As part of the Consolidated Omnibus Budget Reconciliation Act in 1985, EMTALA was created by Congress in 1986. (Trisha Torrey, 2009). The full form of EMTALA is Emergency medical Treatment and Active Labor Act. This act is a statute that governs how and when a patient may be transferred from one hospital to another when the patient is suffering from severe health problem or refused treatment. This act is also referred as the Cobra law. (Jeffery Strickler, 2006). Section 1867(a) of the Social Security Act is also known as EMTALA.
It is included in the U. S code as a part of the section which governs Medicare. EMTALA is not a federal malpractice law. The word ‘Active’ was removed from the official name of the statute in the 1989 amendment. But, the change in the name could not be seen in the official public law. EMTALA applies only to those hospitals which accept the payments made by Centers for Medicare and Medicaid Services and Department of Health and Human Services under the Medicare program.
These participating hospitals should have been entered in to ‘Provider Agreements’. But, in practical, EMTALA applies to all hospitals in U. S except Shriner’s Hospital for Crippled Children and some of the Military hospitals. The patient dumping to Cook County Hospital in 1986 and 1987 was very high. The patients who were transferred to Cook County hospitals were mostly unemployed and minorities. In 87% of cases, the reason of transferring the patient was because of their financial condition and lack of insurance.
In these patients 24% of patients were considered to be in unstable condition and others were considered when they were in very serious condition as when they were likely to die. Because of the financial status of the patient, the hospitals jeopardized the patient’s health. Such transfers have increased in Dallas from 70 per month to 200 per month in 1983. The protection for indigent patients already existed by that time but the doctors and private hospitals ignored because this was not forced by any law.
So, the Federal Government after taking health-care related issues in to consideration, passed the Act which is known as EMTALA. EMTALA is a right to emergency health care. (John Kusske, 2001). The purpose of EMTALA is to prevent hospitals from refusing the treatment for the patients, rejecting patients, or transferring them to county hospitals and charity hospitals because they are unable to pay the expenses of the hospital. EMTALA is a non-discriminative statute. EMTALA imposes affirmative obligations which go beyond non-discrimination.
The Act applies to all Medicare participating hospitals and it protects everyone, not just Medicare beneficiaries, coming to the hospital in search of emergency medical services. EMTALA imposes strict fines and penalties for the violation of the Act. EMTALA imposes three legal duties for the hospitals which are participating in Medicare hospitals. The first one is that the hospitals must provide essential medical screening examination (MSE) to anyone seeking medical care.
The second requirement is that the hospital must determine whether the individual has emergency medical condition (EMC) and if so, the hospital must treat the emergency medical condition and stabilize the patient or the hospital must transfer the individual to the appropriate hospital and the third requirement is that the hospital must not transfer the individual who is in emergency condition which effects on appropriate transfer. EMTALA is a federal statute and the violations of this Act and the cases belonging to EMTALA are heard in federal courts.
These courts include Federal District courts, US Court of Appeals and even in US Supreme Court. In this Act, the term medical screening examination means any hospital that has emergency department and if a patient comes to the emergency department and makes request for the treatment or examination of his medical condition, the hospital is under compulsion that it should provide the patient with necessary medical screening examination to determine whether the emergency condition exists or not.
(Wanda Conkle Smith, 1999). This law prohibits any hospital from delaying such examination to inquire about the payment status of the patient. According to the HSFA rulings, only demographic details about the patient can be obtained if necessary before the medical screening examination and the Act states that the treatment should not delayed for any of the authorization like authorization for advanced tests, specialist consultation or initial evaluation.
This statute states that only hospitals with emergency department are under discussion in this law, however court rulings and HCFA regulations extended the meaning of emergency department and stated that it is not limited to the particular space but can pass on to any area where the patient can be subject to medical screening examination. Thus even a women’s hospital which has no emergency department but delivers babies is subject to EMTALA. The hospital owned and operated ambulance services are considered part of emergency department according to EMTALA.
According to the recent federal court appeals in Hawaii, a patient in any ambulance, even those ambulance run by county or city services can be considered to come in to emergency department. The term screening exam includes laboratory tests, CT scans and specialist consultation. Documentation and assessment of suicide attempt or risk is included for psychiatric patients. Cervical dilation and monitoring of fetal heart tones are included for obstetric patients. The statute states that the person to person medical screening examination must be qualified medical personnel.