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In 1986, the Emergency Medical Treatment and Active Labor Act known as EMTALA (Section 1867 (a) of the Social Security Act) and sometimes referred to as the "Patient Anti-Dumping Act" was passed by Congress and signed into law by President Reagan. The purpose of the Act was to ensure that acutely ill patients who are uninsured or underinsured receive appropriate emergency care and to prevent hospitals from refusing to treat certain populations of patients who present to the emergency department.
Although EMTALA was passed to protect those who lack financial resources or medical insurance, it applies to all seeking care from a hospital's emergency department in all states and territories of the United States. However, not all hospitals have obligations under EMTALA. Only hospitals that accept federal funds from the Centers for Medicare and Medicaid (CMS), a branch of the Department of Health and Human Services (HHS), are subject to civil liability under the Act.
Ironically, he says, "EMTALA was a vehicle that was designed, in large part, to provide protection to Medicare and Medicaid patients. The fact that, in the end, it applied to all patients in all hospitals, even undocumented immigrants, was interesting. And it was good that it did get applied to all patients, especially those whose transfers were economically motivated."
It should be added that the disturbing stories about improper transfers disproportionately involved patients who were members of minority groups, which raised both civil rights concerns and advocacy group ire. And so, in 1985, a four-page provision called the Emergency Medical Treatment and Active Labor Act was inserted into the Consolidated Omnibus Budget Reconciliation Act, which was duly passed and eventually signed by President Ronald Reagan on April 7, 1986.
What Does It Mandate?
There are many misconceptions about what the law requires of hospitals. It does not outlaw transfers of patients who cannot pay or who are otherwise deemed undesirable. It does not (at least as of this writing) require that hospitals provide all care in perpetuity to a patient who receives an evaluation in the ED. It allows for waivers in some situations, such as natural disasters.
What it does require:
That all patients seeking care in an emergency department be evaluated by a competent clinical professional, and if found having a condition requiring emergency care must be treated until stabilized before any transfer.
For women in active labor, the hospital must deliver the baby unless the institution is not equipped to do so (as in the case of a high-risk pregnancy and the lack of a neonatal ICU).
The hospital to which a stabilized patient (or one who must be transferred because the originating hospital does not have the necessary services or personnel) is to be sent must agree to accept the patient. The patient must consent to the transfer, if possible.
Adequate medical records must accompany the transferred patient.
However, EMTALA remains the source of controversy. David C. Seaberg, M.D., president-elect of the American College of Emergency Physicians, says that for his membership, "It's a double-edged sword. The good side is that patients with emergency conditions are being taken care of; they must have an evaluation exam and they have to be stabilized. The negative side is that EMTALA is the largest unfunded mandate [on providers] that the government has ever instituted."