Fed Regulation 2- EMTALA

Question 1

Pre-EMTALA Problems:

Answer 1

No Duty Rule: Doctors not responsible if they refuse to respond to call of person urgently in need of medical assistance
Patient Dumping: Refers to the premature transfer or refusal to care for patients who receive medicare or have no insurance coverage by private hospitals. Himmelstein study found that: 63% of transferred patients did not have insurance at the time of transfer. 21% had Medicaid, 13% had Medicare, and 3% had private insurance coverage. Predominantly male, young, uninsured and minorities.

Question 2

Step 1

Answer 2

Must be a hospital that 1) accepts Medicare; 2) Operates an emergency department

If you are not sure if the treatment facility is “hospital emergency department”, look to agency definitions that rule over the statue or other provisions in the Medicare statute
Any “individual” that comes to an emergency department is entitled to EMTALA protections
Hospitals are required to treat individuals that present experiencing “emergency medical conditions” (prudent layperson standard)

Question 3

Step 2:

Answer 3

Medical Screening Requirement

An individual has to come into the emergency department and a request is made by, or made on the individual’s behalf for examination and treatment for an emergency medical condition. The hospital must provide for an appropriate medical screening examination within capability of the hospital’s emergency department.

Question 4

Steps in Medical Screening:

Answer 4

1) Provider decides, based on initially-available information, what emergency conditions(S) might exist. Errors are NOT EMTALA.
Standard: Judge that by the prudent layperson standard! Patient’s POV

2) Provider must then apply relevant screening protocol for the conditions ID in Step 1
Whether the screening was appropriate: Uniform screening standard → whether a screening would have been performed on a patient in a similar condition

3) Provider must then correctly interpret screening protocol results

Question 5

Step 3: Stabilizing & Transfer Provision

Answer 5

For individuals that come into the emergency dept with an emergency medical condition, the hospital must provide: such examination and treatment as may be required to stabilize the medical condition or transfer to another facility.

Definition of stabilized: Means that no material deterioration of the condition is likely, within reasonable medical probability, to result from or occur during the transfer of the individual from a facility or with respect to an emergency medical condition
Jurisdictions differ on when to transfer

Immediate aftermath of admission: 4th Circuit
No discharge/transfer until patient stabilized: 6th Circuit
Duty ends when patient admitted in good faith: 9th circuit

Question 6

Step 4:

Answer 6

Enforcement

Enforcement by CMS
Private Right of Action → YES, but only to the hospital
Civil Monetary Penalties
CMS can remove hospital or doctor from medicare.