Q: Is there federal law affecting hospital emergency services?
A: Yes. The federal law is called the Emergency Medical Treatment and Active Labor Act, also known as "EMTALA," or the patient “anti-dumping” statute. Congress passed EMTALA in response to widespread concern that private hospitals were dumping indigent or uninsured patients, denying them emergency care or transferring them to public institutions for purely economic reasons, even though the private hospitals were fully capable of providing appropriate medical care to such patients. Basically, EMTALA created a federal right to emergency care. The Centers for Medicare and Medicaid Services, the regulatory agency charged with implementing EMTALA, has published regulations defining the scope of EMTALA protection offered to patients.
Q: Who is entitled to protection under EMTALA?
A: Even though EMTALA is part of the Medicare law, EMTALA protections apply to everyone, not just Medicare beneficiaries.
Q: When are EMTALA protections triggered?
A: These protections are triggered when:
- an individual arrives at a hospital’s dedicated emergency department and asks to be examined or treated for a medical condition; or
- an individual arrives elsewhere at the hospital and asks to be examined or treated for what may be an emergency medical condition.
Q: What does EMTALA require?
A: EMTALA requires the hospital to provide the following services:
- An initial medical screening examination must be provided to determine whether or not an emergency medical condition exists. An emergency medical condition generally is a condition that, if not immediately treated, could be expected to result in serious jeopardy to the health of the individual or an unborn child, serious impairment to bodily functions, or serious dysfunction of an organ or body part.
- If an emergency medical condition exists, necessary stabilizing treatment must be provided within the facilities and capabilities of the hospital. Alternatively, in appropriate circumstances, the patient may be transferred to a different facility.
Q: When may a patient with an emergency medical condition be transferred?
A: A transfer of a patient with an emergency medical condition who has not been stabilized is permitted only if the patient requests the transfer, after being informed of the risks, or a physician certifies that the benefits of the transfer to the patient outweigh the risks. A transferring hospital also must make arrangements to ensure that the receiving hospital is ready to accept the patient and that medical records are transferred. The transferring hospital also must take steps to minimize the risks of the transfer to the patient, and must arrange appropriate transportation, with appropriate qualified personnel accompanying the patient.
Q: What is stabilizing medical treatment?
A: Stabilizing treatment is whatever medical treatment of the condition may be necessary to ensure, within a reasonable medical probability, that the patient’s condition is unlikely to get materially worse as a result of or during his or her transfer or discharge from a facility. Stabilizing a pregnant woman in active labor, for example, would mean completing the delivery.
Q: Does Ohio law also address hospital emergency services?
A: Yes. In 2000, Ohio passed a law creating a trauma system for Ohio hospitals to ensure that seriously injured patients are treated at facilities fully equipped to treat their injuries. Hospitals will need to apply for and eventually be certified by the American College of Surgeons in order to treat severely injured trauma patients. Hospitals also must adopt protocols for evaluating, stabilizing and transferring trauma patients to certified trauma hospitals. Emergency Medical Service (EMS) providers are required to follow rules assuring that trauma patients are transported to appropriate hospitals. Many of the requirements under this law had to be met by November 2002.
Law You Can Use is a weekly consumer legal information column provided by the Ohio State Bar Association (OSBA). This article was originally prepared by Catherine T. Dunlay and Naomi H. Maletz of Taft Stettinius & Hollister, and updated by Naomi Maletz.