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• EMTALA is the Emergency Medical Treatment and Active Labor Act (42 CFR § 489.24)– Emergency transfer law or “patient anti-dumping” law.– EMTALA applies to any hospital with an Emergency
• EMTALA requires participating hospitals to provide medical screening examinations (“MSE”) within its capability to all persons who present to the ED and request service, regardless of that person’s ability to pay for medical services, to determine if an emergency medical condition (“EMC”) exists.
• An EMC is a medical condition manifesting itself by acute symptoms of sufficient severity such that absence of immediate medical attention could reasonably be expected to result in:– Placing the health of individual in serious jeopardy.– Serious impairment to bodily functions.– Serious dysfunction of any bodily organ or part.
• When no material deterioration of the condition is likely, within reasonable medical probability, to result from or occur during the transfer of the individual from a facility. – Hospitals are not required to provide screening
services beyond what is needed to determine if an EMC exists.
– Hospitals are not required to resolve the underlying medical condition(s) to achieve stabilization.
• Not an isolated event, but an on-going process.• Patient’s record must reflect continued monitoring according to
patient’s needs and must continue until he/she is stabilized or appropriately transferred.
• Should be evidence of evaluation prior to discharge or transfer.
• “If a hospital applies in nondiscriminatory manner…a screening process reasonably calculated to determine whether an EMC exists, it has met its obligations under EMTALA.” (CMS Manual, Transmittal 60, July 16, 2010)
What Is Meant By “within the medical facilities capability”?
• Includes ancillary services routinely available to emergency room.
• Includes capabilities of specialists and subspecialists on-call to emergency room and available to provide treatment necessary for stabilization of EMC.– Availability of specialists especially a concern in rural
• Interpretive guidelines state that participating hospital that have specialized capabilities or facilities (e.g., burn units, shock-trauma units, neonatal intensive care units) may not refuse to accept from a referring hospital an appropriate transfer of an individual requiring such specialized capabilities if receiving hospital has capacity to treat the individual.
• Capacity means the ability of the hospital to accommodate the individual and includes such things as – Numbers and availability of qualified staff, beds, and
equipment.– Hospital’s past practices of accommodating additional
• Transfer means movement (including discharge) of individual outside hospital facilities at direction of any person employed by or affiliated with hospital.– Transfer does not include:
• Movement of individual declared dead,• Individual who leaves facility without permission of
• A transfer in which transferring hospital provides medical treatment within its capacity which minimizes risk to individual’s health (or health of unborn child) in which:– Receiving facility has available space and qualified
personnel for treatment,– Has agreed to accept transfer and to provide
appropriate medical treatment,– Transferring hospital sends to receiving hospital
medical records,– Transfer is accomplished through qualified personnel
Does A Hospital Violate EMTALA If A Patient Refuses Treatment?
• No -- An individual may refuse to consent to examination and treatment, but only after the hospital offers further medical examination and treatment and informs the individual of the risks and benefits of examination and treatment – But, hospital must take all reasonable steps to secure
individual’s written informed consent to refusal of further medical examination and treatment.
• EMTALA requires hospitals to maintain an on-call list of physicians :– Who are on the hospital’s medical staff, or – Who have privileges at the hospital, or – Who are on staff or have privileges at another hospital
Can A Physician Who Is On-call Schedule Elective Surgery During His/Her Call Time?
• Yes -- A physician may schedule elective surgery during his/her call time or have simultaneous call duties, but to do so the hospital MUST have policies to provide for emergency services if the on-call physician is not available in the event of an EMC.
Myth: If You Have 3 People In A Group, You Are Required To Come To The ED When Called
Fact: if the physicians in the group are on the hospital’s medical staff, have privileges at the hospital, or are on staff or have privileges at another hospital that participates in a formal community call, then the physician(s) must participate in the call requirements and come to the ED when called according to a schedule
How Can A Physician Cure A Selective Call Violation?
• If a physician agrees to come in for all similarly situated patients or if a physician of the same specialty is available for all emergency patients.– However, this situation would likely create a 24/7 call
requirement • Also, if the established call schedule did not have
the physician on-call, a surveyor may still determine the physician and hospital violated EMTALA by engaging in selective call.
Is It A Violation Of EMTALA For A Physician To Refuse To Take Call?
• Yes
• A hospital should specify call schedule in its hospital medical staff bylaws. Typically those involved will include:
– A physician who is on the hospital’s medical staff; or – Who has privileges at the hospital; or – Who is on staff or has privileges at another hospital that
• It allows hospitals in areas with fewer specialists to share the call responsibilities – It must include:
• Clear delineation of on-call coverage responsibilities,• Define geographic area included,• Signed by representative of each hospital, • Local and regional EMS system protocol includes
information,• Even if individual arrives at hospital that is not
designated as the on-call hospital, it still has EMTALA obligations to do MSE and stabilize.
