Imagine taking a loved one to the hospital for an emergency only to be turned away because you can't afford the treatment or lack adequate health insurance coverage. You know they may not survive without immediate medical care. Can a hospital refuse to treat a patient simply based on that person’s ability to pay? Luckily, federal law known as “EMTALA” prohibits hospitals from doing so.
What is EMTALA?
The Emergency Medical Treatment and Labor Act, EMTALA, is known as the "anti-dumping" statute for its ban on patient dumping. Congress passed EMTALA in 1986 in response to a number of widely reported horror stories about emergency rooms turning away seriously ill or injured patients who had no insurance and no money to pay for treatment.
Prior to EMTALA, there was no requirement that hospitals treat everyone who came to the emergency room and, in many states, hospitals were not held responsible for damages caused by their refusal to treat patients. A hospital could choose not to treat a patient who lacked insurance or enough money to pay for the required medical treatment. In some cases, patients died or suffered serious injuries because of a transfer or delay in treatment.
Does EMTALA Apply to All Hospitals?
EMTALA applies to all hospitals that have emergency rooms and participate in the Medicare program. Since almost all hospitals, public and private, receive Medicare funds, nearly all hospitals are covered by EMTALA.
What Actions Must a Hospital Take Under EMTALA?
EMTALA imposes two essential obligations on hospitals:
1. Appropriate Medical Screening Examination
When a person seeks treatment at a hospital emergency room, the hospital must provide an appropriate medical screening examination (MSE) to determine whether an emergency medical condition (EMC exists).
Generally, an EMC is a medical condition where failure to provide immediate medical attention could reasonably be expected to result in serious harm to bodily functions, serious damage of a bodily organ or part, or serious risk to the health of an individual and/or unborn child. The hospital does not have an obligation under EMTALA to treat the patient if after the MSE the hospital determines there is no EMC.
2. Stabilization of Any Emergency Medical Condition
If the screening reveals an EMC, the hospital must treat the patient and "stabilize" the medical condition before transferring the patient to another hospital or discharging the patient from the emergency room. Under EMTALA, “stabilized” means that no significant worsening of the patient’s medical condition is likely to result because of a transfer or discharge.
In the circumstance of a woman in active labor, stabilization means the woman has delivered the child and placenta. An unstabilized patient may be transferred if the hospital cannot further stabilize the patient and a different facility has the necessary treatment. Hospitals must follow very specific procedures for such transfers.
What If a Hospital Does Not Follow EMTALA?
If a person is injured because a hospital did not provide an MSE or because it did not stabilize the patient before release or transfer, the patient may sue the hospital for money damages based on a violation of EMTALA. Suing a hospital under EMTALA is different than suing under state medical malpractice laws. EMTALA is not a substitute for suing for a wrong diagnosis or improper performance of a medical procedure.
Generally, if a patient is properly given a MSE but misdiagnosed, the hospital has followed EMTALA but may be responsible for damages under state malpractice law. However, an inadequate MSE may still violate EMTALA. Many courts have concluded that an appropriate MSE is one that the hospital would have offered to any other patient with the same symptoms, regardless of whether the patient was insured or could pay for the medical screening. Therefore, a hospital violates the MSE requirement of EMTALA only when individuals who are perceived to have the same medical condition receive different treatment.
Similarly, EMTALA’s stabilization requirement is intended only to regulate a hospital’s care of a patient immediately after admitting the patient for emergency care. Once a patient is admitted to the hospital and placed under the care of physicians, state medical malpractice law, not EMTALA, covers the actions of hospital and doctors.
What Does a Patient Have to Prove in a Lawsuit?
In a lawsuit brought under EMTALA, the patient must establish that the hospital treated them differently from other patients. Some courts have determined that in order to prove he or she did not receive an appropriate MSE, the patient must show there was an improper motive on the part of the hospital. That means, the decision as to what type of screening to provide was motivated by improper factors such as the inability to pay, race, or the sex of the patient.
Is There a Penalty for Violating EMTALA?
Depending on the facts of the case, hospitals or physicians that violate EMTALA are subject to fines and may lose Medicare provider agreements.
Protect Your EMTALA Rights: Call a Health Care Attorney
As you can see, the Emergency Medical Treatment and Labor Act protects your right to receive emergency care regardless of your ability to pay. If you're concerned about how you were screened or treated at a hospital emergency room, you should seek the advice of an experienced health care law attorney.