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EMTALA

EMTALA. Prepared by: Sarah Axler, MD University of Connecticut. Introduction. E mergency M edical T reatment & A ctive L abor A ct Federally-mandated requirement Patient anti-dumping law. Objectives. EMTALA: When? What? Whom? EMTALA requirements EMTALA exceptions Violations.

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EMTALA

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  1. EMTALA Prepared by: Sarah Axler, MD University of Connecticut

  2. Introduction • Emergency Medical Treatment & Active Labor Act • Federally-mandated requirement • Patient anti-dumping law

  3. Objectives • EMTALA: When? What? Whom? • EMTALA requirements • EMTALA exceptions • Violations

  4. When does EMTALA apply? • Individual comes to E.D. & requests treatment • Regardless of ability to pay, insurance status, citizenship, ethnicity, … • ‘Prudent Layperson’ Standard: Individual’s appearance or behavior would cause a prudent layperson to believe that examination or treatment is needed

  5. What constitutes an ‘E.D.’? • Dedicated emergency department • Hospital property • Ambulances

  6. To whom does EMTALA apply? • All Medicare-participating hospitals • Any physician responsible for examination, treatment, or transfer of patient in an ED • Including physician-on-call Photo Courtesy of U.S. Army

  7. EMTALA Requirements • A hospital must perform a medical screening exam to any person coming to ED seeking care • A hospital must treat any patient with an emergency medical condition until stable, or must transfer the patient • A hospital may not transfer an unstable patient

  8. MSE: Medical Screening Exam • Performed by a ‘qualified medical person’ (QMP) • MD, DO, PA, NP, midwife • Anyone defined by hospital privileges as QMP • MSE cannot be delayed to inquire about payment or insurance status • Triage ≠ MSE

  9. EMC: Emergency Medical Condition • Definition: When absence of immediate medical attention could result in: • Placing health of a person or unborn child in serious jeopardy • Serious impairment to bodily function • Serious dysfunction of part of the body • Severe pain • No EMC found? • Hospital has no further legal obligation to treat

  10. Pregnancy • Pregnant women with contractions are considered to be medically unstable (active labor) • QMP must certify that the patient is in false labor

  11. Stabilization • Definition: Medical treatment of an EMCwithin the capabilities of the facility & staff • After stabilization, there are no further EMTALA obligations US Air Force / 445th Airlift Wing Maj. Ted Theopolos

  12. Patient Refusal of MSE or Treatment • Inform patient of risks of refusal • Document this conversation in the medical record • Attempt to obtain patient’s written refusal

  13. On-call Physicians • Must respond within ‘a reasonable amount of time’ when requested • Hospital must have policy in place for back-up or transfer if on-call physician cannot respond

  14. Transfer • Reasons for transfer: • Appropriate care is not available at the current facility • Patient requests transfer • Hospital discharge is considered a ‘transfer’ Picture: Ed Edahl, Federal Emergency Management Agency

  15. Before Transfer … • Treat & stabilize patient as far as possible • Patient must sign certification / informed consent for transfer • Contact receiving hospital • Receiving hospital must accept transfer • Send copies of medical records & test results • Arrange necessary personnel & equipment for transfer

  16. Transfer: Receiving Hospital • Must accept transfer if hospital’s capabilities to treat the patient exceeds risks of transfer • Not obligated to conduct another MSE • Snitch Rule: Receiving hospital must report cases of inappropriate transfers

  17. Patient Refusing Transfer • Inform patient of risks & benefits of transfer • Document conversation in medical record • Attempt to obtain patient’s written refusal of transfer & reason for refusal • Continue to treat patient until stable

  18. Must be posted in all public entrances, registration areas & ED waiting areas EMTALA Sign

  19. Enforcement • Maximum fine per violation: $50,000 • $25,000 for hospitals with <100 beds • Gross violations can lead to termination of Medicare funding • Individual doctors CAN be fined!

  20. Take Home Points: EMTALA • Every patient presenting to any ED must have a medical screening exam • Every patient with an emergency medical condition must be stabilized and/or transferred • Before hospital transfer, a patient must be stabilized as far as possible • EMTALA is enforced with hefty fines

  21. Conclusion • Treat EVERY patient that comes to the ED to the best of your ability without regard to their ability to pay

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