Special Report: When Emergency Rooms Break the Law

Your rights in the ER

The Emergency Medical Treatment and Labor Act, or EMTALA, guarantees a certain level of medical care to anyone who comes to an emergency department that accepts payments from Medicare or Medicaid.

Some labor and delivery units and psychiatric hospitals are also governed by EMTALA.

Under the law enacted in 1986, emergency departments must:

• Offer patients a timely and appropriate medical screening exam.
• This exam is different from triage, in which a nurse or other provider takes vital signs to decide the order in which to see patients.
• Unlike with triage, a health care professional with a certain level of expertise — typically a doctor, advanced practice nurse, or physician assistant — must do the medical screening.
• Medical screening exams are done to find out the cause of a patient’s symptoms. They cannot be delayed or denied in order to ask about a patient’s ability to pay.
• Medical screening exams must make use of all the hospital’s relevant resources, for example, lab tests or CT scans.

Over the last 10 years, the most frequent EMTALA violation by hospitals was the failure to do an adequate medical screening exam.

• Stabilize patients who have emergency medical conditions.

Failure to offer stabilizing treatment was the fourth most common EMTALA violation over the last 10 years.

• If a hospital can’t stabilize a patient, it is required to arrange an appropriate transfer to another facility, including:
• Treatment to lessen the risks of transfer
• Getting consent from the receiving hospital to accept the transfer
• Ensuring the transfer involves qualified personnel and transportation (an ambulance)

Failure to do an appropriate transfer was the second most common way hospitals have violated EMTALA over the last 10 years.

• Keep appropriate records on patients, including a central log of who came to the ER and what happened to them.

Failure to keep this log was the third most common EMTALA violation over the last 10 years.

• Post signs in the ER letting people know about these rights.
• Keep a list of on-call doctors who can see patients in case of an emergency.
• Accept appropriate transfers from other hospitals if the receiving facility has special abilities or is able to care for an incoming patient.
• Not punish any hospital employee who reports a violation.
• Report any improperly transferred patients it receives within 72 hours.

SOURCES:

Centers for Medicare and Medicaid Services, State Operations Manual, Appendix V, Interpretive Guidelines, Responsibilities of Medicare Participating Hospitals in Emergency Cases, 7-16-10.

Editor’s note: If you have experienced what you think may be an EMTALA violation, you can contact your regional Centers for Medicare & Medicaid Services office. You can find your local office from the CMS.gov website. Anyone can report a violation anonymously. The CMS office will need details to properly investigate your claim. Health officials will investigate your claim, but no more involvement is likely necessary on your part, CMS officials say.