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EMTALA EXAM QUESTIONS AND ANSWERS
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EMTALA EXAM QUESTIONS AND ANSWERS
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EMTALA EXAM QUESTIONS AND ANSWERSWhat is EMTALA? - Answers -Emergency Medical Treatment and Active Labor Act
Sometimes referred to as COBRA law
Section 186 (a) of the Social Security Act within section of U.S. Code which governs
Medicare.
Only participating hospitals with agreement to aacept payment for Medicaid/Medicare
Primarily, but not exclusively non-discrimination statute
What are the provisions of EMTALA? - Answers -Patient comes to the ED requesting
examination or treatment must be provided a medical screening exam to determine if
their is an emergency medical condition.
If so, hospital is obligated to provide treatment until stable or to transfer them to another
hospital in conformance with statute's directives.
If not, no further obligation.
A pregnant woman in active labor must be admitted and treated until delivery is
completed unless transfer is appropriate.
What is an "emergency medical condition"? - Answers -A medical condition manifesting
itself by acute symptoms of sufficient severity (including severe pain), such that
absence of immediate medical attention could reasonable be expected to result in
placing the health of the individual in serious jeopardy.
Serious impairment to bodily functions or serious dysfunction of any bodily organ or
part.
Pregnant women with contractions and inadequate time to safely transfer to another
hospital before delivery or if transfer would pose a threat to the health or safety of the
women or child.
What are the provisions for pregnant women in active labor? - Answers -Determination
of whether a women is in labor is considered an "emergency medical condition" (if not in
active labor then she does not fall under the statute).
When can a patient be transferred to another facility? - Answers -A transfer to another
facility before the patient has become stable can only take place if it is an "appropriate
transfer" under the statute.
A transfer after the patient has become stable is permitted.
A transfer of a patient who is not experiences an "emergency medical condition" is
permitted.
What is meant by "stabilized"? - Answers -(For emergency medical conditions) that no
material deterioration of the patient's conditions is likely to result from the transfer or is
likely to occur during the transfer.
(For patients in active labor) the infant and the placenta have been delivered.
What is an appropriate transfer? - Answers -Patient has been treated at the transferring
hospital and stabilized as far as possible within the limits of its capabilities.
, Patient needs treatment at the receiving facility and the medial risks of transferring him
are outweighed by the medical benefits of the transfer.
The weighing process as described above is certified in writing by a physician.
Receiving hospital has been contacted and agrees to accept the transfer and has the
facilities to provide the necessary treatment to him.
Patient is accompanied by copies of his medical records from the transferring hospital.
Transfer is effected with the use of qualified personnel and transportation equipment, as
required by circumstances, including the use of necessary and medically appropriate life
support measures during the transfer.
What if patient refuses examination and/or transfer? - Answers -Hospital has met the
requirement of the medical screening if:
It offers the patient the further medical examination and treatment required
Informs the patient or another on his behalf of the "risks and benefits of the offered
examination or treatment
The patient or another acting on his behalf refuses to consent to the examination or
treatment.
What if patient requests a transfer? - Answers -A patient may request a transfer to
another institution and it appears from the wording of the statute that this request takes
the place of the physician's certification mentioned in section 11 above. The transfer
must still be an "appropriate transfer", however.
Who is covered? - Answers -Most of the provisions of EMTALA apply to hospitals only,
but there are some situations which physicians may be subject to liability, as noted:
A hospital is an institution which can operate only through the people who work within
the walls. A hospital is typically a corporation and a corporation is a legally-recognized
entity which can be sued and which can have its Medicare provider agreement revoked
by CMS. The requirements of EMTALA are imposed on the people who work within and
on behalf of the hospital, but the hospital is the entity which must bear the loss if it is
found that they have violated the statute. A hospital may seek to assert a claim for
reimbursement (indemnity or contribution) in the event that a decision by one of its
employees or staff physicians makes a decision for which it becomes legally liable;
these claims have been recognized by some courts.
The person who will usually have to make the sometimes difficult decisions which are
governed by EMTALA is the emergency physician.
What obligations apply to physicians? - Answers -Section 1395dd(d)(1)(C) imposes a
penalty on a physician who failed to respond to an emergency situation when he is
assigned as the on-call physician.
A physician who signs a certification in support of an appropriate transfer, as detailed in
section 11 below, is liable if he knew or should have known that the certification was
false.
The Balanced Budget Act of 1997 amended section 1395dd(d)(1)(B) to provide directly
for liability of physicians working at specialty hospitals (not just assigned on-call
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