Examples of EMTALA Violations: Meaning & Examples

Examples of EMTALA Violations

Before seeing a doctor, a patient is usually asked to submit payment and insurance information. But emergency rooms are special places; no matter how wealthy or how insured, everyone who has an emergency needs to be treated or stabilized. A federal legislation called the Emergency Medical Treatment and Labor Act (EMTALA) provides the patient protection that makes this possible. Since many patients wouldn’t receive care otherwise, emergency physicians are steadfast in their commitment to helping everyone who needs it. Unfortunately, a significant amount of the care given by emergency physicians is underpaid or uncompensated, which frequently results in the doctors suffering unrecouped losses that make their already challenging jobs even more complex and resource-constrained. This post guides you through the meaning and examples of EMTAlA Violations among others.

Examples of EMTALA Violations: What is EMTALA?

Congress enacted EMTALA in 1986 as a component of the 1985 Consolidated Omnibus Budget Reconciliation Act (COBRA) (42 U.S.C. §1395dd).

The purpose of EMTALA is to stop hospitals from sending Medicaid or uninsured patients to public hospitals without first making sure the patients are stable enough for the transfer if not more.

According to this law, emergency departments in Medicare-participating hospitals must screen and treat patients’ emergency medical issues in a non-discriminatory way, regardless of their financial situation, insurance status, race, creed, or color.

What Is an Emergency According to EMTALA?

A medical emergency is characterized by acute symptoms that are severe enough (including excruciating pain) that it is reasonable to assume that if treatment is not received right away, the patient’s health [or the health of their unborn child] could be seriously jeopardized, their bodily functions could be seriously impaired, or their organs could seriously malfunction.

What Is the Scope of EMTALA?

The law states that when a person visits an emergency department, EMTALA is applicable.

A dedicated emergency department, according to CMS, is a section of the hospital that is staffed and equipped with specialized equipment and is used primarily for the initial assessment and care of outpatients with urgent medical issues. This implies, for instance, that hospital outpatient clinics that don’t have to manage medical crises are exempt from EMTALA requirements and are free to direct patients seeking care to an adjacent emergency department.

Provisions of EMTALA

If a doctor refuses to treat a patient who presents with an emergency medical condition or does not assist in the patient’s appropriate transfer if the hospital is unable to stabilize the patient’s condition, they may face consequences.

Under EMTALA, hospitals have three primary responsibilities:

  • To ascertain whether an emergency medical issue exists, everybody who comes and requests must undergo a medical screening examination. It is not possible to postpone medical examinations and treatments to discuss financial options or insurance coverage. Emergency departments must display notices stating patients’ and visitors’ rights to medical screening assessments and treatment. It may be illegal to post signs that discourage people from getting emergency care under the EMTALA.
  • If there is an emergency medical issue, care must be given until it is stabilized or addressed. An “appropriate” transfer of the patient to another hospital in compliance with EMTALA regulations is of need if the hospital is unable to treat the emergency medical condition.
  • Hospitals that are not equipped to handle unstable emergency medical conditions must accept transfers from hospitals with specialized skills.

Anytime a hospital has grounds to suspect it may have received a patient who was transported from another hospital in violation of EMTALA in an unstable emergency medical condition, it must notify CMS or the state survey agency.

Requirements for Transferring Patients under EMTALA?

EMTALA regulates the guidelines for patient transfers between hospitals. The patient becomes stable for transfer under the law if the treating physician determines that there will not be any significant decrease during the transfer between facilities.

Transfers of stable patients are exempt from EMTALA, while transfers of unstable patients must occur unless:

  • A doctor attests that the anticipated medical advantages of the transfer outweigh the hazards OR
  • After becoming aware of the dangers and the hospital’s responsibilities under EMTALA, a patient files a formal transfer request.

Furthermore, the transfer of unstable patients needs to be “appropriate” according to the law. This means that the transferring hospital needs to: (1) Provide copies of medical records. (2)Confirm that the receiving facility has the space and qualified personnel to treat the condition and has agreed to accept the transfer. (3) Make sure the right medical equipment and competent employees are in use during the transfer.

Case Examples of EMTALA Violations

Below are some examples of EMTALA violations:

Neglecting to perform an EMC screen

In 2018, an Alabama hospital and the OIG reached a settlement of $80,000 over claims that the hospital had neglected to offer stabilizing treatment and sufficient medical screening. A 35-year-old male patient, accompanied by his fiancée, arrived at the emergency department with shortness of breath and chest pain.

When a nurse questioned the patient about why he wanted to see a doctor, the guy became combative. As a result, security had to accompany the patient from the emergency department. The patient went back to the ED a few minutes later.

This time, the patient’s girlfriend informed the ambulance bay as she pulled up that the patient had passed out and was unconscious in her truck. The staff told her they would not assist in getting the patient out of the truck. The security guard also informed her that she needed to depart.

After the patient’s girlfriend brought him to another hospital, he was declared dead 20 minutes after arriving.

Inability to use EMC to stabilize a patient

A Tennessee hospital and the OIG reached a $25,000 settlement over claims that the facility neglected to stabilize an EMC for a 58-year-old patient who came to the emergency department (ED) with dizziness and impaired vision. An ED nurse failed to stabilize the patient’s EMC, a brain infarction and instead sent the patient to a nearby eye specialist after failing to deliver an acceptable EMC.

The hospital did not accept a patient with EMC for transfer.

The OIG and Tennessee Hospital “B” did a settlement of $40,000 on allegations that the hospital was unable to accept an eligible transfer. A 13-year-old boy complained of testicular pain when he arrived at Hospital “A.” The right testicle showed no signs of blood flow, according to an ultrasound.

The patient’s transfer to Hospital “B” was requested by the ED. The patient’s transfer was rejected by Hospital “B’s” on-call urologist, who suggested the patient be moved to a different hospital.

The OIG reports that Hospital “B” denied the appropriate transfer, despite its ability to stabilize the patient’s emergency medical condition.

Unsuitable Patient Transfer Involving EMC

2018 settlement deal with the OIG for claims that it improperly moved a patient to a different hospital.

A 58-year-old lady reported left-sided pleuritic chest and pain upon arriving at the ED of Hospital “A” via private vehicle.

Upon examination, an ED doctor saw that the patient had a diffusely firm abdominal wall and hypoactive bowel noises. The patient had increased lactic acid, hemorrhage, and clotting times, according to blood samples. The patient’s chest X-ray revealed a significant amount of intraperitoneal air under the right diaphragm, which could suggest bowel perforation.

After speaking with the on-call surgeon about the patient’s condition, the emergency department physician suggested that the patient be moved to Hospital “B,” where she had had a dilation and curettage treatment two days prior. Hospital “B” requested that the patient be airlifted to its location and accepted the transfer.

The patient was moved in serious condition to Hospital “B” three hours and forty-seven minutes after arriving at Hospital “A.” The patient was in septic shock and danger of respiratory collapse when they arrived at Hospital “B.” The patient’s condition deteriorated even after emergency surgery to repair a gastrointestinal perforation and the next day she died.

Examples of EMTALA Violations: FAQs

Which EMTALA infractions are the most frequent ones?

Refusals to stabilize patients as soon as possible are frequently the result of delayed patient visits. Rejecting the patient because it appears that their needs are beyond the doctor’s area of expertise. Physicians must provide care within the bounds of their privileges under EMTALA, not their typical scope of practice.

What does California’s Emtala law entail?

If a hospital delays a medical screening exam or stabilizing therapy for a patient, or if it refuses to allow EMS personnel to leave the patient once the patient arrives, then the hospital is violating EMTALA.

What is the meaning of stable condition?

The patient’s vital signs are within normal ranges and they are steady. They most usually reside in an ordinary ward, not an intensive care unit or a high dependency unit.

Examples of EMTALA Violations: Conclusion

In obstetric and psychiatric instances, there is frequently a violation of the EMTALA legislation, which establishes the fundamental needs of screening, stabilization, and appropriate transfer. The statute’s cryptic language emphasizes the need for screening and stabilizing consultations with obstetricians or psychiatrists, but it does not define the infraction. Hospital care staff need to regularly update their EMTALA proficiency. Healthcare providers and hospitals should keep up their education on EMTALA’s requirements.

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