Patients Rights: The Law Under EMTALA

In 1986, Congress enacted the Emergency Medical Treatment and Active Labor Act (“EMTALA”) codified at 42 USC § 1395dd. EMTALA applies to any hospital that participates in the Medicare program (which is virtually every hospital in the United States) and which has an emergency room. It requires that the hospital must provide for appropriate medical screening, within the capabilities of the hospital, to determine whether an emergency medical condition exists for any patient for whom a request for an examination is made. The request for examination may be made by the patient or by someone acting on behalf of the patient.

Under EMTALA, “emergency medical condition” means:

(A) a medical condition manifesting itself by acute symptoms of sufficient severity (including severe pain) such that the absence of immediate medical attention could reasonably be expected to result in—
(i) placing the health of the individual (or, with respect to a pregnant woman, the health of the woman or her unborn child) in serious jeopardy,
(ii) serious impairment to bodily functions, or
(iii) serious dysfunction of any bodily organ or part; or

(B) with respect to a pregnant woman who is having contractions—
(i) that there is inadequate time to effect a safe transfer to another hospital before delivery, or
(ii) that transfer may pose a threat to the health or safety of the woman or the unborn child.

EMTALA further requires that if an individual is determined to have an emergency medical condition that the hospital must provide, within the staff and facilities available at the hospital, further medical examination and treatment as are required to stabilize the medical condition or that the hospital must transfer the patient to another facility.

EMTALA prohibits hospitals with emergency rooms that participate in Medicare (which is virtually every hospital in the United States) from failing to screen and stabilize all patients (not just those receiving Medicare) suffering from an emergency medical condition. EMTALA requires any hospital having an emergency room to screen any patient requesting treatment. Referring a patient to another facility or demanding advance payment in a manner that causes a patient not to receive an examination and treatment for an emergency medical condition have been held to violate the requirements of EMTALA.

If the hospital makes a determination that the patient has an emergency medical condition, the hospital must provide, within its capabilities, further treatment as required to stabilize the condition or for appropriate transfer of the individual to another facility. Hospitals are not permitted to merely transfer (i.e. dump) a patient to another hospital. Instead, if the patient has not been stabilized, the patient (or someone acting on behalf of the patient) must be informed of the risks of the transfer and a certificate must be signed attesting that the medical benefits reasonably expected from treatment at the facility where the patient is being transferred outweigh the risk of transfer to the patient. Also, the transferring hospital must provide medical treatment that it is able to perform to minimize risks to the patient’s health and the receiving hospital must have available space and qualified personnel for treatment and must have agreed to accept the patient and provide the appropriate medical treatment. EMTALA requires that any transfer be by qualified personnel and transportation equipment, including the use of necessary and medically appropriate life support measures during the transfer.