EMTALA

EMTALA Emergency Medical Treatment and Active Labor Act. (Federal Law) Also known as: ● COBRA ● Anti-dumping statute

EMTALA Was enacted in 1985 in response to concerns that some Emergency Departments were refusing to treat indigent or uninsured patient’s, or inappropriately transferring them to other facilities (also known as “patient dumping”). Was enacted in 1985 in response to concerns that some Emergency Departments were refusing to treat indigent or uninsured patient’s, or inappropriately transferring them to other facilities (also known as “patient dumping”).

Examples William Jenness was taken to a private hospital after a car accident. The hospital asked for a $ deposit in advance because he was uninsured. Because Jenness couldn’t pay, he was transferred to the county hospital, where it took four hours before he reached the operation room. Six hours after the accident, Jenness died. William Jenness was taken to a private hospital after a car accident. The hospital asked for a $ deposit in advance because he was uninsured. Because Jenness couldn’t pay, he was transferred to the county hospital, where it took four hours before he reached the operation room. Six hours after the accident, Jenness died.

Examples David Rios was critically wounded with two gunshot wounds and was brought to a private hospital. Because he was uninsured, he was transferred to the county hospital, arriving one hour and 15 minutes later in a medically unstable condition and in shock. He died later that night. David Rios was critically wounded with two gunshot wounds and was brought to a private hospital. Because he was uninsured, he was transferred to the county hospital, arriving one hour and 15 minutes later in a medically unstable condition and in shock. He died later that night.

Examples In, Detroit, an emergency room physician treated a 32 year old female who sustained severe head injuries after being beaten with a baseball bat. The ED physician tried to transfer the patient because he had no neurosurgeon on staff. Fourteen different hospitals in Michigan refused the transfer because the pt had no insurance. The pt was admitted to the original hospital and died. In, Detroit, an emergency room physician treated a 32 year old female who sustained severe head injuries after being beaten with a baseball bat. The ED physician tried to transfer the patient because he had no neurosurgeon on staff. Fourteen different hospitals in Michigan refused the transfer because the pt had no insurance. The pt was admitted to the original hospital and died.

EMTALA Contains Three Major Requirements for Medicare Participating Hospitals

FIRST REQUIREMENT Hospitals are required to provide a Medical Screening Examination (MSE) to any person who comes to the Emergency Department and request examination or treatment for a medical condition. Hospitals are required to provide a Medical Screening Examination (MSE) to any person who comes to the Emergency Department and request examination or treatment for a medical condition.

SECOND REQUIREMENT If a hospital determines that the individual has an emergency medical condition, the hospital must provide further medical examination and treatment to stabilize the medical condition. If a hospital determines that the individual has an emergency medical condition, the hospital must provide further medical examination and treatment to stabilize the medical condition.

THIRD REQUIREMENT If the hospital is unable to stabilize the patient, the hospital must provide an appropriate transfer to another facility. If the hospital is unable to stabilize the patient, the hospital must provide an appropriate transfer to another facility.

WHAT CONSTITUTES EMERGENCY MEDICAL CONDITION (EMC) The term “emergency medical condition” means: 1. a medical condition manifesting itself by acute symptoms of sufficient severity (including severe pain) such that the absence of immediate medical attention could reasonably be expected to result in: (i) placing the health of the individual (or, with respect to a pregnant woman, the health of the woman or her unborn child) in serious jeopardy, (ii) serious impairment to bodily functions, or (iii) serious dysfunction of any bodily organ or part; or 2. with respect to a pregnant woman who is having contractions- (i) that there is inadequate time to effect a safe transfer to another hospital before delivery, or (ii) that transfer may pose a threat to the health or safety of the woman or the unborn child.

WHAT IS THE STATUTORY MEANING OF THE TERM “TO STABILIZE” The Act states: The Act states: –“To stabilize” means, with respect to an emergency medical condition, to provide such medical treatment of the condition necessary to assure, within reasonable medical probability, that no deterioration of the condition is likely to result from or occur during the transfer of the individual from a facility, or, with respect to an emergency medical condition of a pregnant woman, that the woman has delivered the child and the placenta.

Medical Screening Exam (MSE) Performed by Qualified Medical Personnel ● Physician ● PA/NP ● Registered Nurse If not a physician, specialized training and certification is required. At SMC physicians are QMP that do MSE’s

Medical Screening Exam (MSE) Is NOT the same as Triage ● Triage determines the order to be seen. ● MSE determines if an emergency medical condition exist.

Medical Screening Exam (MSE) Registration ● Can be done prior to the MSE as long as it does not delay the screening or treatment. This may include asking the individual about insurance. NOTE: Patients are to be triaged by an RN prior to registration. Registration or triage procedures should not unduly discourage the individual from remaining for further evaluation.

EMTALA THE EMTALA LAW IS TRIGGERED WHEN? ● A person “comes to the emergency department”

“Comes to the Emergency Depart.” Definition: ● Presenting at a hospital’s dedicated ED ● Presenting on hospital property/campus other than the dedicated ED (including parking lot, sidewalks, other departments etc. NOTE: That is why it is important for all staff to be familiar with EMTALA. If an individual comes to your department seeking medical attention, you need to know to direct or assist them to the ED.

Stabilizing Treatment EMTALA regulations identify three types of stabilization: ● Emergency medical condition resolved. The hospital has provided the treatment necessary to completely resolve the pt’s EMC (ex. bee sting) ● Stable for discharge or admission The pt is stable and can be discharged, but needs follow-up care at a later date for the condition to remain stable (ex orthopedic injury). Or The pt’s condition cannot be completely resolved in the ED, and can be treated further if admitted as an inpatient (ex. COPD) ● Stable for transfer The hospital does not have the appropriate facilities and resources to resolve the EMC (ex. burn injury).

Stabilizing Treatment Transfers: Transfers: When transferring a patient with an emergency medical condition that has not been medically stabilized: When transferring a patient with an emergency medical condition that has not been medically stabilized: –1. Provide medical treatment to minimize the risks of transfer –2. Send copies of all relevant medical records available at the time of transfer and send copies of other records as soon as possible –3. Use qualified personnel and transportation equipment, including necessary life support measures; and –4. Obtain the consent of the receiving hospital –5. Include in the transfer documentation the name of any on-call physician who refused or failed to come to the hospital to stabilize the patient. –6. Complete and send copies of certificate of transfer.

Stabilizing Treatment On Call Physicians ● Hospitals are required to maintain a list of on-call physicians to provide treatment necessary to help stabilize a pt with an EMC. - This does not apply to a specialty that has 24/7 coverage such as the ED - This does not apply if limited resources/physicians.

Other Obligations Under EMTALA 1. Maintain a log on patients who come to the hospital seeking emergency services. This log also has to contain those refusing or leaving without treatment. This list must be retained for five years. 1. Maintain a log on patients who come to the hospital seeking emergency services. This log also has to contain those refusing or leaving without treatment. This list must be retained for five years. 2. Maintain medical and other records related to patients transferred to or from the hospital for five years from the date of transfer. 2. Maintain medical and other records related to patients transferred to or from the hospital for five years from the date of transfer. 3. Maintain a list of physicians who are “on-call” to provide treatment necessary to stabilize a patient with an emergency medical condition. The list must be retained for five years. 3. Maintain a list of physicians who are “on-call” to provide treatment necessary to stabilize a patient with an emergency medical condition. The list must be retained for five years. 4. Review all transfers for EMTALA compliancy, and report any violations. 4. Review all transfers for EMTALA compliancy, and report any violations. 5. Post conspicuously in the emergency department a sign stating the right of patients to emergency treatment and whether the hospital participates in Medicaid. 5. Post conspicuously in the emergency department a sign stating the right of patients to emergency treatment and whether the hospital participates in Medicaid.

Required Signage IT’S THE LAW IT’S THE LAW IF YOU HAVE A MEDICAL EMERGENCY OR ARE IN LABOR, YOU HAVE THE RIGHT TO RECEIVE, within the capabilities of this hospital’s staff and facilities: IF YOU HAVE A MEDICAL EMERGENCY OR ARE IN LABOR, YOU HAVE THE RIGHT TO RECEIVE, within the capabilities of this hospital’s staff and facilities: · An appropriate MEDICAL SCREENING EXAMINATION · An appropriate MEDICAL SCREENING EXAMINATION · Necessary STABILIZING TREATMENT (including treatment for an unborn child), · Necessary STABILIZING TREATMENT (including treatment for an unborn child), and if necessary and if necessary · An appropriate TRANSFER to another facility · An appropriate TRANSFER to another facility -even if- YOU CANNOT PAY OR DO NOT HAVE MEDICAL INSURANCE -even if- YOU CANNOT PAY OR DO NOT HAVE MEDICAL INSURANCE or or YOU ARE NOT ENTITLED TO MEDICARE OR MEDICAID YOU ARE NOT ENTITLED TO MEDICARE OR MEDICAID This hospital does participate in the Medicaid Program This hospital does participate in the Medicaid Program

PENALTIES FOR VIOLATING EMTALA The possible penalties for violating EMTALA are: 1. A hospital may be fined between $25,000 and $50,000 per violation 2. A physician may be fined $50,000 per violation. 3. A hospital maybe terminated from its Medicare provider agreement. 4. A physician may be excluded from Medicare and Medicaid programs 5. A patient who suffers personal injury from the violation may sue the hospital in civil court 6. A receiving facility, having suffered financial loss as a result of another hospitals violation of EMTALA, can bring suit to recover damages.