Emergency Medical Treatment and Labor Act

EMTALA

Mary Jacobson

Herzing University

        The scenario described in our assignment could be referred to as ‘patient dumping.’ The underfunded health care system in the United States drives up the implementation of patient dumping and refusal of care by Medicare-funded hospitals and emergency rooms. Patients who do not have insurance for care are costly to hospitals and clinics, especially when visiting emergency rooms, because this department is often not reimbursed for its service. In this essay, the Emergency Medical Treatment and Labor Act (EMTALA), and its implications are evaluated in the scenario of an overcrowded ER and the possibility of a case of ‘patient dumping.'

        EMTALAwas established in 1986 as a Federal law placing restrictions on hospitals that receive money from Medicare. There are three EMTALA requirements that Medicare participating hospitals  must comply with when a patient arrives to an emergency room for care.  The AMA Journal of Ethics outlines these requirements as follows; “1. Conduct medical screening examinations.  2. Provide necessary stabilizing treatment to any patient seeking emergency medical care in an emergency department. 3. Hospitals that are unable to do 1 & 2 may transfer the patient to a facility that can provide those services in a manner that accords with EMTALA guidelines” (Kahntroff & Watson, 2009).  To elaborate on these requirements further, an ER  physician must assess and screen every patient that comes into the ER; they  must also provide necessary stabilizing treatment to a patient, including patients in labor. If the ER is not capable of, or they do not have the capacity to provide treatment, only then can they transfer the stabilized patient to another facility.

        In applying the EMTALA to the assignment scenario, the patient came into the ER with a gunshot wound to the stomach area. The protocol was followed, in that he was medically screened and from the brief description, it can be assumed he was in stable condition. His blood pressure was low, but he was alert and oriented; there are no further details on the severity of the injury or why the triage nurse knew he was facing surgery. Given this information, it appears the surgery was not imminent. The ER was re-routing other patients even before the gunshot wounded patient came into the ER, so we cannot jump to the conclusion that this hospital is patient dumping in this case. The patient did state he did not have insurance. However, he is medically stable for transport, and the ER was in a situation of overload, and excessive wait time already, thus this case falls into the category of the hospital not having the capacity to admit this patient and it would make sense for them to re-route him as they were doing with other potential patients. Per EMTALA guidelines, this is an ‘acceptable’ transfer. According to the American College of Emergency Physicians, “a patient is considered stable for transfer if the treating physician determines that no material deterioration will occur during the transfer between facilities” (“EMTALA//ACEP,” n.d.).  

        These guidelines can be easily manipulated and can cause  confusion. Per the AMA Journal of Ethics, “Disagreement persists over whether the three duties imposed on medical personnel—to provide an appropriate medical screening examination, to stabilize, and to appropriately transfer patients—are separate duties that should be considered individual causes of action under law or whether they should be viewed conjunctively” (Kahntroff & Watson, 2009).  This imposes an ineffectiveness of enforcing these guidelines, however, if a health care entity is blatantly transferring a patient merely because they cannot pay for services there are stiff penalties. The penalties could include the hospital being closed or the physician’s Medicare provider agreement terminated. The hospital could incur fines up to $50,000 ($25,000 for hospitals with less than 100 beds). Physicians can be fined $50,000 per violation or the hospital could be sued for personal injury in civil court.  In some cases, there is difficulty proving unethical behavior on the part of the hospital. This does not mean that health care workers or doctors need to fear treating, discharging or transferring patients that come into the ER, it means they need to place the welfare of the patient above all other considerations and act ethically, and in accordance with  the intent of the law.