1. EMTALA - Patient Anti-Dumping Laws
Module 13
EMTALA - Patient Anti-Dumping Laws
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2. What is EMTALA Emergency Medical Treatment and Active Labor Act
Commonly referred to as the “Patient-dumping” laws
Enacted in the late 1980’s to ensure equal access to emergency services and care without regard to financial or insurance status or other clinically irrelevant factors.
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3. EMTALA Compliance Who is covered under the law? ER Patients
Women in Labor
Psych Patients
Chemical Dependency Patients
Anyone “on campus” (and some “off-campus”) who is seeking medical care for “emergency medical condition”
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4. Where does EMTALA Start?
When a person “comes to the emergency department”
on the hospital campus
in any facility or department of a hospital that is located off-campus that is considered to be provider-based
in a hospital-owned ambulance
in a non-hospital ambulance on hospital property.
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5. Medical Screening Examinations
Process to determine within reasonable clinical confidence whether a patient has an emergency medical condition
Not triage
Must be provided in a non-discriminatory manner to all patients presenting with same or similar signs and symptoms
Provided by staff designated by the Medial Staff
On-going process - from the E.D to monitoring and reassessment at discharge
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6. Labor and Delivery Labor is an emergency medical condition
Labor is defined as the latent or early phase of labor and continunig through the delivery of the placenta
A woman having contractions is presumed to be in labor (unless a physician, after a reasonable period of observation certifies that the woman is in false labor.
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7. Transfer of Woman in Labor
EMTALA regulations define an emergency medical condition as there being inadequate time to effect a safe transfer
Contractions are emergency medical condition
Stabilized is the delivery of the child and placenta
May not be transferred unless she requests a transfer or if a physician certifies that the benefits outweigh the risks associated with transfer.
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8. Psychiatric Patients Must comply with EMTALA requirements
May need both medical screening exam and psychiatric screening exam as determined by the provider
Psychiatric Emergencies include:
History of drug ingestion in comatose condition
Depression/suicidal
Delusions
Assaultive, self-mutilative, destructive behavior
Inability to maintain nutrition
Impaired reality testing
Acute detoxification
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9. Telemedicine
Telemedicine consultations are utilized as an enhancement to services and not a substitute for medical screening
Utilized for patients meeting criteria regardless of payer class
Is directed by the ED physician who may determine an in-person evaluation is needed.
The on-call physician must respond if requested by the ED physician.
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10. Patient Transfer
If emergency condition is not resolved, may transfer if-
Hospital does not have the capability to provide necessary stabilizing treatment
Request by patient
Treating physician determines with reasonable clinical confidence that patient may be transferred without material deterioration to condition; and
Receiving facility has capability to manage patient and foreseeable complications
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11. Patient Transfer Appropriate Transfer
Continue treatment until departure
Receiving hospital accepts patient; has space/personnel/capacity
Medical records forwarded
Appropriate transportation, personnel and equipment
Documentation of physician certification or patient informed request for transfer
Documentation of patient evaluation immediately preceding discharge
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12. Psychiatric Patient Transfer and Discharge
Psychiatric Patients
If emergency condition is not resolved may transfer if patient is protected and prevented from injuring self or others
May discharge if patient is no longer a threat to self or others
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13. Patient Discharge
Patient may be ready for discharge when deemed stabilized by the treating physician, and determined with reasonable certainty that the emergency medical condition has been resolved and can be treated as an outpatient if needed
Patient is informed to return to the ED if they are unable to find a physician or other provider for follow-up.
Patient is given plan for appropriate follow-up with discharge instructions.
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14. Other Requirements Central log
Medical record for all presenting patients
Signage
Obligation to report violations
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15. Physician On-Call Responsibilities
Roster of on-call specialists
Must be prospectively aware of physicians who are on-call
Must respond by coming to the hospital if necessary
Failure to respond must be entered in patient chart transferred to receiving hospital
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16. Things Never to Do
Don’t refuse to provide exam or stabilizing care due to:
financial ability; signing paperwork that may delay treatment or discourage the patient from staying
health insurance or no insurance
race, ethnicity, national origin, citizenship, age, sex, sexual orientation, preexisting medical condition, or physical or mental disability
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17. Consequences of an EMTALA Violation
HCFA Certification survey
PRO/OIG Investigation
Monetary Sanctions (up to $50,000 per violation for hospitals and physicians) and/or Exclusion
Office of Civil Rights Review
Private right of action
Negative publicity/facility disruption
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