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EMTALA: Ethics and the Law

Dr. Em's & Dr. Taul's
Emergency Room Adventure

Patricia S.  Beach MD  &  John J. Fraser MD


After completing this module, you should be able to answer the following questions.

  1. What is EMTALA?

  2. What happens if I choose not to follow EMTALA guidelines?

  3. Who is impacted by EMTALA?

In 1968 Congress passed the Emergency Medical Treatment and Active Labor Act of 1986 (EMTALA) in response to the practice of emergency rooms transferring patients from one emergency room to another for care (dumping).  Patients were ostensibly transferred to another facility better equipped to provide for their medical care, but in reality were selected because they lacked insurance or evidence of the ability to pay for their medical care.  In many cases the receiving emergency facility was unaware of the transfer until the patient arrived.

In practical terms, EMTALA regulations require that all persons seeking treatment in a hospital emergency room should be evaluated promptly, regardless of their ability to pay.  Monetary and civil penalties are incurred if individuals are not evaluated appropriately.   EMTALA applies to all hospitals that receive Medicare funding and have emergency rooms.  A Medical Screening Examination (MSE) must be provided to all persons requesting examination or treatment.  The MSE must not be delayed or denied while inquiries about payment or insurance take place.

The purpose of the MSE (perform by a physician or qualified medical person) is to determine whether a condition is present that is deemed a medical emergency.  MSE may include ancillary services and specialty consultation within the facility's ability.  An emergency medical condition is any acute symptom including pain that could reasonably result is serious jeopardy to the person's health, serious dysfunction of an organ, or body parts without immediate treatment.

Consider your decisions for each of the following clinical scenarios.

  Transferring patient 

  Second Opinion 

  Neonatal Transfer 

  Watching the Basketball Game 


  ED not on Managed Care contract 

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