Duty to Provide Emergency Medical Care



Duty to Provide Emergency Care: The Emergency Medical Treatment and Active Labor Act 

            The United States medical system, though not without its faults, seeks to ease access to emergency medical care and give provide lifesaving care to those in need.  

Prior to 1986, private hospital emergency rooms could turn away patients, even if they were in desperate need of medical treatment. Since private hospitals could turn away indigent patients (a practice known as “patient dumping”), public hospitals became overcrowded. To address this issue, Congress passed the Emergency Medical Treatment and Active Labor Act (which we’ll refer to as the “Act”) in 1986.

This presentation will focus on how the Act’s provisions and requirements have affected patients’ access to emergency medicine. 

Basics of the Act

            The Act applies in all 50 states and can be enforced in federal court. Every hospital which receives any federal government funding must abide by its provisions. Because the vast majority hospital accepts Medicare and/or Medicaid, the Act must be followed by almost all hospitals.

The Act prevents doctors and physicians in emergency rooms from dumping a patient to other hospitals because of lack of insurance, race, creed, sex, or nationality. Initially, the law only applied to emergency departments operating within hospitals, but its reach has expanded to cover a wide array of other venues for medical services, including departments within a hospital, urgent care facilities, outpatient surgery centers, psychiatric facilities, and even ambulances.[1]

The Act applies to patients with emergency medical conditions, which are defined as conditions that manifests acute symptoms of sufficient severity that are expected to result in

(1) the health of the person being in serious jeopardy,

(2) a serious impairment of bodily functions, or

(3) serious dysfunction of any bodily organ.

It also covers pregnant women having contractions. In addition, the Act requires that hospitals provide the same care to US citizens, legal immigrants, and illegal immigrants.[2]

Specific Provisions of the Act

            The Act requires that emergency medical services providers:

(1) screen every person seeking help for an emergency medical condition; and

(2) if an emergency medical condition exists, render stabilizing treatment or transfer the patient to a facility that can render such treatment.

            The purpose of the medical screening is to determine whether the patient has a medical condition that requires immediate treatment. While the Act does not define the term “appropriate screening,” courts have found that to comply, all screenings must be reasonably calculated to identify critical medical conditions and be applied uniformly to patients with similar symptoms. How hospitals implement these two requirements varies based on the types of diagnostic tools that are available and how the hospital wants to treat patients. The effects of these two requirements are that all patients, regardless of whether they can pay, must receive the same initial medical care.[3]

Once a physician determines that a person suffers from an emergency condition that requires immediate treatment, she must either render stabilizing treatment or transfer the patient to another facility that can provide the treatment. Physicians are only required to stabilize patients if doing such is within their skills and their facilities’ capabilities. Stabilizing treatment means treatment that preserves the patient’s health and prevent it from deteriorating further. If an emergency physician decides to transfer the patient, she must take steps to minimize the risks to the patient’s health during the trip.[4]

The Act allows states a fair amount of latitude in determining how to implement its provisions. In some states, when patients are formally admitted to hospitals as “inpatients,” they can no longer sue under the Act’s provisions, because they are admitted and are thus receiving treatment. Other states, go further to protect patients. For example, Michigan allows a patient to recover for EMTALA violations, even if she has been formally admitted to the “inpatient” portion of the hospital for an extended period of time.[5]

There are two ways of transferring a patient to another hospital if the hospital he arrives at cannot treat his emergency medical condition. First, he can make a written request to be transferred. Alternatively, the attending physician can determine that the medical benefits of receiving treatment at a different facility outweigh the risks of the transfer. When the patient is to be transferred to another facility, the current hospital must do everything it can to minimize the risks of the transfer and it must send the relevant medical records to the receiving hospital. The receiving hospital must agree to accept the patient and the transfer must be made with qualified personnel and life sustaining equipment, if necessary.[6]

Violations of The Act

Violations of the Act carry serious penalties. A hospital that violates its provisions can be fined up to $50,000 per violation, have its Medicare provider agreement terminated, be sued by a patient for personal injuries in civil court, and be sued by the receiving hospital if the hospital that eventually provides emergency services suffered financial losses because of the failure of the initial treatment. In addition, physicians at hospitals can be fined up to $50,000 per violation and can have their Medicare provider agreements terminated for violations.

            For a patient to successfully bring a private cause of action against a hospital, she must do so within two years of the alleged violation. Private causes of action for violations differ from ordinary medical malpractice claims in that they can be brought in federal court and are subject to the Act’s standards, whereas ordinary malpractice actions are typically brought in state court and are judged under tort principles applicable to professional malpractice. Additionally, medical malpractice claims require unfavorable impacts on patients, meaning that the patients must have been injured by the malpractice. Lawsuits under the Act require the allegation of a violation, not necessarily injuries or damages.[7]

The federal government enacted the Emergency Medical Treatment and Active Labor Act more than 30 years ago to safeguard the welfare of those seeking emergency medical assistance. The Act has been successful in preventing hospitals from dumping patients onto other hospitals and treating patients who are in dire need of care.

Footnotes


[1] Zibulewsky, Joseph, “The Emergency Medical Treatment and Active Labor Act (EMTALA): What It Is and What It Means for Physicians.” Proceedings (Baylor University. Medical Center) 14.4 (2001): 339–346. Print.

[2] Gusmano, Michael, “Undocumented Immigrants in the United States: U.S. Health Policy and Access to Care” retrieved from http://undocumentedpatients.org/issuebrief/health-policy-and-access-to-care/

[5] Sapega, Danielle, “Federal Code Blue: The Emergency Medical Treatment and Active Labor Act's Prolonged Venture into Malpractice Law,” 29 Temp. J. Sci. Tech. & Envtl. L. 99 (2010); See e.g. Moses v. Providence Hosp. & Med. Ctrs., Inc., 561 F.3d 573 (6th Cir. 2009)

[6] Cohen, Beverly, “Disentangling EMTALA from Medical Malpractice: Revising EMTALA's Screening Standard To Differentiate Between Ordinary Negligence and Discriminatory Denials of Care,” 82 Tul. L. Rev. 645 (2007)

[7] “EMTALA” retrieved from https://www.acep.org/news-media-top-banner/emtala/