Many if not all of us will experience a medical emergency at some point in our lives – either our own or that of a loved one. In the event that this occurs, we want to know that we will receive prompt medical attention in an emergency room, regardless of our ability to pay, insurance status, race, creed, sex or national origin. EMTALA is the federal law that protects individuals with medical emergencies.
The Emergency Medical Treatment and Active Labor Act (EMTALA), was passed by Congress in 1986. Often referred to as the “Anti-Dumping Law”, EMTALA was passed as a remedy to a growing trend in hospitals to “dump” patients in critical condition onto public facilities without adequately treating them, due to a lack of insurance or ability to pay. EMTALA applies to all Medicare participating hospitals with an emergency department. Fortunately, this includes nearly all hospitals, with the exception of a few specialized facilities. Although one of the primary effects of EMTALA is to protect individuals without insurance or the ability to pay, it applies to all individuals presenting at the ER with a medical emergency.
EMTALA provides a private right of action (ie., permits a lawsuit) against a hospital for individuals injured by a violation of its provisions.
The Three Provisions of EMTALA:
EMTALA has three mandatory provisions that all participating hospitals and physicians must abide by. The first provision entitles patients to a “reasonably calculated medical screening exam” to determine whether the patient has an “emergency medical condition” in a reasonable amount of time. The second provision dictates that, if there is an emergency medical condition, the emergency health staff must stabilize the patient's condition before transferring them to a different facility. These two provisions essentially mean that, if you go to the hospital with an emergency condition, you must be provided a thoughtfully considered diagnosis of your symptoms, and you are not allowed to be “dumped” to another facility until you are no longer critical condition. This is provided to you regardless of whether you have the ability to pay.
There are a few exceptions to the second provision, however, and one of the most common appears in situations where emergency staff are unable to stabilize a patient's condition with the resources they have available to them, and the health benefits of transferring him or her outweighs the consequences. This leads to the third provision, which mandates that facilities that would be better able to treat the patient are in turn obligated to admit the patient and stabilize his or her condition.
What is an Emergency Medical Condition?
Stabilizing treatment under EMTALA applies to emergency medical conditions. EMTALA defines an emergency medical condition as “a condition manifesting itself by acute symptoms of sufficient severity (including severe pain) such that the absence of immediate medical attention could reasonably be expected to result in placing the individual's health [or the health of an unborn child] in serious jeopardy, serious impairment to bodily functions, or serious dysfunction of bodily organs.” If, after the medical screening exam (the first step under EMTALA), an individual is determined to have an emergency medical condition, the hospital must move onto to the second requirement of EMTALA: stabilize the patient and only transfer if certain conditions are met.
If you have questions about your rights as a patient seeking emergency medical care, feel free to give us a call at 518-308-8339. We are always happy to speak to potential clients and our initial consultations are free.