Emergency Medical Treatment & Labor Act (EMTALA) Requirements


This paper outlines The Emergency Medical Treatment & Labor Act (EMTALA), related cases and regulations about the same and the extent to which hospitals in the U.S. are meeting these set rules. This information has been gathered through secondary data or desktop research. It has been derived from books and previous publications by authors acknowledged in the text. This study shows that the American Congress over the years has strived to implement and enforce the EMTALA. This Act was implemented to ensure that every citizen has access to emergency medical treatment regardless of their status or social, economic class. A surprising result, however, indicates that despite stiff penalties being put in place in some regions, some hospitals still fail to meet this minimum requirement. Statistics shows that there has been an increase in the number of hospitals that pay penalties for failing to comply with these laws. Introduction

The Emergency Medical Treatment & Labor Act (EMTALA) was passed in 1986 by the Congress to ensure that the public accessed emergency services irrespective of their ability to pay. EMTALA necessitates hospitals that have emergency departments to give medical screening examination to all people who come to the emergency units and requests for such examinations. It prohibits hospitals with emergency units from declining to examine or give treatment to individuals with an emergency medical situation. A hospital with an emergency department is defined as one with a dedicated emergency department.

This paper will analyze the compliance of health care facilities with EMTALA requirements.

Legal Information and Related Cases, Statutes, Regulations about EMTALA

The Cleland vs. Bronson Health Care Group, Inc., 917 F.2d 266, 271 (6th Cir. 1990) Case:

This case arose from highly exposed incidents where hospitals with emergency units failed to provide screening to patients who would have otherwise been treated due to their financial inadequacies. They also discharged or transferred patients without putting in place measures that would have been given to a paying patient. Congress was dissatisfied with the outcome of the laws that had been put in place for hospitals that got funds from the government under the Hill-Burton Act. They therefore saw it fit to fit that perceived evil by enacting a law Preventing Patient Dumping.

The Reynolds vs. Mainegeneral Health, 218 F.3d 78 (1st Cir. 2000) Case:

Once again, Congress enacted EMTALA in 1996 in the wake of increasing number of cases that hospital emergency units are refusing to accept and treat patients with emergency conditions due to lack of medical covers. EMTALA fashioned a solution for patients in specific contexts where a claim was not available under the state medical practice law. Although the clear scope of rights guaranteed to patients with an emergency is still not completely described, the intent for the Congress to push for all patients to be treated equally upon arrival in the emergency units of a hospital was clear. They fought so that patients who are in need of emergency treatment would at minimum get the 1st response and get turned away.

With reference to Baber vs. Hospital Corp. of America, 977 F.2d 872, 880 (4th Cir. 1992), it is clarified that EMTALA's purpose was neither to assure that each and every patient is diagnosed properly nor to ensure that they received adequate medical care but was to give, at least, an adequate first response to people in a medical crisis. They advocate that all Americans, regardless of their status or wealth, would be assured that a hospital would give them the services it can in moments of emergency physical distress.

The Congress further argued that since Mr. Reynold's was already in a hospital room getting treatment for injuries he had acquired; it would be illogic to deny him further treatment that would arise from failures in treatment or misdiagnosis.

Benchmark information for determining hospitals' compliance to EMTALA

A hospital is considered to comply to EMTALA when it:

  1. Provides medical screening examination to all their patients that come to their premises – this provision requires hospitals to accept and give the first screening to patients for come to its premise even when not scheduled and regardless of their ability to pay
  2. Provides stabilizing care – this means that the hospital should ensure that the patient is not rationally at risk to deteriorate in the process of, or following discharge or transfer. Also, a pregnant female undergoing contraction is not considered stable legally until she has delivered the baby and the placenta
  3. Does not relocate a patient who is rationally unstable if the hospital has the physical capacity or capability to treat the patient. Transfer of patients is ideally required to be a last resort.
  4. Provides a help line system to help patients who are stabilizing – the 2003 regulations requires that hospitals will have a properly call list to ensure that their patients are advised and checked upon until they fully recover
  5. When a patient is transferred due to a medical necessity, the hospital is required to provide medically appropriate transfers – for example, a physician is required to be on board during such transfers, transfers to be done by appropriate medical transfer vehicles and after the patient or a relative has authorized the transfer to be done
  6. Take requests for incoming transfers – if a hospital has specialized competencies needed by a patient, and the hospital transferring the patient is less able to take good care of the patient, it is required to agree to that transfer. The hospital can, however, reject a transfer request where they feel that the incoming patient is not in dire need of their services.

Extent to which facilities are not compliant

Though publications by the U.S. Department of Health are scarce, a group of emergency researchers who evaluate violations against EMTALA have established that citations of complaints about the past decade have increased by over 10 percent. These violations have led to the U.S. Department of Health and Human Services Appeals Board to impose a maximum fine of $ 50,000 on St. Joseph's Medical Center in Stockton.

There is a very low risk of having to pay the EMTALA violation fine, but it seems to be gradually increasing. In the 1990s, only one out of four hospitals cited for violations paid the fine. However, in 2001, one out of three hospitals cited for violation of the EMTALA Act paid the fine.


Though the EMTALA is a noble initiative by the U.S. Congress, it is yet to be adopted by some hospitals. Different reports by various medical emergency researchers indicate that many hospitals still do not comply with this statute. As it may be known, as much as hospitals are opened to benefit the community, there is also the profit making concept. A hospital requires money to operate, hence the drawback in providing free emergency and even transfer services to any patient who visits their promise. It is important for the Congress to educate people on the importance of having medical cover to safeguard oneself in case of an emergency. If the emergencies were few, it would be easier for hospitals to adhere to these rules than the current situation where hospitals feel that people are taking advantage of EMTALA.

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