Emergency Medical Treatment And Active Labor Act: A Case Study

Since the development of the EMTALA Act in 1986, any individual which presents to the emergency department, must be accessed and triaged by qualified medical personnel. (www.cms.gov) Individuals are aware that if they present to the emergency department, regardless if it is for just a tooth ache or a major illness like a heart attack, they will have to be treated. “This mandate does not extend to private physician offices, however, which creates an incentive for those without the means to pay for care to

The Emergency Medical Treatment and Active Labor Act (EMTALA) was enacted in 1986 as a part of the Consolidated Omnibus Budget Reconciliation Act (COBRA) of 1985. EMTALA was enacted to prevent hospitals with Emergency Departments from refusing to treat or transferring patients with emergency medical conditions (EMC) due to an inability to pay for their services. This act also applies to satellite locations whom advertise titles such as “Immediate Care” or “Urgent Care,” and all other facilities where one-third of their patient intake are walk-ins. Several rules and regulations to this act have been established and it has become a very serious piece of legislation and health

hospitals receive a huge amount of funding from the state. As a result, they have been able to

In 1986, Congress enacted the Emergency Medical Treatment & Labor Act (EMTALA) to ensure public access to emergency services regardless of a person’s ability to pay. The law's initial intent was to ensure patient access to emergency medical care and to prevent the practice of patient dumping, in which uninsured patients were transferred, solely for financial reasons, from private to public hospitals without consideration of their medical condition or stability for the transfer. EMTALA is considered one of the most comprehensive laws guaranteeing nondiscriminatory access to emergency medical care and to the health care system.

The Emergency Medical Treatment and Active Labor Act (EMTALA) is a law enacted by Congress to ensure individuals could receive emergency medical treatment without regards to their ability to pay. It applies to all hospital that have emergency departments and participate in Medicare. EMTALA requires hospitals that fall under the conditions stated above to conduct an appropriate medical screening to determine if an emergency medical conditions exists. If it is determined that an emergency medical condition exists, the hospital has two options under EMTALA, one it can provide medical treatment to the patient, or two they may transport the patient to another facility so long as the transfer meets all transfer requirements under federal law.

Raised since 1985 and even more to generate the Emergency Medical Treatment and Active Labor Act (EMTALA) by Congress in remedy to its torts, patient dumping still appear to be an issue in our society today. In fact, patient dumping occurs when hospitals deny treatment to emergency patients -- often because those patients can't pay. As Patient dumping is the practice of refusing to treat patients who cannot pay for healthcare services. Federal anti-dumping law, initiated by Congress as part of the Consolidated Omnibus Budget Reconciliation Act of 1985, was designed to reverse a disturbing trend among hospital emergency rooms that either

"I would see patients transferred with knives still in their backs, or women giving birth at the door of the hospital, simply because they were uninsured" recalled Dr. Ron Anderson, the former president and CEO in the 2010s and emergency department medical director in the 1980s of Parkland Memorial Health and Hospital System in Dallas, Texas. Anderson witnessed many cases of “dumping” throughout his time as director and similar events occurred at emergency departments across the country (Friedman, 2011). In 1986, the bill entitled the Emergency Medical Treatment and Labor Act (EMTALA) was enacted under the Reagan Administration as part of the Consolidated Omnibus Budget Reconciliation Act (COBRA) to not only prevent hospitals

There are several legal cases that have been documented in United States in which uninsured patients are either denied of care in hospitals or are charged more than insured patients. All these issues brought about the existence of Emergency Medical Treatment and Active Labor Act (EMTALA). The implications of the Roberts v Galen of Virginia case are that the case would not be successful because the plaintiff does not have enough evidence to prove that the patient was recommended for a transfer due to financial considerations or an improper motive such as the patient’s insurance status, race, sex, etc. The case demonstrated that:

No, even though hospitals are obligated to provide a medical exam and stabilizing treatment for anyone that comes to the ED during a disaster; the facility is only requires to provide services within their capabilities. Under EMTALA, if an individual’s condition requires immediate stabilizing treatment and the hospital do not have the capability to stabilize the individual, then the individual should be appropriate transfer to another hospital for medical care. Transferring a patient because the hospital cannot provide stabilizing treatment is a violation of EMTALA (Gravely, Whaley, & Sanders 2007).

I learned this week that in Humble, Texas, a city 10 miles northeast of Houston, TX that there are free standing emergency rooms that aren’t attached to hospitals, but are targeted for patients that are privately insured. “ASCs are paid about 50 percent of what hospitals are paid for the same procedure. Hospitals argue that this extra payment is in exchange for all the other things that hospitals do (e.g., trauma and specialized care, uncompensated care, etc.) and is necessary for hospital financial survival. Physicians and providers assert that these subsidies are unfairly beneficial to hospitals and subsidize hospitals' ability to employ physicians and move business to hospitals” (Becker, 2012). There are facilities that are called Texas Care Emergency Centers that are, “a facility that feels like a Western lodge with its earth-toned brick walls, leather chairs and coffee bar” (Galewitz, 2013).

For one reason or another hospitals are closing their doors. In this paper we will look at how the downsizing of hospitals is affecting medical care in the United States. Why have some of these hospitals closed?

Most of you who are reading this, are here because you live, breathe, and bleed Emergency Medicine. EM offers the perfect mix of patients, procedures, and adrenaline. Unfortunately, not all parties involved do it for the love of Emergency Medicine. While EM may be one of the youngest specialties, its short history is rife with conflict pitting hospitals against Emergency Medicine practitioners in the form of Contract Management Groups (CMGs) 1. For an excellent history lesson as told by James Keaney, MD MPH FAAEM, the first president of AAEM, we highly suggest that every medical student and resident interested in EM read The Rape of Emergency Medicine 2.

The Stand Alone ER "The Rapid Evolution of Health Care" By Steve Okhravi, MD, MBA, CPE July 16, 2012 Emergency care in the US is at a breaking point. Per data from The Institute of Medicine, over 1000 hospitals closed in the past few years because of the enormous cost associated with operation. There has been an increase in the number of visits to emergency rooms (ERs) to more than 120 million mostly due to those who are uninsured who, as a result, have a lack of access to primary care. As the number of those who are uninsured grows because of the recession so, too, does the community who turns to ER services for their health care needs. Clearly, ER provides a safety net for the medically underserved.

EMTALA applies to the hospitals or providers that get reimbursed by Medicare. Almost every hospital or provider accepts Medicare in the United States. Under the EMTALA statues, the provider has a duty to render an appropriate medical screening examination to the patient in distress and necessary treatment or reasonable care to stabilize the patient’s emergency medical condition. If the patient’s chest pain is not determined as an emergency medical condition based on an appropriate examination, no further obligation is imposed on the provider by EMTALA. The same examination or procedure should be applied to all patients with similar circumstances. If the patient declines an appropriate medical screening examination or treatment, the provider is required to document the refused examination or treatment and make reasonable efforts to obtain a written informed refusal.

To prevent the spread of infection anyone who encounters a patient is required to wash their hands. In the film hand washing stations were not shown to be present in patient rooms and there were no signs that encouraged hand washing. Hand washing also protects the healthcare provider from contracting a condition from the patients he or she treats. In addition, patients that include: small children, elderly with problems walking, elderly who have a history of falling, and those who are on medication that can impair the ability to walk should be labeled as fall risks. The medical beds shown in the movie do not have railings and there are no arms bands to show that the patient is a fall risk. Falling out of a medical bed when in recovery can cause serious injury or the fall can cause new conditions that need medical attention. Furthermore, forcing a patient to leave medical care due to not having insurance is not only morally wrong, it is a violation of the Emergency Medical Treatment and Active Labor Act (EMTALA). CMS wrote, “in 1986, Congress enacted the Emergency Medical Treatment & Labor Act (EMTALA) to ensure public access to emergency services regardless of ability to pay” (Emergency Medical Treatment & Labor Act (EMTALA), 2012). As a result, the CMS detailed standards and processes for stabilizing patients and what qualifies as an emergency. According to the American College of Emergency