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Monday, April 14, 2014

EMTALA - Emergency Medical Treatment and Active Labor Act

Patient, single male adult admitted through emergency ward at Sacred Heart Medical Center.  Primary physician after reviewing results of MRI advised emergency surgery.  Patient was told by physician that if the condition worsened he could lose total use of his legs and because of where the malfunction was, he could also lose his bowel function.  While waiting for pre-op consultation with surgeon, patient's condition worsened and he was suffering relentless excruciating pain, loss of use of legs and was no longer able to stand.

He was driven to Sacred Heart Medical Center ER and was moved inside with the use of a gurney.  He was admitted to the hospital where the medications for pain, muscle relaxants and anti-inflammatory were administered in heavy doses.  No relief was found.  A second MRI was ordered and confirmed a herniated (ruptured disc) at L5/S1. 

NOTE: Apparently the hospital is attempting to discharge this young man without stabilizing his condition or offering any further help outside of an increasing number and types of medications.  The alleged plan was to have him moved to another facility that is better equipped to handle this emergency however it may be "patient dumping" is imminent due to inability to pay as hospital staff are now saying they have been planning his discharge with no follow up/ referral or relief.  Patient is unable to care for himself.  Further research is warranted.

Items of interest:

 The Emergency Medical Treatment and Active Labor Act (EMTALA)[1] is an act of the United States Congress, passed in 1986 as part of the Consolidated Omnibus Budget Reconciliation Act (COBRA). It requires hospitals to provide emergency health care treatment to anyone needing it regardless of citizenship, legal status, or ability to pay. There are no reimbursement provisions. Participating hospitals may not transfer or discharge patients needing emergency treatment except with the informed consent or stabilization of the patient or when their condition requires transfer to a hospital better equipped to administer the treatment.[1]

 EMTALA applies to "participating hospitals." The statute defines "participating hospitals" as those that accept payment from the Department of Health and Human Services, Centers for Medicare and Medicaid Services (CMS) under the Medicare program.[2] "Because there are very few hospitals that do not accept Medicare, the law applies to nearly all hospitals."[3]
EMTALA's provisions apply to all patients, not just to Medicare patients.[5][6]

Hospital obligations

Hospitals have three obligations under EMTALA:
  1. Individuals requesting emergency care, or those for whom a representative has made a request if the patient is unable, must receive a medical screening examination to determine whether an emergency medical condition (EMC) exists. The participating hospital cannot delay examination and treatment to inquire about methods of payment or insurance coverage, or a patient's citizenship or legal status. The hospital may only start the process of payment inquiry and billing once they have ensured that doing so will not interfere with or otherwise compromise patient care.
  2. The emergency room (or other better equipped units within the hospital) must treat an individual with an EMC until the condition is resolved or stabilized and the patient is able to provide self-care following discharge, or if unable, can receive needed continual care. Inpatient care provided must be at an equal level for all patients, regardless of ability to pay. Hospitals may not discharge a patient prior to stabilization if the patient's insurance is canceled or otherwise discontinues payment during course of stay.
  3. If the hospital does not have the capability to treat the condition, the hospital must make an "appropriate" transfer of the patient to another hospital with such capability. This includes a long-term care or rehabilitation facilities for patients unable to provide self-care. Hospitals with specialized capabilities must accept such transfers and may not discharge a patient until the condition is resolved and the patient is able to provide self-care or is transferred to another facility.

 Emergency Treatment and the Law


Can hospitals turn away patients?

Privately-owned hospitals may turn away patients in a non-emergency, but public hospitals cannot refuse care. Public hospitals, funded by taxpayer dollars, are held to a different standard than privately owned for-profit hospitals. This means that a public hospital is the best option for those without health insurance or the means to pay for care.

The Emergency Medical and Treatment Labor Act (EMTLA)

Public and private hospitals alike are prohibited by law from denying a patient care in an emergency. The Emergency Medical and Treatment Labor Act (EMTLA) passed by Congress in 1986 explicitly forbids the denial of care to indigent or uninsured patients based on a lack of ability to pay. It also prohibits unnecessary transfers while care is being administered and prohibits the suspension of care once it is initiated, provisions that prevent dumping patients who cannot pay on other hospitals. The treatment of indigent and uninsured patients is a huge financial drain upon the health system, especially in areas where no public hospitals are available.
While EMTLA does not prohibit care providers from asking about a patient’s ability to pay, it does make it very clear that emergency treatment cannot be delayed while ability to pay is being checked. Essentially, the law establishes a “treat first, ask questions later” policy. This policy serves a dual purpose by protecting both private hospitals and patients. Private hospitals are protected because they can deny non-emergency care based upon ability to pay and patients are protected because refusal or delay of emergency care based on means to pay is illegal.

Patient Protection Under The EMTLA

What is to prevent a hospital from denying care and then lying about the severity of a patient’s condition? A schedule of stiff fines included in EMTLA is intended to discourage lying about a patient’s condition with extreme prejudice. Both hospitals and individual doctors can be held liable under EMTLA, doubling potential financial punishment. In a business that, for better or for worse, revolves around the bottom line, the threat of fines in excess of $50,000 is enough to give most hospitals and doctors pause before downplaying a patient’s condition.
Imagine a pregnant woman without health insurance living in an area that does not have a public hospital. If she goes into labor and the closest hospital is privately-run, the EMTLA requires that the hospital must admit the woman regardless of her ability to pay as childbirth is considered an emergency situation. The woman's labor and delivery care, regardless of length and complication, should be indistinguishable from that of a fully insured patient. This equal treatment will continue until the end of the emergency (i.e. after the child is born and there are no complications).

Hospital Bills

Hospitals are not shy about trying to collect from uninsured emergency patients. Their efforts can involve the hospital’s internal billing department, collection agencies, and even lawsuits. The collection process can be unpleasant: wages may be garnished and liens may be instituted on property. Hospitals, like any business, do not like getting stiffed on the tab, no matter what the law says.
Going back to the previous example of the uninsured mother, the privately-run hospital that delivered the baby can resume payment talks once it is clear that there are no further complications. At this point the hospital's billing department may take a harder line and discharge the woman within 24 hours. Once the emergency (childbirth) has been resolved, the hospital is under no obligation to provide treatment to the mother or her child. Elective procedures such as circumcision will likely not be an option and the hospital will continue to attempt to bill the woman for the services provided.
Public hospitals may not deny patient care based on ability to pay (or lack thereof). Private hospitals may, in non-emergency situations, deny or discontinue care. If you think you were unlawfully denied care or your treatment was not adequate because of lack of insurance or inability to pay, contact a local malpractice attorney to discuss your options.

 Patients' Rights
West's Encyclopedia of American Law
 Healthcare Agencies and Facilities Complaint Process


One of the doctors at Sacred Heart was witnessed as saying "we don't like to do the back surgery because we get sued too often". (?)

In one case: CORPORATE

Hogan v. Sacred Heart Med. Ctr., 94 P.3d 390 (Wash. Ct. App. July
15, 2004)
A patient won a jury award for over $7 million after suing her anesthesiologist
and the medical center at which he worked. The patient had been injured by
the anesthesiologist’s accidental insertion of an interscalene block into
her spinal cord. The jury concluded that the anesthesiologist was an apparent
agent of the medical center. Interestingly, the jury also concluded that the
medical center should be vicariously liable for the anesthesiologist’s negligence
because its employed CRNA, who was administering the patient’s general anesthesia,
failed to prevent harm to the patient.

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