EMTALA has regulated how emergency departments accept, treat, or transfer patients since its inception in the 1980’s.

Rachel Quintela

Posted Date

Feb 24, 2022, 8:10 PM

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EMTALA has regulated how emergency departments accept, treat, or transfer patients since its inception in the 1980’s. Proponents of the law argue its necessity to ensure vulnerable patients seeking emergency services are assessed, treated, and appropriately transferred, or not, while those opposed to the regulation believe it has exacerbated ED overcrowding and misuse.

A recent analysis of EMTALA violations found that between 2002 and 2018, approximately 20% of civil financial payments involved psychiatric emergencies (Brund, 2018). Failure to perform a medical screening examination was the most common reason for civil monetary payouts in both psychiatric and nonpsychiatric cases, though failure to stabilize was a much more prevalent offense in psychiatric cases (Burk, 2018).

There has even been case law determined as whether or not EMTALA stipulations end when one has been admitted to inpatient status, most notably Moses v. Providence Healthcare System. Other hot topics of legal discourse pertain to “reverse-dumping”, which is the EMTALA provision that prevents facilities from refusing patients who require specialty services or facilities if the hospital has the capacity to treat them (Zhou, Amantullah & Frick, 2019).

A man sustained significant hand injuries and requested that EMS take him to a specialty hand center, but because it was over an hour away, he was instead taken to the closest hospital. Here, he was administered medication and his hand was splinted (thus, he was stabilized). Since this facility’s hand specialist was unavailable, attempts were made to transfer him to the hand center he had initially requested, yet they refused to accept him. So, an orthopedic surgeon (who was not a hand specialist) operated on the gentleman’s hand at the facility where he was brought to. Unfortunately, there were complications which caused permanent disability to the gentleman’s hand, and litigation ensued. The ruling was that the first hospital did not violate EMTALA, since he was assessed, treated, stabilized, and attempts to transfer him to a specialty center were made. However, the specialty hand center was found to have violated EMTALA by refusing an appropriate transfer of a patient requiring its’ services.

References

Brunk, D. (2018). Psychiatric cases tied to 20% of EMTALA violations. Clinical Psychiatry News, 46(11). https://go-gale-com.lopes.idm.oclc.org/ps/retrieve.do?tabID=T002&resultListType=RESULT_LIST&searchResultsType=SingleTab&hitCount=29&searchType=AdvancedSearchForm&currentPosition=2&docId=GALE%7CA564218459&docType=Brief+article&sort=Relevance&contentSegment=ZONE-MOD1&prodId=AONE&pageNum=1&contentSet=GALE%7CA564218459&searchId=R3&userGroupName=canyonuniv&inPS=true.

Zhou, J. Y., Amantullah, D. F. & Frick, S. L. (2019). EMTALA (Emergency Medical Treatment and Active Labor Act) obligations: A case report and review of the literature. The Journal of Bone and Joint Surgery, 101(12).  DOI: 10.2106/JBJS.18.01166.