Emergency Medical Treatment and Active Labor Act - Part I

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EMTALA:

EMTALA is the Federal Statute, enacted in 1986, that eliminated the historic, common-law precept of “no duty to treat”. Until its drafting and codification, physicians were not duty-bound to treat anyone but their own patients. Since EMTALA became law, hospital triage departments (ER and OB) have a duty to timely and thoroughly evaluate each individual presenting for care, rgardless of insurance status or ability to pay.1

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Patients Presenting To OB Triage

When a pregnant patient presents to a hospital OB triage unit for care, EMTALA requires that the evaluating physician or midwife provide a medical screening exam (MSE) to determine if there is an emergency medical condition (EMC). Pregnant patients are not condisered to have an (EMC) if they are certified to be in false labor or there is time for a safe transfer to another hospital prior to delivery.2 Underer the Statute, those experiencing contractions are only considered stabilized after the baby and placenta are delivered, the laboring patient no longer has discernible contractions, or “a physician, certified nurse-midwife, or another qualified medical person (QMP) certifies that the individual is experiencing false labor”.3

EMTALA Violations in OB Triage

Common EMTALA violations in OB Triage include improper or inadequate physical evaluation of mother and baby, improper discharge home from triage, (discharge and transfer are considered to be equivalent according to the Statute), improper refusal by an on-call midwife to come to the triage unit and perform an examination, failure of the midwife to rule out active phase labor, or failure to certify false labor. Timely initial assessments, stabilizing care, and the ability to evaluate and act according to patient acuity are additional components of care required by EMTALA.4

Monetary Fines For EMTALA Violations

Fines up to $50,000 can be imposed on hospitals, physicians, and other clinicians (CNMs and APRNs) for violating the Statute. Unlike a malpractice lawsuit, monetary penalties are not awarded to injured parties. Penalties paid for violations of EMTALA go directly to the United States Treasury Department. Those individuals harmed from violations of EMTALA may seek private attorney representation, enabling civil money penalties to be awarded for their triage injuries and losses.5 (See EMTALA: Treating patients with emergency medical conditions and risk of violating State statutes).

1. Rosenbaum S, Cartright-Smith L, Hirsch J. Case Studies at Denver Health: patient dumping in the emergency department despite EMTALA; the law that banned it. Health Affairs. 2012;31(8):1-17.

2. Emergency Medical Treatment and Active Labor Act, 42 CFR 489.24(b), definition of Transfer. 42 USC 1395dd(e)(1)(8); 42 CFR 49.24(b) definition of emergency medical condition.

3. Emergency Medical Treatment and Active Labor Act, 42 CFR 489.24: Special responsibilities of Medicare hospitals in emergency cases; (2)(ii). 42 CFR 489.24(a)(i),(c).

4. Emergency Medical Treatment and Active Labor Act. 42 USC 1395dd(d); 42 CFR 1003, 103(e); 45 CFR 102.3.

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