The third primary principle of EMTALA states that when the participating hospital has specialized facilities or capabilities like shock-trauma units, burn units, neonatal intensive care units etc, should not refuse to accept the transfer of the patient who is in need of the specialized treatment. This section of the statute is known as the ‘reverse-dumping provision’. This provision prevents the hospitals like BUMC from accepting the patient who has the ability to pay for the services.
In this case, when the emergency department of the other hospital contacts the BUMC emergency department to transfer the patient, this act does not allow asking any questions about the insurance status. The considerations that can be made before accepting the patient are whether it has the capacity to take the patient and whether it has capability of treating such situation. If the answer for both these considerations is yes and if BUMC refuses the patient, then it is subjected to HCFA investigation and liable under EMTALA Act.
This statute includes sections on capability of patient to refuse the transfers and treatment, both of these reasons should be in writing from patient. This should be done by the hospital. HCFA required hospitals emergency departments to post a sign that is visible about 20 feet away, by giving the information whether the hospital can provide treatment under EMTALA, medical screening examination and whether it allows Medicaid. If the participating hospitals violate EMTALA, then the hospitals may be given penalty.
For any of the EMTALA violations, the law established a statute of limitation of 2 years to bring an action after the violation of the act. Both OIG and CMS have administrative enforcement powers about EMTALA violations. The penalties include termination of the Medicare provider agreement of the hospital or physician. Fine is given up to $ 50,000 to the hospital. If the hospital has less than 100 beds, then the fine may be $25,000. Physician may be given fine of $50,000 including on-call physicians. Under ‘private cause of action’, the hospital may be sued for personal injury.
The receiving hospital, if suffered loss due to other hospital’s EMTALA violation, it can bring suit to recover damages. An inadequate screening examination, adverse patient outcome, malpractice action also amounts to EMTALA violation. If the patient voluntarily refuses the treatment or examination without any coercion, then it is not considered to be EMTALA violation. In several case laws, the federal courts have given many decisions in favor of EMTALA Act. In Marshall on behalf of Marshall v. East Carroll Parish Hospital Service District C. A. 5 Louisiana 1998, 134 F.
3d 319, patient dumping was prevented which is the practice of refusing the patients who cannot have the funds to pay the charges. In Hernandez v. Starr County Hospital District, S. D. Texas 1999, 30 F. Supp. 2d 970, it says that to transfer the patient, the hospital owned or operated ambulance is not required. In Scott v. Hutchinson Hospital D. Kansas 1997, 959 F. Supp. 1351, ensured that each patient is given same level of treatment. EMTALA Act has improved health services for uninsured people. With the effect of EMTALA, everyone is legally guaranteed to receive the treatment.
Currently, EMTALA should focus on the hospitals to stabilize the emergency. EMTALA has increased the cost pressure on the hospitals. According to the centers for Medicaid and Medicare services, 55% of US emergency care goes uncompensated. The provider hospitals must shift the costs on those who can pay or go uncompensated. Because of the recent influence of cost control initiatives and managed care, insurance company’s hospitals are stabilized and are not shifting much cost. Illegal immigrants of the U. S using medical services through EMTALA Act are a big controversy.
According to Census bureau, among 45. 7 million uninsured people, 9. 7 million people were non-citizens in 2007. Even then, EMTALA is very useful for the people who are unable to pay and many people are benefited through this law.
REFERENCES
Jeffery Strickler, JONA’s Healthcare Law, Ethics, and Regulation, Volume 8, Number 3, July/September 2006, Pages 77-81. http://www. google. co. in/search? rlz=1C1CHNH_enIN326IN327&sourceid=chrome&ie=UTF-8&q=665176 Jerome FX Naradzay, Joseph Wood, COBRA Laws and EMTALA, November 15, 2006.