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EMTALA. Prepared by: Sarah Axler, MD University of Connecticut. Introduction. E mergency M edical T reatment & A ctive L abor A ct Federally-mandated requirement Patient anti-dumping law. Objectives. EMTALA: When? What? Whom? EMTALA requirements EMTALA exceptions Violations.

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emtala
EMTALA

Prepared by:

Sarah Axler, MD

University of Connecticut

introduction
Introduction
  • Emergency Medical Treatment & Active Labor Act
  • Federally-mandated requirement
  • Patient anti-dumping law
objectives
Objectives
  • EMTALA: When? What? Whom?
  • EMTALA requirements
  • EMTALA exceptions
  • Violations
when does emtala apply
When does EMTALA apply?
  • Individual comes to E.D. & requests treatment
    • Regardless of ability to pay, insurance status, citizenship, ethnicity, …
  • ‘Prudent Layperson’ Standard: Individual’s appearance or behavior would cause a prudent layperson to believe that examination or treatment is needed
what constitutes an e d
What constitutes an ‘E.D.’?
  • Dedicated emergency department
  • Hospital property
  • Ambulances
to whom does emtala apply
To whom does EMTALA apply?
  • All Medicare-participating hospitals
  • Any physician responsible for examination, treatment, or transfer of patient in an ED
    • Including physician-on-call

Photo Courtesy of U.S. Army

emtala requirements
EMTALA Requirements
  • A hospital must perform a medical screening exam to any person coming to ED seeking care
  • A hospital must treat any patient with an emergency medical condition until stable, or must transfer the patient
  • A hospital may not transfer an unstable patient
mse medical screening exam
MSE: Medical Screening Exam
  • Performed by a ‘qualified medical person’ (QMP)
    • MD, DO, PA, NP, midwife
    • Anyone defined by hospital privileges as QMP
  • MSE cannot be delayed to inquire about payment or insurance status
  • Triage ≠ MSE
emc emergency medical condition
EMC: Emergency Medical Condition
  • Definition: When absence of immediate medical attention could result in:
    • Placing health of a person or unborn child in serious jeopardy
    • Serious impairment to bodily function
    • Serious dysfunction of part of the body
    • Severe pain
  • No EMC found?
    • Hospital has no further legal obligation to treat
pregnancy
Pregnancy
  • Pregnant women with contractions are considered to be medically unstable (active labor)
  • QMP must certify that the patient is in false labor
stabilization
Stabilization
  • Definition: Medical treatment of an EMCwithin the capabilities of the facility & staff
  • After stabilization, there are no further EMTALA obligations

US Air Force / 445th Airlift Wing

Maj. Ted Theopolos

patient refusal of mse or treatment
Patient Refusal of MSE or Treatment
  • Inform patient of risks of refusal
  • Document this conversation in the medical record
  • Attempt to obtain patient’s written refusal
on call physicians
On-call Physicians
  • Must respond within ‘a reasonable amount of time’ when requested
  • Hospital must have policy in place for back-up or transfer if on-call physician cannot respond
transfer
Transfer
  • Reasons for transfer:
    • Appropriate care is not available at the current facility
    • Patient requests transfer
  • Hospital discharge is considered a ‘transfer’

Picture: Ed Edahl, Federal Emergency Management Agency

before transfer
Before Transfer …
  • Treat & stabilize patient as far as possible
  • Patient must sign certification / informed consent for transfer
  • Contact receiving hospital
  • Receiving hospital must accept transfer
  • Send copies of medical records & test results
  • Arrange necessary personnel & equipment for transfer
transfer receiving hospital
Transfer: Receiving Hospital
  • Must accept transfer if hospital’s capabilities to treat the patient exceeds risks of transfer
  • Not obligated to conduct another MSE
  • Snitch Rule: Receiving hospital must report cases of inappropriate transfers
patient refusing transfer
Patient Refusing Transfer
  • Inform patient of risks & benefits of transfer
    • Document conversation in medical record
  • Attempt to obtain patient’s written refusal of transfer & reason for refusal
  • Continue to treat patient until stable
enforcement
Enforcement
  • Maximum fine per violation: $50,000
    • $25,000 for hospitals with <100 beds
  • Gross violations can lead to termination of Medicare funding
  • Individual doctors CAN be fined!
take home points emtala
Take Home Points: EMTALA
  • Every patient presenting to any ED must have a medical screening exam
  • Every patient with an emergency medical condition must be stabilized and/or transferred
  • Before hospital transfer, a patient must be stabilized as far as possible
  • EMTALA is enforced with hefty fines
conclusion
Conclusion
  • Treat EVERY patient that comes to the ED to the best of your ability without regard to their ability to pay