons were behind these actions. Congress thought the delay and denial of emergency treatment was causing injuries and deaths. So Congress passed The Emergency Medical Treatment and Active Labor Act ("EMTALA"). The intent of the law was to stop "patient dumping."
What does the EMTALA cover?
EMTALA is a federal law. It makes hospitals give exams and treatment to patients with medical emergencies. This article only deals with what this law requires hospitals to do. It does not address other laws which might apply to hospitals.
Where does the law apply?
EMTALA only applies to hospitals which:
- have an emergency room, and
- take part in the Medicare program.
What does the law require?
When you go to a covered hospital for emergency help, it must provide one of these types of care:
- a proper screening, and
proper treatment to stabilize the problem, or
a proper transfer.
The hospital may not delay your screening to find out your insurance status or how you will pay or what. The hospital does not need to use the latest technology or the best test. The hospital must only screen you the way other patients are screened. The hospital cannot treat you differently from other patients with the same or similar medical condition.
What if you go to the hospital, but not the emergency department?
EMTALA still applies to the hospital no matter what part of the hospital you go to for emergency care. If you are already an inpatient at the hospital, EMTALA normally does not apply to you.
Does the hospital have to follow EMTALA if you are picked up by an ambulance?
Yes, but there are exceptions. It depends on who owns and operates the ambulance. It also depends on if there are agreements about which hospital the ambulance must go to first.
A doctor or other certified medical staff must see you when you go to the hospital for emergency treatment. A doctor must appropriately screen you and decide if you have an emergency. Sometimes a nurse might only see you. Even if you are only seen by a nurse, the nurse must report to the doctor and the doctor must decide if you have an emergency.
What if you don't have a "medical emergency?"
If you do not have medical emergency, the hospital does not have to examine or treat you any further.
What if you DO have an emergency?
If you do have an emergency, then the hospital has two options:
- offer you necessary exams and stabilizing treatment if the hospital has the ability and space, or
- transfer you to another facility that has the space and ability to treat you.
Are there rules about what a hospital must do before treating a patient?
Before you are examined or given stabilizing treatment, the hospital must explain the risks and benefits of the exams or treatment. They must get your consent before they can examine or treat you. You may make a decision not to be examined or treated. The hospital must provide enough care so your condition does not get worse. The hospital must stabilize you within their capability.
What happens after you are "stabilized?"
Once you are stabilized, the hospital may transfer, admit or discharge you. The hospital does not have to cure you or do everything to make you better. The hospital just has to make sure, to the best of their ability, that you do not get worse.
What must a hospital do before transferring a patient somewhere else?
If you are not stabilized, the hospital may not transfer you unless:
- you agree to the transfer, and
- a doctor signs a certification that the medical benefits to transfer outweigh the risks of not transferring you. (If there is no doctor at the hospital at the time of your transfer, other qualified medical staff may sign the certification only after consulting with a doctor and the doctor decides that the benefits of transfer outweigh the risks. The doctor must later countersign the certification), and
- before you can be transferred, the receiving facility must first agree to accept and treat you. Facilities that have special units like burn units or neonatal intensive care, for example, cannot refuse to accept a transfer if it has the capability to treat you, and
- the hospital must transfer all of the medical records about your emergency condition, and
- as appropriate for your condition, qualified personnel using qualified transport equipment may transfer you and give you any necessary and medically appropriate life support during the transfer.
The hospital must also explain the risks and benefits to a transfer. They must get your consent before they can transfer you.
Does EMTALA Apply to Inpatients?
The hospital is not covered by EMTALA after you are admitted as an inpatient. The hospital cannot admit you, though, just to avoid their duties under EMTALA.
Why is EMTALA important?
The numbers of people who are uninsured and under-uninsured continue to grow. Medical costs continue to rise. The number of people going to the emergency room for care continues to increase. All these factors mean hospital emergency departments face more pressure. As a result, EMTALA will continue to play an important role in emergency care.
What can happen if you believe the EMTALA has been Violated?
An investigation will happen after a complaint is filed with the Centers for Medicare and Medicaid Services or Iowa Foundation for Medical Care. If a hospital or doctor violates EMTALA, they can be fined and possibly lose the right to get payments from the Medicare program. When a hospital violates EMTALA, they can be fined up to $50,000 for hospitals with more than 100 beds and up to $25,000 for hospitals with less than 100 beds. A doctor can be fined up to $50,000.
Who can be sued under EMTALA?
Only hospitals can be sued under this law. Doctors cannot be sued under EMTALA. It is important to remember that EMTALA does not take away any rights that a patient may have under other laws, like medical malpractice. A patient may be able to sue the hospital if it violates EMTALA and causes harm to the patient as a result.
What kinds of actions violate EMTALA?
Here are some possible examples:
- not screening the patient like other patients with the same or similar medical condition;
- delaying or denying screening unreasonably by asking for payment information before screening;
- refusal or failure to provide examination or stabilizing treatment to the patient within the hospital's capability;
- failure to inform patient of the risks and benefits of treatment or transfer;
- hospital misrepresenting the patient's condition;
- transferring an unstable patient without a doctor certifying that the benefits outweigh the risks;
- not transferring the patient's emergency record;
- not providing life support during transfer if needed; or
hospital refusing to accept a transfer.
This list only has examples. It is not a complete list of possible violations.
Where can you file a complaint if you think that your rights were violated?
Complaints can be made to:
Centers for Medicare and Medicaid Services - Region 7
Richard Bolling Federal Building, Room 235
601 East 12th Street
Kansas City, MO 64106
Phone: (816) 426-2011
Fax: (816) 426-3548
OR
Iowa Foundation for Medical Care
Attn: Case Review
6000 Westown Parkway
West Des Moines, IA 50266-7771
Phone: (800) 752-7014
Fax: (515) 223-2141
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