E.M.T.A.L.A.

What is EMTALA EMTALA stands for Emergency Medical Treatment and Active Labor Act Originated in 1986 as managed care evolved and created situations in which uninsured patients were “dumped”. EMTALA became known as the “Anti-Dumping Act”

EMTALA Historic Case Example Sharon Ford went to the Brookside Hospital’s emergency department in active labor. She was transferred to another Hospital in Oakland because she was a member of a Medicaid HMO with a contract. Ms. Ford’s name was not on the HMO’s eligibility list, so she was transferred to Highland General Hospital, the county hospital. Shortly after arrival, she delivered a stillborn baby. This case is why the law specifically covers “active labor” as an emergency medical condition.

What hospitals must comply with EMTALA? If a hospital has an emergency department and it participates in the Medicare program, it must comply with EMTALA. By accepting Medicare payment, hospitals “voluntarily” agree to abide by EMTALA

EMTALA A person who presents anywhere on the hospital campus and requests emergency services must be handled under EMTALA. Other presentations outside the emergency room do not invoke EMTALA. The 250-yard zone does not include non-medical businesses (shops and restaurants located close to the hospital), nor does it include physicians' offices or other medical entities that have a separate Medicare identity.

EMTALA EMTALA does not apply to any off-campus facility, regardless of its provider-based status, unless it independently qualifies as a dedicated emergency department. If the patient does not have an "emergency medical condition", the statute imposes no further obligation on the hospital.

EMTALA Requirements EMTALA required hospitals to have policies and procedures to ensure patients have the following: Medical screening exams (MSE) for all patients (MSE is a separate exam from triage exam in the ED) Access to emergency resources to determine if an emergency medical condition exists On-call physicians to evaluate, treat and stabilize patients Appropriate transfers of stable patients An accepting hospital for patients requiring transfer to a “higher level of care” Appropriate medical transport, personnel and life support equipment for patients who are transferred

What is an Emergency Medical Condition? Acute symptoms that could result in the following constitute an emergency condition: Serious health jeopardy without treatment Serious impairment to bodily function Serious dysfunction of a bodily organ or part When a pregnant woman is having contractions, it is an emergency condition if: There is inadequate time to transfer before delivery Transfer could pose threat to the health/safety of the woman and/or unborn child Women in active labor are considered unstable

EMTALA and Obstetric Patients Labor – “a woman experiencing contractions is in true labor unless a physician, midwife or nurse practitioner certifies that the woman is in false labor”. Essentially, any female in labor can go to any hospital in the US for delivery. EMTALA requires that the hospital deliver the baby.

GSMC Policy for Obstetric patients presenting to the ED for care Patients who are 16 weeks pregnant or more and present to the hospital for pregnancy related issues (i.e. active labor, uterine contractions, pre-term labor, abdominal pain etc.) will be evaluated by the Labor and Delivery department. Registration staff shall call the Labor and Delivery Department and direct the patient to L&D for evaluation. If ANY questions or issues arise, call the House Supervisor or Administrator on Call.

GSMC Procedure for Pregnant Patients Presenting to MOBS/L&D Unit All patients will be logged on the census sheet L&D/MOBS patient will have a MSE L&D/MOBS patients will have a reasonable period of observation for presenting condition An Obstetrician or Nurse Midwife must determine if the patient is not in labor and provide the discharge order.

Medical Screening Exam All patients presenting to the ED/L&D for treatment will be screened by a Qualified Medical Provider. The QMP can be a specially trained Registered Nurse. A patient may leave Against Medical Advice (AMA) or Left Without Being Seen (LWBS) of their own free will, the hospital is not in violation of EMTALA

Do not discuss cost of care at Registration Hospitals may not discuss cost of care or services with patients presenting to the ED prior to the Medical Screening Exam Hospitals may not try to “discourage” a patient from seeking care by establishing long wait times, delays in care or “suggesting” that the cost of care is high, instead the hospital should covey to the patient that screening and treatment are critical importance. Hospitals are encouraged to tell patients to defer questions on cost of care until after being treated.

EMTALA and Minor Patients A minor can request an exam or treatment for an emergency medical condition. A medical screening exam should not be delayed by waiting for parental consent If after screening the minor, it is determined that no emergency condition is present, the staff can wait for parental consent before proceeding with further treatment.

When EMTALA does not apply EMTALA does not apply to inpatients, or patients seeking elective treatment. Non-emergent conditions are not covered under EMTALA, once the individual is screened and it is determined that no emergency medical condition exists. When an individual is brought to the ED by law enforcement for blood alcohol testing and exam or treatment is not requested.

Patients Who Refuse Exam or Treatment The hospital has met requirements of a medical screening if: The patient has been offered further medical exam and treatment required The patient (or another on his behalf) has been informed of the risks and benefits of the offered examination and treatment The patient (or another on his behalf) refuses to consent to the examination and/or treatment

Patients Who Refuse Exam or Treatment The medical record must contain a description of the examination and/or treatment which was refused The hospital must take all reasonable steps to secure the refusal in writing The document to be signed by the patient should include a statement explaining that the patient (or another on his behalf) has been informed of the risks and benefits of examination and/or treatment

Cost of EMTALA Violation A hospital which negligently violates the statute may be subject to a civil money penalty (i.e., a fine, but without criminal implications) of up to $50,000 per violation.

Terminology EMTALA - The Emergency Medical Treatment and Active Labor Act COBRA - The Consolidated Omnibus Budget Reconciliation Act of 1986 CMS - Centers for Medicare and Medicaid Services, a division of the Department of Health and Human Services. Transferring hospital - A facility at which a patient is seen initially and whose personnel determine that transfer to another facility is warranted Receiving hospital - A facility to which a patient is transferred

Terminology OIG- Office of the Inspector General State survey agencies- abbreviated SA-like the Department of Health Technical Advisory Group (TAG)- created by Modern Modernization Act of 2003