EMTALA, Federal Emergency Medical Treatment and Active Labor Act

This is a complex rule finalized in its current form in 2003, which is posted , compared to proposed regulations, and commented on at the preceding links.

This applies if the patient's treatment was given in the hospital, and covers all physicians as they deliver care in an emergency setting. This includes call coverage. The fine can be $50,000 per violation.

The rules go into effect when a patient presents in a hospital covered area or dedicated emergency room and requests service, has is requested by someone, or a prudent layman would believe there is a need. When a patient presents for non-emergency service, a screening procedure would need to be done to determine first if EMTALA could apply.

It does not apply in a non hospital setting, such as a nursing home, ambulatory care center, or your office. If your office is attached to or in a hospital it still does not apply there. It does not apply to non medical facilities in the hospital. But a patient in the hospital lobby with an emergency condition could be covered by EMTALA. Furthermore if a patient has an emergency condition in the parking lot or other grounds within 250 yards of the main building it applies.
It is also constrained by what kind of care the patient is getting, for example if the patient is in a scheduled outpatient visit which has started it does not apply.

EMTALA requires services offered in the hospital to be offered in the Emergency Room. The ER physician wtih the patient has the responsibility for decision making in any question about whether a physician they consult should come in to see the patient.

Regarding transfer, the focus is on patients who are not stable, and once a patient is stable they are not covered by EMTALA. Patients can be transferred if they are stable, or if an unsolicited request for transfer is received. Thus the physician cannot request transfer but the patient can.

EMTALA terminates once a patient is admitted.

 

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