By Nancy Young, director of Risk Management, Crozer-Chester Medical Center

EMTALA, also known as the Emergency Medical Treatment and Active Labor Act, or the anti-dumping law, was enacted in 1986. Over the years the intent of the law has not changed; however, there have been different interpretations and clarifications of the regulations. 

The purpose of the act is to ensure individuals are not discriminated against due to their ability to pay or source of payment for services. The hospital has administrative policies and procedures to provide guidance to staff to ensure compliance.

EMTALA stipulates that individuals who present to the hospital for emergency care must be provided with an appropriate medical screening examination (MSE) by a qualified medical person (as directed by the governing body of the hospital) to determine whether an emergent medical condition exists. This screening cannot be delayed due to inquiries about method of payment or type of medical coverage. All individuals must be provided the same care/services and stabilized within the hospital’s capabilities. Triage does not qualify as a MSE.  

An individual does not necessarily need to present to the Emergency Department for EMTALA guidelines to be effective. If he/she presents to the hospital, whether it be the main lobby or Labor/Delivery unit, for emergency care, then the hospital has an obligation to provide a medical screening exam and to stabilize the individual without delay due to inquires regarding reimbursement.

For example, if an individual presents to the hospital Emergency Department parking lot via family car or ambulance, and the hospital is on divert or there is a long wait, no one (Security, Nursing, physician, etc.) can refuse the patient or encourage the patient/family to go elsewhere for care.

EMTALA requires that the hospital have an on-call schedule specific to the facility’s needs, with the names of the given physician (not name of physician group, but specific physician name) who is responsible to be on-call for a given time period. This on-call schedule is maintained for five years plus. On-call physicians must respond within a reasonable period of time (per by-laws) if called by the hospital. If the patient is transferred as a result of refusal or non-response by the on-call physician, then the transfer paperwork must reflect this. 

An individual may not be transferred from the Emergency Department unless specific criteria have been met. First and foremost, no patient shall be transferred for the physician’s convenience. The patients must also be stable prior to any transfer. The transfer of an unstable patient may only be done with a written request by the patient/responsible party, or written physician certification that the benefits of transfer outweigh the risks. Consent by the patient/responsible party must be obtained either way.  Conversely, if the patient refuses a transfer despite being informed of the risks of refusal, then consent is also necessary- technically informed refusal.

Patients waiting to be transferred must be treated within the hospital’s capacity until the transfer. The transferring physician is responsible for contacting the receiving physician and ensuring he/she has accepted service- this must be documented on the transfer form.  This cannot be delegated to Nursing. Additionally, the receiving hospital must confirm that they have a bed and the capacity to accept the given patient, and appropriate transportation, copies of medical records, staffing, and executed documents must be prepared prior to the transfer.

Patients being transferred to a physician’s office to have a medical exam completed (i.e., physician with special equipment that the hospital does not have such as ophthalmologist) may only do so if the proper steps and forms have been completed.  Note, there should be no delay due to registration and/or inquiries as to financial obligations prior to the transfer and exam.

EMTALA is a buzz word that many are familiar with, yet the actual specifics can be open to interpretation. Any complaint by another facility or the public, leaves an institution open for intense investigation and potential fines. Repercussions include loss of Medicare certification for providers and a $50,000 fine per violation which can be imposed on both the physician and/or facility. Additionally, a civil suit can surface along with poor public relations. 

If you have questions, please contact Joan Meighan, director of Risk Management at DCMH, at (610) 284-8156, 12-8156, or Nancy Young, director of Risk Management at Crozer, at (610) 447-2995, 15-2995.