EMTALA

The Emergency Medical Treatment and Active Labor Act of 1986, amended in 1989, was enacted by Congress to guard against patient dumping in hospital emergency rooms. The law and its corresponding regulations is called by different names, most particularly EMTALA, COBRA (because its provisions were part of the major 1986 Consolidated Omnibus Budget Reconciliation Act of 1986), or PADS (referencing patient dumping). Since its inception, complaints under the law have increased and governmental enforcement, particularly through the Office of Inspector General (OIG), can be aggressive.

The basic requirements of the law include 1) appropriate medical screening for all persons coming to the emergency room; 2) necessary stabilization of the emergency medical condition, if any; 3) transfer only if stable or the patient requests or a physician certifies that the transfer benefits outweigh transfer risks; and 4) prohibited initial inquiry about insurance or ability to pay. Complaints alleging EMTALA violations are first inspected by the Iowa Department of Inspections and Appeals (DIA), the federal Medicare surveying agency, which files its findings with the federal Department of Health and Human Services; those reports are available to the Centers for Medicare and Medicaid Services (CMS) and the Office of Inspector General (OIG), both of which can bring enforcement actions against hospitals and physicians for EMTALA violations.

Regulations are important to understanding the definitional and interpretative framework for EMTALA. EMTALA regulations are found at 42 CFR 489.24 (Code of Federal Regulations). Those regulations were amended in 2003 to clarify the enforcement meaning and intent of EMTALA in several respects including physician on-call coverage.