Is Your ED Compliant With EMTALA?


The Emergency Medical Treatment and Active Labor Act (EMTALA) is a statute that governs when and how a patient may be refused treatment or transferred from one hospital to another when he is an unstable medical condition. The Act was passed as part of the Consolidated Omnibus Budget Reconciliation Act of 1986, and is also known as Section 1867(a) of the Social Security Act.

EMTALA applies only to hospitals which have entered into provider agreements under which they will accept payment from the Department of Health and Human Services, Centers for Medicare and Medicaid Services (CMS) under the Medicare program for services provided to beneficiaries of that program. The provisions do not just apply to Medicare patients, but to all patients.

The purpose of the statute is to prevent hospitals from rejecting patients, refusing to treat them, or transferring them to charity hospitals because they are unable to pay for services. In essence, EMTALA says that patients who present with an emergency medical condition, but cannot pay, cannot be treated differently than patients who have health insurance coverage.

EMTALA provisions ensure that any patient who comes to the emergency department requesting examination of a medical condition must be provided with an appropriate medical screening examination to determine if he is suffering from an emergency medical condition. If so, then the hospital must either provide him with treatment until he is stable or transfer him to another hospital. The hospital is not obligated further if it is established that no emergency medical condition exists. The medical screening examination must be performed by a qualified medical person determined by hospital bylaws.

If a pregnant women presents to the emergency room in active labor, she must be admitted and treated until delivery (including the placenta), unless there is an appropriate transfer made. Whether or not a woman in labor has an emergency medical condition is determined by whether there is adequate time for a safe transfer to another hospital before delivery. If she is not in labor (no contractions), then she does not come under the terms of EMTALA, unless she has another emergency medical condition. A medical screening examination must be performed to determine whether a safe transfer can occur.

A patient can be transferred without triggering EMTALA's restrictions if he has become stable. Stable, according to the statute is, "that no material deterioration of the patient's condition is likely to result from the transfer or is likely to occur during the transfer; for patients in active labor, delivery of the infant and placenta." Ultimately, the determination of whether a patient is stable is a result of the clinical judgment of the medical professional who has assessed the patient.

An appropriate transfer that occurs before stabilization is legal under EMTALA but must include all of the following:

  • The patient was treated at the transferring hospital and stabilized as far as possible within the limits of its capabilities.
  • The patient needs treatment at the receiving facility and the medical risks of transferring him are outweighed by the medical benefits of the transfer.
  • The weighing process is certified in writing by a physician.
  • The receiving hospital has been contacted and agrees to accept the transfer, and has the facilities to provide the necessary treatment to him.
  • The patient is accompanied by copies of the medical records from the transferring hospital.
  • The transfer is effected with the use of qualified personnel and transportation equipment, as required by the circumstances, including the use of necessary and medically appropriate life support measures during the transfer.


American College of Emergency Physicians. Patient Center. EMTALA

Fosmire, S. Frequently asked questions about the emergency medical treatment and active labor act (EMTALA)


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    Stan Kenyon
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