Title: What is EMTALA? | FAQs | TigerConnect
Headings: What is the Emergency Medical Treatment & Labor Act (EMTALA)?
What is the Emergency Medical Treatment & Labor Act (EMTALA)?
Frequently Asked Questions
Emergency Medical Treatment & Labor Act (EMTALA) Overview
The Basic Concept
How it All Started: The First Case
On-Call Requirements
CMS Recommends to Hospitals
Community Shared Call
Simultaneous Call
Scheduled Elective Surgery
Medical Staff Exemptions
EMTALA FAQs
Who decides if the on-call specialist has to come in to see a patient?
If your Hospital has “specialized capabilities” does your Emergency Department have to accept a transfer from a hospital that does not have the capabilities?
Can you put a “group or practice” name on the call schedule to show who is on-call?
Can your “admitting” department talk to the patient about if they have insurance or have a co-payment before being seen by an Emergency Room Physician?
Can you evaluate an emergent patient who is under the age of 18 without consent?
Can you tell a patient in the parking lot of your hospital that is suspected to have EBOLA that they must go to an EBOLA approved treatment facility before being evaluated?
Can you use Telemedicine to evaluate an Emergent patient?
If your Emergency Department is on diversion for Neurology, and a patient shows up at your facility with a possible Stroke can you immediately transport them without an evaluation to another facility?
If you are the on-call physician do you have to evaluate an emergent patient that you have a restraining order against?
If you are on-call at two hospitals can you ask that the patient be transferred to the facility that you are currently working at?
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Content: Emergency Medical Treatment & Labor Act (EMTALA) Overview
In 1986, Congress enacted the Emergency Medical Treatment & Labor Act (EMTALA) to ensure public access to emergency services regardless of ability to pay. Section 1867 of the Social Security Act imposes specific obligations on Medicare-participating hospitals that offer emergency services to provide a medical screening examination (MSE) when a request is made for examination or treatment for an emergency medical condition (EMC), including active labor, regardless of an individual’s ability to pay. Hospitals are then required to provide stabilizing treatment for patients with EMCs. If a hospital is unable to stabilize a patient within its capability, or if the patient requests, an appropriate transfer should be implemented. The Basic Concept
Hospitals that participate in the Medicare program must provide a medical screening exam to determine if the patient is in an emergency medical condition (EMC) and if so must be provided stabilizing treatment or transfer: Provided to any person who comes to the ED requesting emergency services
Passed to prohibit hospitals from denying care to women in labor
How it All Started: The First Case
January 28, 1985, Eugene Barnes, a 32-year-old male presented to Brookside Hospital Emergency Department in California • Mr. Barnes had a penetrating stab wound to the scalp and the on-call Neurosurgeon refused to come to the hospital • ED physician called 3 other hospitals who also refused to take Mr. Barnes • SF General accepted the transfer 4 hours after initial presentation • Mr. Barnes died. On-Call Requirements
Hospital must maintain a list of physicians who are on-call
The hospital has to keep the list of physicians who are on-call to provide necessary treatment to stabilize a patient with an Emergency Medical Condition
This on-call requirement applies to hospitals without an ED if they have specialized capabilities (Ortho Hospital)
Staff must be aware of who is on-call including specialists and sub-specialists
The on-call list must be composed of physicians who are members of the medical staff and who have hospital privileges
ED physician can call the on-call physician for consultation and the on-call physician does not have to show up if not requested
The hospital has direct liability (not vicarious liability) if harm comes to a patient due to a failure of the on-call system to work
Physicians who are on call are not representing their office practice when they are on call, they are representing the hospital
The on-call physician must immediately be required to notify the ED or hospital promptly if he or she becomes unable to respond when on call
CMS does not have a specific requirement regarding how frequent physicians have to be on call
CMS uses the “relevant factor test”
This would include a number of physicians on the medical staff, other demands of physicians, number of times requiring stabilizing services of the on-call physician, vacations, and conferences –
Hospital does a significant number of cardiac catheterization and holds itself out as a center of excellence so CMS would expect 24-hour coverage
CMS Recommends to Hospitals
Have an On-Call policy
Clearly delineate the responsibilities of the on-call physician to respond, exam, and treat
Address the steps to follow if an on-call physician can not respond due to circumstances beyond their control
Clarify that if the on-call physician is requested to come to the ED and refuses, it is a violation against both the physician and the hospital
Clarify that it is a violation if the physician refused to come within a reasonable time
Community Shared Call
If the hospital participated in the community call must include the names of the physicians pursuant to this plan
Hospitals need to provide sufficient on-call physicians to meet the needs of the community
The plan for community call must clearly articulate which on-call services will be provided and when
Sending the hospital must still conduct a medical screening examination and stabilize within its capability and capacity if the patient has an emergency medical condition
Hospitals participating in the community call plan must still accept appropriate transfers from hospitals not participating in the plan
All Medicare-participating hospitals must fulfill their EMTALA obligation whether participating in a community call plan or not
EMTALA does not apply to pre-hospital setting or paramedics in the field but good to educate them on this
Updates to the community call plan must be communicated to EMS providers so they include the information in their protocols
Simultaneous Call
Hospitals can permit physicians if they want to be on call at two or more facilities
Hospitals have to be aware and agree to this
Hospitals must have a policy and procedure on this
Staff will follow the written policy and procedure if on-call is not available when called to another hospital
Back up plan might be to transfer the patient to the next appropriate hospital
Scheduled Elective Surgery
Hospital can decide if they will allow on-call physician to do elective surgery or elective procedures
Hospitals need to have policy and procedure on this
Hospital must have back up plan in case on-call physician is not available
Medical Staff Exemptions
No requirement that all the physicians on the MS must take call
For example, a hospital may exempt a senior physician (over 60) or physicians who have been on the staff for over 20 years
However, can not permit physicians to selectively take call
Hospital needs to ensure adequate call schedule
EMTALA FAQs
Who decides if the on-call specialist has to come in to see a patient? The Emergency Room physician who has eyes on the patient EMTALA places the decision power with the physician with eyes on the patient. The response is not negotiable or debatable.