EMTALA establishes three primary requirements for hospitals with emergency departments: performing a medical screening examination for anyone requesting treatment, providing stabilizing treatment for emergency medical conditions and labor, and restricting transfers unless the patient's emergency condition is stabilized. It aims to prevent patient dumping by ensuring access to emergency medical care regardless of ability to pay. Hospitals and physicians can face civil monetary penalties and exclusion from Medicare/Medicaid for EMTALA violations.

1. EMTALA

2. Three primary requirements for
EMTALA
o Performance of a Medical Screening Examination
o Provide necessary stabilizing treatment for Emergency
Medical Conditions and Labor
o Restricting transfers unless Emergency Medical
Condition is stabilized

3. Performance of Medical Screening
Examination
o If any individual comes to the emergency department and
request is made on the individual’s behalf for examination
or treatment for a medical condition, the hospital must
provide appropriate medical screening examination within
the capabilities of the hospital’s emergency department
(including ancillary services routinely available to the
emergency department) to determine if an emergency
medical condition exists.

4. Providing Necessary Stabilizing Treatment for
Emergency Medical Conditions and Labor
o If any individual comes to a hospital and the hospital
determines the individual has an emergency medical
condition
o The hospital must provide either:
• The staff and facilities to provide such further
examination & treatment to stabilize the
medical condition
OR
• Transfer the individual to another facility in
accordance with regulations

5. Emergency Medical Condition
defined:
o A medical 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 health of the
individual (or, with respect to a pregnant woman, the
health of her unborn child) in serious jeopardy; risking
serious impairment to bodily functions; or risking serious
dysfunction of any body organ or part.

6. Payment Inquiries
o Medical screening and/or stabilizing treatment may not
be delayed in order to inquire about the patient’s method
of payment or insurance status.
o Requesting a patient to sign a conditions of admissions
form which contains an agreement for payment (but not
an inquiry as to payment source) is acceptable so long as
medical screening and/or stabilizing treatment are not
delayed and are provided even if patient refuses to sign.

7. Important Definitions – On Call
Physicians
o If emergency room physician determines an on-call
specialist physician’s services are necessary and an on-
call physician is notified and fails or refuses to appear
within a reasonable time, and transfer is ordered – the
hospital and on-call physician are at risk for an EMTALA
violation
• NOTE: The emergency room physician ordering transfer will
not be subject to civil money penalties.

8. On Call Physicians
CMS says:
o An EMTALA violation subjects the hospital and on-call
physician to civil money penalties and termination from
the Medicare and Medicaid programs.
o If physician schedules elective surgery or other elective
procedures while “on-call”, physician must make
arrangements to satisfy the “on-call” obligations.

9. On Call Physicians (at a Receiving
Facility)
o On-call physicians should neither accept nor decline a
transfer. The decision to either accept or decline a
transfer will be made by the House Supervisor. The
House Supervisors have been trained to make decisions
in accordance with EMTALA.
o It is appropriate for on-call physicians at a receiving
facility to discuss matters with transferring facility staff
such as the patient’s clinical condition and the
management the patient is likely to require.

10. “Appropriate Transfer”
o Transferring hospital provides medical treatment within its
capacity which minimizes the risks to the individual
o Receiving facility has available space and qualified personnel
to treat the individual and has agreed to accept the transfer
o Transferring hospital sends all medical records
available, including name and address of any on-call physician
who refused or failed to appear when called
o Transfer is effected through qualified personnel & equipment

11. Duties of Receiving Hospital
o A hospital that has “specialized capabilities or facilities”
(i.e., the ability to provide a higher level of care) may not
refuse an “appropriate transfer” if –
• The individual being transferred requires the “specialized
capabilities or facilities”; and
• The receiving hospital has the “capacity” to treat the
individual
• Having the “capacity” means a bed available and staff to
provide care to the patient.

12. Capacity
o Capacity means the ability of the Hospital to
accommodate the individual requesting examination or
treatment of the transferred individual.
o Capacity encompasses such things as numbers and
availability of qualified staff, beds and equipment and the
Hospital’s past practices of accommodating additional
patients in excess of its occupancy limits.

13. Receiving Hospital
o Receiving Hospital must defer to the judgment of the
transferring Hospital if representation is made that patient
needs treatment that receiving Hospital is able to provide.
That is, if in doubt, accept the transfer.
o If a Receiving Hospital has a bed available and an
appropriate specialist on call, the receiving Hospital is
obligated to accept transfer.

14. Duty to Report Inappropriate
Transfer
o A receiving Hospital that receives what it believes is an
inappropriate transfer is obligated under Federal
regulations to report the transferring Hospital to CMS.
o The report is to be made within 72 hours after receiving
the inappropriate transfer. This is NOT optional.

15. EMTALA
o EMTALA is a federal statute. A hospital or physician
cannot refuse to accept transfer of patient from another
state if receiving hospital has capacity to treat.
o Hospital’s obligations under EMTALA end once an
individual is admitted for inpatient care.

16. On Call Physician Liability
o EMTALA provided two penalties against physicians who
commit a violation:
• Civil Money Penalties of $50,000 per violation against any
physician who is responsible for examination, treatment, or
transfer of an individual, including an “on-call physician”
• If violation is “gross”, “flagrant” or
“repeated”, physician may be excluded from Medicare and
Medicaid programs.

17. Penalties for Hospitals
o Civil Money Penalties of $50,000 per violation ($25,000
for hospitals with fewer than 100 beds)
o Termination of Medicare/Medicaid provider agreements

18. Hospital Dilemmas
o Must enforce on-call physician responsibility
o If Hospital condones activity of non-compliant
physicians, it is exposed to EMTALA liability.

19. EMTALA
o The federal law that created the patient stabilization and
transfer requirements for hospitals and physicians.
Also known as: “patient dumping law”, EMTALA, and
“patient treatment law.”