Slave Labor and Liability?
The Effect of EMTALA on Physicians

The burdens of EMTALA have been well documented since the enactment of the Federal law which requires the medical stabilization of patients presenting at a hospital's emergency room before any transfer. Given the expansive interpretation of EMTALA's mandates and the harsh penalties imposed for EMTALA violations, there has been significant discussion and great effort undertaken to educate hospitals and develop mechanisms to assure compliance. Nevertheless, the actual daily and nightly responsibility for carrying out the duties necessary has been the burden of physicians, which includes the ER physicians and particularly on-call physician specialists.

The tension between hospitals and physicians over the imposition of EMTALA responsibility has only increased as a result of concerns about medical liability and a continued emphasis on medical specialization. More than the debate over free service is at issue. Aside from the challenges faced by individual physicians and physician practices, the issue has also become a very divisive matter not only between physicians and hospitals, but also within organized medical staffs.
Definition: In 1986, the U.S. federal government passed the Emergency Medical Treatment and Labor Act (EMTALA). This act requires any hospital that accepts payments from Medicare to provide care to any patient who arrives in its emergency department for treatment, regardless of the patient's citizenship, legal status in the United States or ability to pay for the services. EMTALA applies to ambulance and hospital care.

EMTALA was developed to combat "patient dumping," the practice of refusing to treat people who did not have the ability to pay for healthcare services. It guarantees those with insufficient means to get medical help.

EMTALA is contained within the Consolidated Omnibus Budget Reconciliation Act (COBRA) and falls under the auspices of CMS, the Center for Medicare Services.

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