Expert answer:Emergency Medical Treatment and Active Labor Act
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Running head: EMTALA
Emergency Medical Treatment and Active Labor Act (EMTALA) of 1986
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EMTALA
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Emergency Medical Treatment and Active Labor Act (EMTALA)
The Emergency Medical Treatment and Active Labor Act of 1986 (EMTALA) was
enacted in 1986 by the U.S Congress. The Act requires that all hospital emergency
departments that accept Medicare payments to carry out a medical screening examination
(MSE) for anyone who needs treatment for a medical condition irrespective of their legal
status, citizenship, and whether they can pay for the treatment or not (LII, n.d). Furthermore,
hospitals that are covered by the law are not allowed to transfer or discharge the patients who
the treatment but only by getting need consent and if the student has stabilized (LII, n.d). The
other condition is when their condition needs transfer to a care facility that is better equipped
and able to give the treatment.
Legislations that led to Act
EMTALA was passed by Congress in 1986 as a part of the Consolidated Omnibus
Budget Reconciliation Act (COBRA) that was enacted in 1985 (ACEP, 2016). COBRA was
passed by Congress; it allows an insurance program to provide payment to certain employees
the chance to get health insurance coverage once they are out of employment. COBRA
factored in amendments to the 1974 Employee Retirement Income Security Act (ERISA).
The law covers various issues and areas such as supports for tobacco prices, pension plans,
treated in emergency rooms, insurance for disability, deny tax deductions, and the postal
service. EMTALA was passed to bring an end to the practice of patient dumping that is a
practice of shifting the patients that are not insured or those receiving Medicaid (ACEP,
2016). At the minimum, the hospitals were to carry out medical screening examination so as
not to put the lives of the patients at risk as they were being relocated. EMTALA went on to
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become the primary law that enabled people who are uninsured to obtain screening (ACEP,
2016). By 2000 Congress pushed for greater enforcement of the law and EMTALA became a
priority and compulsory for all the hospitals. To further enforce it, a penalty was attached to
it, within just ten years approximately 1.8 million was collected as penalty for any facilities
that contravened the law (ACEP, 2016).
History and development of EMTALA
EMTALA was developed on the backdrop of patient dumping concerns. Patients that
were brought to hospitals emergency units did not have any help or right to being provided
with treatment let alone evaluations (Ansell and Schiff, 1987). If the patients had no way of
proving that they could cater for their treatment they would be released or turned away, sent
to another facility and in the process, they could experience delayed care which could result
in fatalities. The various article would appear in the cases of dumping; examples were from
medical facilities like the Cook County Hospital (Ansell and Schiff, 1987). Many of the
transfers to Cook County Hospitals were from minorities and the unemployed. The primary
reasons for transfer were attributed to lack of insurance and made up 87 percent of the cases
while a paltry 6 percent was as a result of written consent requiring a transfer (Ansell and
Schiff, 1987). The patients who were being transferred were twice as likely to die as
opposed to those that were treated in the facilities (Zibulewsky, 2001). Further investigations
concluded that such transfers were done mainly for financial reasons which had the effect of
delaying care and jeopardizing the patients’ health (Zibulewsky, 2001).
EMTALA was enacted as a part of COBRA the Consolidated Omnibus Budget
Reconciliation Act (COBRA) that was enacted in 1985. COBRA was passed by Congress
and was created to allow for an insurance program that provided payment to certain
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employees and gave them the chance to get health insurance coverage once they were out of
employment. COBRA factored in amendments to the 1974 Employee Retirement Income
Security Act (ERISA). COBRA deals with a host of subjects relating to the tobacco price
help support, the pension plans, the treatment in emergency rooms, insurance of disabilities,
railroads. It is also led to the development of Title X which was the amendment of the
Internal Revenue Code and the Public Health Service Act which blocked tax deductions of
incomes by employers who had 20 or more full-time employees. The deductions were denied
for contributions to health plans unless certain coverage requirements that assured continuity
were effected.
Impact of EMTALA
Since the introduction of EMTALA, various changes have occurred. There has been a
sharp increase in the number of uninsured patients seeking emergency and acute medical
treatment (Zibulewsky, 2001). The emergency department plays a critical role regarding
providing 24-hour access in all the days of the week. However, the amount of cost burden as
a result of EMTALA obligations is having an impact on their performance (Downe, n.d). The
hospital visits between 1992 and 2002 went up by close to 20 million, which is
approximately 39 percent of the country’s population (Downe, n.d). The number of
emergency department, however, went down by roughly 15 percent indicating that there was
more demand but the access was less. That resulted in congestion of emergency departments.
Before the enactment, the physicians’ on-call list to emergency cases was the responsibility
of the medical staff’s membership to a given hospital. However, these days those in the
managed care plans are the ones that get more calls and therefore leading to greater friction
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between the EDs and the on-call physicians (Zibulewsky, 2001). The physicians feel they do
not have to come and see a patient whenever they are called.
EMTALA also led to the introduction of reversed dumping, a hospital that has
specialized capabilities is required not to refuse to accept any appropriate transfers of
individuals who are requesting for specialized treatment. Such specialized facilities are
barred from refusing to serve the given patients by their inability to pay for their services.
There is also the high costs and a backlog of payment and reimbursements since the
introduction of EMTALA. Uncompensated costs were estimated to be over $400 million as
of 1996 while those that were to the hospitals for inpatient care was at $10 billion (Fields,
2000). Back in 2000, the emergency physicians had reported that out of the debt cases they
had, 61 percent were from EMTALA care as mandated by the law. Judging from the data of
reports from Medical Expenditure Panel Survey between the periods of 1996 and 1998. The
percentage of charges paid to Medicaid and Medicare together with those of the uninsured
had remained constant while the figures for patients who were privately insured had gone
from approximately 77 to 66 percent (Tsai, 2003).
The contribution of the insurance companies to the bad debt cases was going up; it,
therefore, made it hard for those emergency doctors to shift the costs to get compensation.
There have also been the challenges brought about with legality and contravention of various
EMTALA requirements. They have resulted in numerous cases being brought below the
courts; some examples include the Moses v. Providence Hospital and Medical Centers Inc,
Ritten v. Lapeer Regional Medical Center E.D Michigan and Vickers v. Nash among others
(Ream, n.d; Weiss, 2012). The courts have handled numerous cases since the enactment of
the law.
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EMTALA court cases
Estate of a woman murdered was allowed to follow EMTALA claims was allowed in
2009 by the U.S Court of Appeal. In Moses v. Providence Hospital and Medical Centers Inc.,
6th Cir., No. 07-2111, 4/6/09. The estate of the wife of the affected party was allowed to
follow up on a claim after a hospital released a patient who was mentally ill and was to be
under their care (Ream, n.d). On being released, the mentally ill patient went on to murder
his wife. Marie Moss-Irons, the plaintiff, requested the court. The patient Lessem was to be
kept in the psychiatric unit but it never happened and instead was released. The plaintiff filed
a federal suit against the facility citing that EMTALA law was violated and several other
negligence claims. The defendants, on the other hand, filed for a summary judgment
mentioning that there was no basis for suing, the EMTALA requirements had been met as
soon as they admitted the patient and the patient had been screened, but the doctors found he
did not have an emergency condition (Ream, n.d). The court ruled that the plaintiff had the
right to sue, it ruled against the summary judgment, and it was held that the mental health
case qualified as an emergency case. It is evident that there was great neglect by the medical
team and the hospital administration. Better treatment should have been provided in line with
the EMTALA requirements (Ream, n.d).
In Ritten v. Lapeer Regional Medical Center E.D Michigan in 2009, the physician
was allowed by the court to pursue a case of retaliation under EMTALA for being suspended
from his clinical privileges after he refused to release a patient who was in labor and need of
medical attention (Ream, n.d). The hospital committee rescinded the decision of reinstating
the benefits, but the plaintiff went on to file the case. The CEO of the facility had threatened
the physician of dire consequences to the extent of losing his job if he did not release the
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patient. The defendants argued the EMTALA provision stopped to work once the patient was
admitted to the facility, they argued that the facility had met its obligation of the law. The
court indicated that it felt the dismissal claims as threatened by the administration was in
retaliation to the plaintiffs’ noncooperation in releasing the patient. The court dismissed the
summary ruling request by the defendants and affirmed that EMTALA protected the
physicians from such reprisal measures. It also ruled immunity from liability also could be
conferred under Health Care Quality Improvement Act (Ream, n.d).
In Bode v Parkview Health System Inc. the U.S District Court for Northern District of
Indiana allowed the parents of a deceased son to pursue their claim after the given hospital
declined to perform the requisite screening as stipulated in the EMTALA provisions (Ream,
n.d). Makota Norris had various developmental challenges and other multiple health
conditions. The parents filed a case that the hospital had released their son without carrying
out the right screening and checks (Ream, n.d). The plaintiff argued that the defendant
contravened the EMTALA by deviating from the standard screening procedures as required
by the law. The court ruled that the hospital should have carried an appropriate medical
screening as laid out the EMTALA. The improper examination could be attributed to such
misdiagnosis. There was a contravention of the EMTALA screening requirements. The
defendants admitted to the deviation; however, they filed for a summary dismissal citing that
there were no grounds and filed that there is no genuine issue and it lacked in facts. The court
ruled that there was a slight deviation and that was not a violation of EMTALA (Ream, n.d).
Nevertheless, the court denied the summary judgment of the defendants’ motion on screening
and allowed the plaintiff to go and launch the claim (Ream, n.d).
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In Vickers v. Nash in 1996, a patient came into the emergency room after a head
injury gotten from a fight after being intoxicated (Weiss, 2012). The patient was attended to
and kept under observation for 11 hours, however, on being released the patient died. The
court stated that the plaintiff did not allege that they receive unequal screening and also that
hospitals can only stabilize EMCs that they know of (Weiss, 2012). The case of Summers v.
Baptist Med. Filed by the defendant after an inappropriate screening was done following an
accident from falling off a tree stand. The hospital discharged the patient citing that he only
had muscle spasms. However, ongoing to another hospital a couple of days after, the patient
got a bilateral hemopneumothorax, multiple ribs and vertebral compression fractures and
sternal fractures (Weiss, 2012). The plaintiff alleged negligence and the court defined
inappropriate exam comparing it to same placed patients. It was the responsibility of the
hospital to carry out a through the exam, and if they were not well equipped to meet that
requirement, they should have transferred the patient to a well-equipped facility according to
EMTALA requirements (Weiss, 2012).
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References
ACEP. (2016). EMTALA. American College of Emergency Physicians. Retrieved October
30, 2017, from https://www.acep.org/news-media-topbanner/emtala/#sm.000e0v7en10m8emnw1u23hwp8gi5h
Ansell, D.A and Schiff, R.L. (1987). Patient dumping. Status, implications, and policy
recommendations. JAMA.257:1500–1502.
Downe, B. (n.d). The Impact of the Emergency Medical Treatment and Labor Act (EMTALA).
Southern New Hampshire University. Retrieved November 2, 2017, from
http://www.academia.edu/9997250/THE_IMPACT_OF_THE_EMERGENCY_MED
ICAL_TREATMENT_AND_LABOR_ACT_EMTALA_Topics_Health_Administration
Fields W. (2000). Defending America’s safety net. ACEP News.19(4):1–6.
LII. (n.d). 42 U.S. Code § 1395dd – Examination and treatment for emergency medical
conditions and women in labor. Legal Information Institute. Cornell Law School
Retrieved October 30, 2017, from
https://www.law.cornell.edu/uscode/text/42/1395dd
Ream, K. (n.d). Recent Court Cases Involving EMTALA. Washington Watch. AAEM.
Retrieved October 30, 2017, from
http://www.aaem.org/UserFiles/file/washingtonwatch_0709.pdf
Tsai A. (2003). Declining Payments for Emergency Department Care, 1996-1998. Annals of
Emergency Medicine.41(3)299-308.
Weiss, D. L. (2012). EMTALA: The Great Cases (2012 UPDATE). Retrieved October 30,
2017, from https://umem.org/files/uploads/1201110818_ProfDevelop212012.pdf
EMTALA
Zibulewsky, J. (2001). The Emergency Medical Treatment and Active Labor Act
(EMTALA): what it is and what it means for physicians. Proceedings (Baylor
University. Medical Center), 14(4), 339–346.
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