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Emergency
Medical Treatment and Active Labor Act (EMTALA) Resources
New
EMTALA Regulations Finalized on September 2, 2003.
The
Emergency Medical Treatment and Active Labor Act serves to
provide structure to the proper examination, treatment and
transfer of Emergency Department patients. Adherence to the law
is dependent upon attendance to those who present for care on
hospital property, life sustaining care, and informed patient
transfer. Documentation of each aspect of care and communication
is central to compliance with the law.
From
the CMS Press Release About New Revisions:
"The revisions provide clear, common sense rules for
responding to people who come to a hospital for treatment of an
emergency condition. They are designed to ensure that people
will receive appropriate screening and emergency treatment,
regardless of their ability to pay, while removing barriers to
the efficient operation of hospital emergency departments."
EMTALA
requires a hospital to provide an appropriate medical screening
examination to any person who comes to the hospital emergency
department and requests treatment or an examination for a
medical condition. If the examination reveals an emergency
medical condition, the hospital must also provide either
necessary stabilizing treatment or an appropriate transfer to
another medical facility.
EMTALA
applies to all hospitals that participate in the Medicare
program and offer emergency services and covers all patients
treated at those hospitals, not just those who receive Medicare
benefits. Hospitals that violate EMTALA may have their Medicare
participation terminated and may be subject to civil money
penalties ("CMPs") of up to $50,000 per violation.
Individuals who have suffered personal harm and hospitals to
which a patient has been improperly transferred and that have
suffered financial loss as a result of the transfer are also
provided a private right of action against hospitals that
violate EMTALA.
The
new rule expands the definition of emergency department to mean
any department or facility of the hospital, whether situated on
or off the main hospital campus, that: (1) is licensed by the
state as an emergency room or emergency department; (2) is held
out to the public as providing care for emergency medical
conditions without requiring an appointment; or (3) during its
previous calendar year, has provided at least one-third of all
its outpatient visits for the treatment of emergency medical
conditions on an urgent basis.
Other
key provisions of the final rule include:
- Clarification of the circumstances in which physicians,
particularly specialty physicians, must serve on hospital
medical staff "on-call" lists. Under the revised
regulations, hospitals will have discretion to develop their
on-call lists in a way that best meets the needs of their
communities. In keeping with traditional practices of
"community call," physicians will be permitted to
be on call simultaneously at more than one hospital, and to
schedule elective surgery or other medical procedures during
on-call times.
- Clarification that hospital-owned ambulances may comply
with citywide and local community protocols for responding
to medical emergencies and thus be used more efficiently for
the benefit of their communities.
- Permits hospital departments that are off-campus to
provide the most effective way of caring for emergency
patients without requiring that the patient be moved to the
main campus—when this would not be best for the patient.
The final rule clarifies that EMTALA does not apply to
individuals who come to off-campus outpatient clinics that do
not routinely provide emergency services or to those who have
begun to receive scheduled, non-emergency outpatient services at
the main campus – for example, routine laboratory tests. Other
regulations and state licensing laws already cover the hospital’s
obligations to patients in such circumstances.
In addition, the rule clarifies that EMTALA does not apply
after a patient has been seen, screened, and admitted for
inpatient hospital services, unless the admission is made in bad
faith to avoid the EMTALA requirements. This provision was
adopted to conform to the decisions of five circuits of the
United States Courts of Appeals.
"We believe this regulation will help to ensure that
emergency departments and specialty physicians are there for
those who need them," Administrator Scully said. "It
is consistent with the recommendations of the Secretary’s
Advisory Committee on Regulatory Reform to help hospitals focus
less on unnecessary requirements and more on providing quality
care to their patients."
The final rule will be published in the September 9, 2003 Federal
Register, and becomes effective November 10, 2003.
Final
Regulations: Pdf Version
Commonly Used Terms:
EMTALA - The Emergency Medical Treatment and Active Labor
Act
COBRA - The Consolidated Omnibus Budget Reconciliation
Act of 1986
HCFA - The Health Care Financing Administration -
previous name for CMS
CMS - Centers for Medicare and Medicaid Services, a
division of the Department of Health and Human Services.
Responsible for the Medicare program and the development and
enforcement of regulations on EMTALA.
Transferring hospital - A facility at which a patient is
seen initially and whose personnel determine that transfer to
another facility is warranted
Receiving hospital - A facility to which a patient is
transferred
EMTALA 250 yard regulation-Based upon the Ravenswood
Hospital case, this regulation requires hospitals to be capable
of responding directly (not just EMS) to patients requiring
assistance who present within 250 yards of the hospital
building. This also includes off-site departments that are
separated by non-hospital buildings and are within 250 yards of
the hospital building.
Articles, case studies, and
resources for further study:
This
list of resources is highly selective and does not include every
web site related to this
topic. If you would like to add a resource click
here.
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The
"20 Commandments" of COBRA/EMTALA-The main
points of EMTALA regulations broken down into an easy to
read & understand form. Printable so it could be posted
in the ER staff lounge for quick review as needed. [Courtesy
of Stephen A. Frew, J.D., Frew Consulting Group.]
-
Certification
of False Labor-EMTALA-CMS policy issued January
16, 2002 regarding EMTALA requirements for women in labor.
-
Question
and Answer Relating to Bioterrorism and EMTALA-
Clarification regarding EMTALA obligations of hospitals
when staff encounter situations related to the actual or
potential exposure of a biological agent. [CMS November 8,
2001]
-
Hospital
Capacity Issues -EMTALA- Clarifies policy
regarding EMTALA requirements for a sending hospital when
it lacks capacity and EMTALA responsibilities of the
recipient hospital for accepting patients under those
circumstances. [CMS November 29, 2001]
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EMTALA
Case Study 1-ER
Nurses fail to take vital signs in accordance with
hospital protocols resulting in EMTALA violation and
lawsuit. [Case Summary courtesy of Legal Eagle Eye
Newsletter for the Nursing Profession].
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EMTALA
Case Study 2- Court reviews EMTALA criteria for
Screening, Stabilization, and Patient Transport. [Case
Summary- Smith vs. Janes, 895 F. Supp. 875 (S.D.
Miss.,1995)].
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Nurses
and the Law: A Guide to Principles and Applications-
Covers ethical and legal issues affecting nurses. Includes
an updated ethics chapter, guidance on quality assessment,
managed care, and assisted suicide, expanded nursing roles
and settings, and more.
-
The
Advanced Practice Nurse's Legal Handbook-
Addresses liability issues, licensing, state nurse
practice acts, and patient rights. Includes real-life
examples, case studies, and guidance on the trial and
discovery process. [Lippincott, June, 2002].
-
Blood
Alcohols, Labs and Minor Treatments in the ED- The
ER is often used by police to draw blood alcohol levels on
allegedly intoxicated drivers, physicians obtain lab tests
or x-rays during off-hours, and hospitals provide urine
drug screens on injured workers, prescription refills,
allergy shots, rabies vaccinations or blood transfusions.
The question is whether hospitals are required to perform
a medical screening examination in each of these scenarios
under EMTALA regulations. [ACEP News]
-
EMTALA:
Frequently Asked Questions- Frequently asked
questions and answers about how EMTALA affects Emergency
Nursing practice. [Emergency Nurses Association].
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