EMTALA

WHAT IS EMTALA

WHAT is EMTALA

• EMTALA IS THE EMERGENCY MEDICAL TREATMENT AND ACTIVE LABOR ACT
• ENACTED IN 1986 TO ADDRESS THE PRACTICE OF "PATIENT DUMPING" OF
• INDIGENT PATIENTS IN EMERGENCY SITUATIONS.
• BASIC REQUIREMENT IS TO PROVIDE APPROPRIATE MEDICAL SCREENING TO
• DETERMINE IF A EMERGENCY MEDICAL EXISTS.

PRINCIPLES OF EMTALA

• ANYONE PRESENTING TO THE ED OR HOSPITAL CAMPUS
• REQUESTING MEDICAL TREATMENT IS ENTITLED TO A MSE
• THE MSE INVOLVES A PROCESS OF SUFFICIENT COPE TO CONCLUDE,WITH REASONABLE CLINICAL CONFIDENCE, WHETHER AN EMERGENCY
• MEDICAL CONDITION DOES OR DOES NOT EXIST
• IF THE NATURE OF THE REQUEST IS NOT EMERGENT, THE REQUIREMENT TO PERFORM A SCREENING APPROPRIATE FOR ANY INDIVIDUAL PRESENTING IN THE SAME MANNER.

Dedicated Emergency Department

• Meets at least one of the following:
• Licensed under applicable state law as an ED
• Held out to the public as a place that provides care on an urgent basis wihout appointment
• At least 1/3 of outpatient visits for the previous calendar year were for the treatment of EMC

ROLE OF ON-CALL PHYSICIANS IF YOU ARE ON CALL, YOU ARE OBLIGATED UNDER EMTALA TO COME TO THE ED WHEN REQUESTED BY AN ED PHYSICIAN

• MUST MAKE ARRAGEMENS TO DATISFY OBLIGATIONS, IF HE/SHE IS SCHEDULED TO PERFORM ELECTIVE PROCEFURES DURING THE ON-CALL PERIOD
• ON-CALL SPECIALIST WHO ARE NOTIFIED AND FAIL TO RESPOND IN A TIME MANNER OR REFUSE TO TREAT , WHICH RESULTS IN PATIENT TRANSFER
• RISK CIVIL PENALTIES FOR THE HOSPITAL AND PHYSCISN
• TERMINATION OF PARTICIPATION IN MEDICARE/MEDICAID PROGRAMS

Keypoints

• Maintain a central log & on call list
• Triage for chief complaint & urgency
• Do not delay the MSE to verify method of payment
• Define qualified MSE examiner
• Perform medically indicated tests to rule out or confirm EMC

Compliance Requirements

• Hospital shall maintain records for 5 years
• central log
• Transfer records
• physicisan on call list

Hospital owned/operated ambulances are exempt IF:

• The examination or treatment of an individual inan ambulance owned by a hospital is NOT subject to EMTALA if
• if it operates under community wide EMS protocols
• operates at the direction of a physician not employed or affiliated with the hospital

Who gets screened

• Anyone presenting to the ED or hospital campus requesting treatment for a medical condition is entitled to a MSE
• and then if warranted, stabilization and transfer.
• If the nature of the request of an individual is not an emergency, the requirement to perform MSE
• a screening appropriate for any individual presenting in the same manner

Stabilizing and Transfer

STABILIZATION

• Provision of treatment for the EMC to ensure , within reasonable medical probablity, that no material deterioration of the EMC is likely to result from, or occur
• during, the transfer of the patient
• Women in labor are considered stabilized if the woman has delivered the child and the placenta

Transfer Keypoints

• Stabilize patient, send records
• Confirm capability & capacity
• Document risks & benefits to support need for transfer
• Provide appropriate transport
• Maintain records for 5 years

EMTALA VIOLATIONS

• Potential $50,000 fine per patient incident
• Termination from Medicare & Medicaid
• Potential lawsuit for civil damanges
• Potential lawsuit for civil rights violation
• Publication of the violation and penalty