Emergency Physicians’ Duty to Care for Anyone, Anytime
A patient is typically required to provide insurance and payment information before seeing a doctor. But, emergency departments are unique—anyone who has an emergency must be treated or stabilized, regardless of their insurance status or ability to pay. The patient protection that makes this possible is a federal law known as the Emergency Medical Treatment and Labor Act (EMTALA).
Emergency physicians are firmly committed to providing care for everyone who needs it, otherwise many patients would go without treatment.
But a large portion of the care provided by emergency physicians goes uncompensated and under-compensated, frequently leaving the doctors with unrecouped losses that add layers of complexity and resource constraints to an already difficult job.
EMTALA and Reproductive Health
The overturning of Roe v. Wade creates worrisome ambiguity around physicians’ duty to patients under EMTALA. New state laws that restrict access to reproductive health care or services could directly conflict with existing federal EMTALA obligations to provide care, which could put emergency physicians in an impossible position where they must choose between their patient’s health or their own exposure to liability, which in some states could be criminal charges.
Emergency physicians are working to untangle and assess the vast implications and worrisome ambiguity resulting from the Supreme Court’s decision.
Emergency physicians are currently analyzing medical liability, medical record and personal health data security, and other areas of uncertainty to develop recommendations to help address gaps in regulations or statutes that could create clinical and legal barriers to how emergency physicians practice emergency medicine.
Find more resources here.
What is EMTALA?
EMTALA was enacted by Congress in 1986 as part of the Consolidated Omnibus Budget Reconciliation Act (COBRA) of 1985 (42 U.S.C. §1395dd).
EMTALA was designed to prevent hospitals from transferring uninsured or Medicaid patients to public hospitals without, at a minimum, providing a medical screening examination to ensure they were stable for transfer.
This law requires Medicare-participating hospitals with emergency departments to screen and treat the emergency medical conditions of patients in a non-discriminatory manner to anyone, regardless of their ability to pay, insurance status, national origin, race, creed or color.
How does EMTALA define an emergency?
An emergency medical condition is defined as "a condition manifesting itself by acute symptoms of sufficient severity (including severe pain) such that the absence of immediate medical attention could reasonably be expected to result in placing the individual's health [or the health of an unborn child] in serious jeopardy, serious impairment to bodily functions, or serious dysfunction of bodily organs."
What is EMTALA's scope?
What are the provisions of EMTALA?
Physicians can get penalized for refusing to provide necessary stabilizing care for an individual presenting with an emergency medical condition or facilitating an appropriate transfer of that individual if the hospital does not have the capacity to stabilize the emergency condition.
Hospitals have three main obligations under EMTALA:
A hospital must report to CMS or the state survey agency any time it has reason to believe it may have received an individual who has been transferred in an unstable emergency medical condition from another hospital in violation of EMTALA
What are the requirements for transferring patients under EMTALA?
How common is uncompensated care?
Uncompensated care should be recognized as a legitimate practice expense for emergency physicians:
What are the penalties for violating EMTALA?