EMTALA Act

The Emergency Medical Treatment and Active Labor Act (EMTALA Act) was passed by the U.S. Congress in 1986 to prevent hospitals from rejecting, refusing, or transferring patients because they are unable to pay or because they have public health insurance.

The main purpose of EMTALA Act is to ensure nondiscriminatory patient access to emergency medical care and to prevent the transfer of uninsured patients from private to public hospitals without consideration of medical condition or clinical stability.

Although the act has historically been associated with care in the emergency department, it is important to realize that EMTALA Act imposes three specific legal duties on the entire hospital, including the intensive care unit (ICU).

First, hospitals must perform a screening examination on any person who comes to the hospital to evaluate whether he or she has a medical emergency.

Second, if an emergency medical condition exists, hospital staff must stabilize the patient to the best of their capabilities and transfer the patient to another hospital if specialized care is needed and not available at their own institution.

Finally, hospitals with specialized capabilities are required to accept patient transfers if they have the capacity to care for them.

Intensive care unit management can be provided at most hospitals, but certain circumstances may necessitate specialty care (e.g., burns, trauma, neonatal ICU) that requires transfer of the patient to another institution. In this case, the referring physician is obliged to first stabilize the patient.

If the medical benefits of transfer outweigh the medical risks, then the physician should effectively communicate results and treatment and transfer the patient to an accepting facility with the capability to treat the patient’s condition.

Although not required by EMTALA Act, it is often a good idea to follow up with the accepting physician after the transfer has occurred to ensure proper continuity of care.

The accepting physician in the ICU of a tertiary care center also has obligations under EMTALA Act rules and must have a good working knowledge of his or her specific ICU with regard to capacity (beds and staffing) and capability. A patient should not be accepted if the ICU is full.

A transfer for high-frequency oscillatory ventilation, extracorporeal membrane oxygenation, or continuous renal replacement therapy should not be accepted if an ICU does not have these specific capabilities immediately available.

This may sound trivial, but mistakes like these happen and compromise patient care. If beds and staffing are available and the ICU can provide for a stabilized patient requiring specialized care, then not only it is appropriate, but it is also required by law to accept the patient.

Again, it is fitting to provide relevant follow-up information regarding the transfer or the patient’s condition to the referring physician. Many hospital systems have a physician access line to help facilitate this process.

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