CHAPTER 33
EMTALA in Urgent Care Medicine
Rachel A. Lindor
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THE EMERGENCY MEDICAL TREATMENT AND ACTIVE LABOR ACT (EMTALA), commonly referred to as the “patient anti-dumping act,” is designed to prevent hospitals and emergency departments (EDs) from refusing to treat patients who are unable to pay for their care. Enacted in 1986, EMTALA was inspired by a smattering of highly publicized cases in which patients with life-threatening conditions were turned away from EDs because they were uninsured.
Although EMTALA was originally designed to protect indigent patients who presented to EDs, its scope has expanded considerably since 1986. Currently, the provisions of EMTALA apply to all patients, regardless of insurance status, age, immigration status, or any other characteristic. In addition, the act’s provisions apply to a number of clinical care sites, not only the traditional EDs that were originally targeted by the legislation. Identifying these additional sites is the first major focus of this chapter.
For health-care providers and institutions that are subject to EMTALA, the law can be broken into three main requirements. First, all patients must be given an appropriate medical screening exam designed to detect emergency medical conditions. Second, if an emergency medical condition is found, patients must be stabilized before being discharged or transferred. Third, if an emergency medical condition is found and the institution does not have the capabilities to stabilize the patient, the act requires both that the patient be transferred to a site that does have the necessary capabilities and that the site with the specialized capabilities accept that transfer as long as it has the capacity to do so. Additional details regarding these requirements are the second major focus of this chapter.
The requirements of EMTALA are enforced through three major avenues. First, the Centers for Medicare & Medicaid Services (CMS)—the federal agency that interprets and oversees EMTALA—receives and investigates claims for alleged EMTALA violations from state surveyors. In 2000, the last year in which EMTALA violations were internally reviewed, CMS received around 400 claims and found violations in about half of those, representing roughly 5% of hospitals with EDs. When CMS finds that a violation has occurred, the agency can begin the process of terminating a hospital’s Medicare provider agreement. In almost all cases, the hospital submits a corrective action plan that details changes it will make to prevent future violations, thus putting a halt to the termination process and retaining its provider agreement.