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Provider Liability Under EMTALA: An Overview

Article by Ryan King, Esq.

The Emergency Medical Treatment and Active Labor Act (EMTALA) is a federal law that Congress enacted in 1986 to prevent discrimination against individuals in need of emergency medical treatment who cannot afford to pay or do not have in-network insurance coverage. The law is specifically intended to stop patient “dumping” and “parking,” and it requires hospitals and other facilities to appropriately transfer patients when necessary regardless of their ability (or perceived ability) to pay.

EMTALA is not a federal medical malpractice statute. The courts have made this clear. However, hospitals and other facilities can still face civil liability for violating EMTALA and, as a result, it is imperative that they have adequate policies and procedures in place to ensure compliance.

Which Healthcare Providers Are Subject to EMTALA?

While EMTALA applies principally to hospitals, it applies to certain other healthcare providers as well. Specifically, providers that are subject to EMTALA include:

  • Medicare-participating hospitals with emergency departments
  • Other hospitals that hold themselves out as providing emergent care on an urgent basis
  • Offsite urgent care facilities owned by hospitals
  • Physicians working at the facilities listed above (including on-call physicians)

When Does EMTALA Apply?

For covered health care facilities and physicians, EMTALA applies when a patient presents with an emergency medical condition (EMC) and faces serious health risks if he or she does not receive immediate medical care. Specific instances in which EMTALA applies include:

  • Failure to treat a patient or unborn child presents “serious risk”
  • Failure to treat may reasonably result in impairment of a bodily function
  • Failure to treat may reasonably result in serious dysfunction of an organ or body part
  • Failure to treat an expecting mother with contractions when there is insufficient time to safely transfer the mother to another facility or a transfer poses a threat to the mother or the fetus

What Is EMTALA Intended to Prevent?

EMTALA is intended to apply in a variety of different scenarios, and it is generally intended to prevent covered providers from making care-related decisions based on patients’ financial circumstances. For example, EMTALA prevents covered providers from:

  • Refusing treatment to patients with EMCs because they cannot pay
  • Transferring patients with EMCs because they cannot pay for treatment
  • Discharging patients with EMCs because they can’t pay
  • Parking patients with EMCs because they may not be able to pay
  • Delaying treatment because of inability or perceived inability to pay
  • Delaying treatment while questioning patients about their ability to pay
  • Providing lesser care to patients because of an inability or perceived inability to pay

What Are the Risks of Violating EMTALA?

Providers that violate EMTALA can face civil penalties in federal enforcement proceedings. The statute also gives patients and families a private cause of action against covered facilities (but not covered physicians). Currently, EMTALA fines stand at $106,965 per violation for facilities with more than 100 beds, $53,484 per violation for facilities with less than 100 beds, and $53,484 for physicians. Flagrant or repeated violations can also result in Medicare exclusion.

What Can (and Should) Covered Providers Do To Comply with EMTALA?

Given the risks of non-compliance, covered providers must take adequate steps to ensure that their triage and treatment practices meet EMTALA’s demands. Some examples of steps that covered providers can (and generally should) take to maintain compliance with the statute include:

  • Implementing uniform patient screening policies and practices
  • Never delaying screening while assessing a patient’s ability to pay
  • Providing consistent treatment without regard to a patient’s ability (or perceived ability) to pay
  • Stabilizing and transferring patients when necessary without regard to ability (or perceived ability) to pay
  • Thoroughly documenting all instances in which patients refuse treatment
  • Complying with EMTALA in good faith (courts have held that admitting a patient as a “ruse” and then discharging the patient does not satisfy the statute’s requirements)