American College of Emergency Physicians, Coursework Example

The Emergency Medical Treatment and Active Labor Act (EMTALA) was created in 1986 in order to enable all patients to be provided with emergency services, regardless of their ability to pay for these services (CMS.gov, 2012). This is part of the Social Security Act and requires healthcare providers to offer a medical screening examination (MSE) to patients, and if a patient has an emergency medical condition (EMC), the healthcare provider must offer stabilizing medical treatment, whether or not the patient is able to pay (CMS.gov, 2012). This Act requires emergency departments to evaluate and treat these patients, even if they cannot pay for these services, and this has had a number of implications for healthcare organizations (Zondorak & McCormick).

Under these conditions, it is expected that organizations will treat many patients with an emergency medical condition; however, this also enables some patients to be treated for non-emergency conditions because they know that if they enter the emergency department, they will receive treatment regardless (Zondorak & McCormick). These conditions reflect an opportunity to take advantage of the system because the law requires, at minimum, an initial examination to determine what is wrong (Zondorak & McCormick). This poses a risk to the ever-increasing costs associated with healthcare services and how these costs impact patient care for those who are able to pay, particularly when clinical staff are stretched thin to accommodate those without insurance (Zondorak & McCormick). The burden of costs associated with this Act are significant throughout the United States, thereby creating a difficult set of challenges for healthcare organizations in many ways because they may face serious legal complications if they refuse to treat patients who are unable to pay, even if they suspect that patients are taking advantage of the emergency department with an illness or condition that is not a real emergency (Zondorak & McCormick).

Due to the requirements of EMTALA, it is important to identify what actions occur once patients are stabilized, as they face critical challenges that require further consideration and evaluation at this stage. For example, patients who are stabilized at one facility may be transferred to another facility for further treatment (Guido, 2009). These circumstances are likely to occur when patients are treated in the emergency department of a facility that will not continue their treatment on another unit due to inability to pay, such as a private hospital (Guido, 2009). At this stage, it is likely that a county hospital will be required to receive the patient and to provide further care and treatment (Guido, 2009). Furthermore, all patients who enter the emergency department must be provided with a screening in order to determine what is necessary in the short term in order to stabilize the patient as best as possible, particularly for women who are in labor (Guido, 2009).

In recent years, a number of lawsuits continue to transpire regularly, in spite of the required enforcement of the Act at healthcare emergency facilities (Guido, 2009). Under these conditions, the most common offenders are Health Management Organization (HMO)-based hospitals (Guido, 2009). Noteworthy cases include Johnson v. University of Chicago, whereby the latter would not admit an infant in cardiac arrest for treatment because the pediatric intensive care unit at the time was full, and the paramedics were required to take the patient to a facility further away (Guido, 2009). As a result, the patient died and a lawsuit was born, but in this case, EMTALA had not been proven to be violated (Guido, 2009). In another case, Henderson v. Medical Center Enterprise, EMTALA was directly violated because the process of patient registration led to a significant delay, and as a result, the patient left the facility without receiving treatment (Guido, 2009). This violation was due in large part to possible questions raised regarding the availability of insurance, which further delayed the patient’s access to treatment and subsequent lack of treatment that was received (Guido, 2009). An organization cannot purposely prohibit or delay a patient from receiving the appropriate assessment and treatment due to the registration process, as this is a clear ethical violation of practice that should not be tolerated under any circumstances (Guido, 2009).

A number of cases involving pregnant patients in labor have also been the subject of lawsuits, as one example violated its own standard protocol for a pregnant patient with bleeding who was also in her third trimester (Guido, 2009). Under these conditions, it was determined that the patient did not receive the proper examination for her condition in order to determine if there were any signs of placentia previa or other complications that could be contributing to her bleeding state (Guido, 2009). As a result, the patient was sent home with medications and returned to a different hospital the next day to give birth (Guido, 2009). In this and in other examples, these patients faced emergencies that required proper evaluation, and when this was not received in the emergency department, legal action was taken to prove that a violation was made (Guido, 2009).

The legal precedent known as EMTALA has forever changed how healthcare emergency departments evaluate and treat patients who enter through their doors. This Act has been instrumental in ensuring that healthcare organizations are compliant with its requirements; however, when this is not the case, they may be subject to harsh penalties, such as $50,000 per violation or in extreme cases, active termination of the hospital’s Medicare provider agreement, which is a devastating complication (American College of Emergency Physicians, 2013). Therefore, organizations must remain compliant with this Act in order to prevent any of these complications that could impact their overall ability to provide quality care and treatment to patients.

References

American College of Emergency Physicians (2013). EMTALA. Retrieved from http://www.acep.org/News-Media-top-banner/EMTALA/

Centers for Medicare & Medicaid Services (2012). Emergency Medical Treatment & Labor Act (EMTALA). Retrieved from https://www.cms.gov/Regulations-and-Guidance/Legislation/EMTALA/index.html?redirect=/emtala/

Guido, G.W (2009). Legal and Ethical Issues in Nursing. Pearson Education.

Zondorak, L., & McCormick, C. The implications of HIPAA and EMTALA on public health. Retrieved from http://www.cwru.edu/med/epidbio/mphp439/HIPAA.htm