Law requires service to all
Hospitals continue to experience increased utilization of their emergency departments as uninsured patients who are unable to obtain services elsewhere go to emergency departments for treatment of both chronic and acute conditions. For many uninsured patients, the emergency department has become their de facto primary care provider. Hospitals’ obligations to these patients are governed, in large part, by the federal Emergency Medical Treatment and Active Labor Act (“EMTALA”) and Florida’s emergency access laws.
EMTALA’s protections extend to every person who comes to the hospital and either seeks emergency treatment or whose appearance or behavior would lead a reasonable observer to believe that the person was in need of emergency treatment.
The law requires hospitals to provide a medical screening examination to every person who comes to the hospital’s emergency department to determine if the patient has an emergency medical condition (“EMC”). If the patient is found to have an EMC, the hospital must provide the necessary treatment, within the hospital’s service capability and capacity, to stabilize the patient’s EMC. Capability, in this context, generally means the services that are provided to the hospital’s inpatients and/or reflected on the hospital’s license. Capacity refers to the hospital’s ability to accommodate the patient.
If the hospital lacks the capability or capacity necessary to stabilize the patient’s EMC, it must provide for an appropriate transfer to a facility that does have capability and capacity. A hospital that receives a request to accept the transfer of a patient with an EMC must accept the patient if it has the requisite capability and capacity. The determination that a patient has an EMC that requires stabilizing treatment is made by the physician at the patient’s bedside, and the lack of capability or capacity is made by the transferring hospital. Receiving hospitals that second guess the transferring hospital’s representation that a patient has an EMC requiring stabilizing treatment that the transferring hospital cannot provide because it does not have the capability or capacity do so at their peril.
Penalties for violations by hospitals or physicians include significant fines and the loss of Medicare and Medicaid provider status. In addition, both hospitals and hospitals and physicians can be sued for damages by any person injured by a violation.
Notwithstanding, inappropriate transfers, referred to as “patient dumping,” sometimes occur, as when a hospital falsely claims it lacks capability or capacity to provide stabilizing treatment to a patient. Transfers that do not comply with EMTALA’s requirements, as well as refusals to accept appropriate transfers (“reverse-dumping”), must be reported to the Agency for Health Care Administration for investigation and, if applicable, the imposition of sanctions against the offending hospitals and physicians.
Being familiar with EMTALA and other emergency access laws is critical for every hospital with an emergency department. As more uninsured patients turn to emergency departments for primary care, hospital administrators will need to carefully review their policies to ensure they are following the letter of the law as they strive to protect the bottom line.
