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.