DDBA 8562 Week 2 EMTALA Authority Brief Example

What the Emergency Medical Treatment and Labor Act Requires of a Participating Hospital, What It Is Often Read to Require and Where It Falls Silent: An Authority Brief Limited to the Statute's Own Terms

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Walden University

DDBA 8562: Seminar in Law and Ethics in Healthcare Management

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Month Day, Year

What the Emergency Medical Treatment and Labor Act Requires of a Participating Hospital, What It Is Often Read to Require and Where It Falls Silent: An Authority Brief Limited to the Statute's Own Terms

The Authority Identified

Congress's 1986 emergency care statute, known by its acronym EMTALA and codified at 42 U.S.C. § 1395dd, reaches any hospital that both takes Medicare and keeps an emergency department open. Almost every acute care hospital in the United States participates in Medicare, so the statute reaches nearly all hospital emergency departments, including those of nonprofit, for-profit and public hospitals. It was enacted in 1986.

What the Statute Establishes

The statute places three core duties on a covered hospital. First, anyone who arrives at the department and asks, or on whose behalf someone asks, for examination or treatment must receive a screening examination adequate to find out whether an emergency condition is present, using what the department, including its routinely available ancillary services, is able to provide. Second, if the hospital determines that an emergency medical condition exists, it must either provide treatment to stabilize the condition within its staff and facilities or arrange an appropriate transfer. Third, it may not transfer an individual whose condition has not been stabilized unless specific conditions are met, such as the patient's informed written request or a physician's signed judgment that moving the patient offers more expected benefit than risk, and the transfer itself meets stated requirements, including a receiving facility that has agreed to accept the patient.

The statute also forbids a participating hospital from delaying the screening examination or stabilizing treatment while staff look into insurance or a patient's ability to pay. It allows civil monetary penalties against hospitals and physicians who violate it and permits individuals harmed by a violation to sue the hospital for damages.

What It Is Often Read to Establish

EMTALA is often described as guaranteeing emergency treatment to everyone. That overstates it. The obligation runs to screening and, where the screening finds an emergency, to stabilizing or properly transferring the patient. It does not require a hospital to provide care beyond stabilization, and it does not require that care be free. It is also sometimes read as a national standard of care for emergency medicine; it is not a malpractice statute, and courts have generally read the screening duty as requiring the hospital to apply its own screening procedures uniformly, not as setting a clinical standard. Rosenbaum (2013) described the statute's lasting role as a narrow guarantee of emergency screening and stabilization rather than a general right to health care, which is the reading this brief adopts.

Where the Statute Ends

The statute says nothing about whether, or how much, a hospital may bill a patient it has screened and stabilized. Once the duties above are met, a separate authority governs the bill: for nonprofit hospitals, the Internal Revenue Code's requirements for financial assistance policies and limits on charges, at 26 U.S.C. § 501(r), and for all hospitals, state law and the hospital's own charity care policy. The question of what a hospital should charge a stabilized uninsured patient lies beyond EMTALA.

References

Emergency Medical Treatment and Labor Act, 42 U.S.C. § 1395dd (2018).

Requirements for charitable hospitals, 26 U.S.C. § 501(r) (2018).

Rosenbaum, S. (2013). The enduring role of the Emergency Medical Treatment and Active Labor Act. Health Affairs, 32(12), 2075-2081. https://doi.org/10.1377/hlthaff.2013.0660