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EMTALA: What hospitals and physicians need to know

Jennifer McAleer (jennifer.mcaleer@swedish.org) is Chief Compliance & Privacy Officer, Research Integrity Officer, Office of Compliance & Privacy, Swedish Health Services, Seattle, WA.

The Emergency Medical Treatment and Labor Act (EMTALA),[1] passed by Congress in 1986 as a result of high-profile patient dumping, has morphed into a complex regulation with implications many hospitals might not fully comprehend.

In short, if an individual presents at a Medicare-participating hospital’s emergency department (or anywhere within 250 yards of the hospital’s property) requesting treatment, EMTALA requires that the hospital provide a medical screening examination (MSE) to the individual, regardless of the individual’s actual or perceived ability to pay for the services.[2] An MSE is defined as an appropriate medical screening examination within the capability of the hospital’s emergency department, including tests routinely available to the emergency department, to determine whether or not an emergency medical condition exists. If the individual presents to the emergency department but is unable to request treatment for themselves, the requirement still stands if a prudent layperson/observer would reasonably believe that the individual needs examination or treatment.

If an emergency medical condition (EMC)[3] is determined to exist, the patient must then be stabilized prior to transferring or discharging them. An EMC is defined as 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 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; serious impairment to bodily functions; or serious dysfunction of any bodily organ or part. If a pregnant woman is having contractions, there must be adequate time to effect a safe transfer to another hospital before delivery, or that transfer may pose a threat to the health or safety of the woman or the unborn child.

In some cases, patients can be transferred to another hospital if the EMC that caused the patient to seek care is stabilized (even if an underlying medical condition persists), if the patient requests the transfer, or if the patient requires specialized treatment that cannot be provided at the initial facility, as long as the medical benefits of the transfer outweigh the risks. In all circumstances, a transfer form must be completed prior to the transfer taking place.

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