The Emergency Medical Treatment and Active Labor Act is a federal law that states that any patient who "comes to the emergency department" requesting "examination or treatment for a medical condition" must be provided with "an appropriate medical screening examination that uses emergency department resources, including specialized tests such as a CAT scan or consultations" to determine if they are suffering from an "emergency medical condition."
If the examination reveals an emergency medical condition, the hospital must also provide either "necessary stabilizing treatment or an "appropriate transfer to another medical facility, regardless of the patient's ability to pay."
In essence, the federal law obligates the emergency departments of hospitals to provide screening and treatment for all patients. This is often called "charity" and all hospitals that obtain Medicare benefits from the federal government are required to provide specific free services to any patient asking for emergency services.
EMTALA protection is also referred to as the "anti-dumping law." The initial intent of EMTALA was to address the alleged practices of some hospitals transferring, discharging or refusing to treat patients who did not have insurance. EMTALA regulations apply to all hospitals that participate in the federal Medicare program. Shriners' Hospital for Crippled Children and many military hospitals are EMTALA exempt.
Essentially an anti-discrimination law, EMTALA is given teeth by monetary penalties up to $50,000 per violation, liable claims against attending physicians and possible revocation of the Centers For Medicare and Medicaid Services provider agreement.
The CMS, a division of the federal Department of Health and Human Services, the CMS is responsible for the Medicare program and enforcement of the rules on EMTALA.
When a person comes to the hospital's emergency department after a fall at home, with complaints of neck pain, is this an emergency or urgent care situation? If the person is examined and found to have a sprain, without any serious medical conditions, it most likely is considered urgent care. The patient is offered further care after they prepay for services with the understanding that no further care will be given unless the patient provides insurance information or money. If they cannot pay or are without insurance, the patient is told that they can seek care at the community clinic.
If the injury to the neck caused significant internal damage, resulting in the need for immediate treatment or surgery, it most likely is an emergency. In an emergency, the inability to pay does not delay required treatment.
The hospital is responsible for costs of EMTALA-mandated emergency care. EMTALA does not require health insurance companies, governments or individuals to pay for mandated emergency medical services. The hospital with the capacity to treat the patient is obligated to accept the transfer from another facility. If the "patient is transferred in an unstable condition," this must be reported to the CMS as a violation of EMTALA.
In 1998, a lawsuit was filed by the family of a Hawaii resident, Harold Arrington, who had a heart attack on his way to work. The ambulance drove Arrington to the nearest hospital, The Queen's Medical Center, and radioed the emergency room that they were on their way. Dr. Norbert Wong at Queen's told the paramedic to take Arrington to Tripler Army Medical Center, a more distant hospital where Arrington had been a patient. Arrington died 40 minutes after his arrival at Tripler.
U.S. District Judge David Ezra dismissed the Arrington family's lawsuit in 1998.
In 2001, the 9th Circuit Court of Appeals decided that the telemetry contact between the paramedic and physician on behalf of a patient is covered by EMTALA. An excerpt from the opinion states, "A hospital may not prevent a nonhospital-owned ambulance from coming to the hospital unless it has a valid treatment-related reason for doing so. Moreover, even if the hospital is in diversionary status, where the ambulance comes to the hospital in spite of an instruction to take the patient elsewhere, that ambulance 'comes to' the hospital and emergency treatment of that patient must be provided."
The court's decision was based on the belief that EMTALA's scope exists to also protect patients from telemetry schemes that may result in patient dumping. The court decision makes these regulations binding in Hawaii and eight other Western states. The case may be appealed to the U.S. Supreme Court or stayed until further action is taken by Congress, but to date the decision has held.
* Eve Clute is a 30-year resident of Maui and earned a doctorate in public health. She lives in Lahaina.