The Emergency Medical Treatment and Active Labor Act of 1985 (“EMTALA”) was passed as part of the Consolidated Omnibus Budget Reconciliation Act of 1986, a federal law that is more commonly known as “COBRA”. EMTALA is the portion of COBRA that determines the circumstances under which a patient can be refused medical treatment, and/or be transferred to another hospital.
EMTALA applies to all hospitals that receive public funding from the Medicaid and Medicare programs, which includes most hospitals in the United States. The main purpose of EMTALA is to prevent hospitals from discriminating against patients who cannot afford to pay for medical care by refusing to treat them or transferring them to other hospitals. Essentially, EMTALA does not permit a hospital to treat a patient with a medical emergency, but who does not have health insurance, any differently than a patient who has health insurance or can pay for treatment.
More specifically, if a person comes to the emergency department of a hospital and requests treatment for an emergency medical condition, the hospital must provide screenings and/or examinations in order to determine whether the person truly has an emergency medical condition. If the person has an emergency medical condition, then the hospital must treat the patient with no regard to his or her ability to pay for medical treatment. EMTALA also specifies that hospitals must treat pregnant women who are in active labor until they deliver, unless safe transfer to another hospital is appropriate.
Emergency medical conditions include those conditions that, in the absence of immediate treatment, could result in serious jeopardy to one’s health, serious impairment to bodily functions, and/or serious dysfunction of any bodily organ or part. Emergency medical conditions also encompass any similar risks to a pregnant woman’s unborn child.
Generally, EMTALA prohibits hospitals from transferring patients to other medical facilities prior to their medical conditions becoming stable. However, there are circumstances under which a hospital can transfer a patient with an unstable medical condition. Typically, transfer of an unstable patient is permissible under EMTALA when the hospital has stabilized the patient to the extent of its capabilities, the patient needs further treatment available at another facility, and the medical benefits of a transfer outweigh the risks. In this case, the hospital must make prior arrangements with the other facility to receive and treat the patient, send the patient’s medical records with him or her to the other facility, and transfer the patient with the appropriate medical measures in place.
EMTALA also addresses situations where a patient refuses treatment or requests transfer to another facility. If a patient refuses treatment against the advice of medical personnel, the hospital has completed its duty to screen the patient for an emergency medical condition, and has no further responsibilities under EMTALA. Likewise, a hospital can transfer a patient to another facility upon his or her request, but it still must be an appropriate transfer as defined by EMTALA.