EMTALA (Emergency Medical Treatment and Labor Act)

When is a Medical Screening Examination required?

Whenever an individual 'comes to the emergency department' (broadly construed to include anyone presenting on hospital property requesting examination or treatment) and a request is made on the individual's behalf for examination or treatment for a medical condition. The MSE must be performed by qualified medical personnel and be sufficient to determine whether an emergency medical condition exists. Triage alone is not an MSE. The hospital cannot delay the MSE to inquire about insurance, payment ability, or method of payment.

What is an 'emergency medical condition' under EMTALA?

Per 42 CFR 489.24(b), an emergency medical condition is a medical condition manifesting itself by acute symptoms of sufficient severity that the absence of immediate medical attention could reasonably be expected to result in: (a) placing the health of the individual in serious jeopardy; (b) serious impairment to bodily functions; or (c) serious dysfunction of any bodily organ or part. Active labor is included as an emergency medical condition. The standard is from the perspective of a reasonable layperson observing symptoms.

What are the EMTALA transfer requirements?

When a hospital cannot stabilize a patient or the patient requests transfer, an 'appropriate transfer' is required: (1) treatment within capacity to minimize transfer risks; (2) the receiving hospital has agreed to accept and has appropriate capabilities; (3) transfer is via qualified personnel and transportation equipment; (4) all medical records related to the emergency condition accompany the patient; (5) physician certification that medical benefits of transfer outweigh risks. Improper transfers ('dumping') are the most-cited EMTALA violation, particularly transfers based on insurance status or ability to pay.

Does EMTALA apply to specialty hospitals or rural hospitals?

EMTALA applies to any Medicare-participating hospital with an emergency department, including: full-service hospitals, specialty hospitals (cardiac, orthopedic, etc.) if they have an ED, rural hospitals, critical access hospitals, and free-standing emergency departments operated by a Medicare-participating hospital. Specialty hospitals without EDs are not directly covered by EMTALA but may have on-call obligations to other hospitals' ED needs. Critical access hospitals have specific EMTALA provisions reflecting their typically smaller scope.

Can an individual sue a hospital under EMTALA?

Yes. EMTALA provides a private right of action under 42 USC 1395dd(d)(2)(A) for any individual who suffers personal harm as a direct result of an EMTALA violation. Damages available include actual damages and costs/attorney fees. EMTALA private suits are typically brought alongside state-law malpractice claims. Statutes of limitations vary by state — typically the same as state medical malpractice limitations.