Hospitals And Emergency Departments: Are They Mandatory?

While the Merriam-Webster definition of a hospital does not mention an emergency department, most payer and Medicare definitions of a hospital do include one. In the US, the Emergency Medical Treatment and Labor Act (EMTALA) gives everyone protections in a hospital emergency department that receives Medicare funds, which includes most US hospitals. EMTALA ensures that a hospital provides a screening exam and offers treatment for an emergency medical condition, regardless of insurance status. EMTALA regulations also require hospitals to maintain on-call lists of doctors and specialists to meet patient needs, although hospitals are not required to have coverage for every specialty 24 hours a day.

EMTALA protections

The Emergency Medical Treatment and Active Labor Act (EMTALA) was enacted by the United States Congress in 1986 as part of the Consolidated Omnibus Budget Reconciliation Act (COBRA). EMTALA protections apply to hospitals that accept payments from Medicare, which is nearly all hospitals.

EMTALA was designed to prevent hospitals from refusing to treat people because of inability to pay, insufficient insurance, or transferring or discharging emergency patients on the basis of high anticipated diagnosis and treatment costs, also known as "patient dumping". The law requires Medicare-participating hospitals with emergency departments to screen and treat emergency medical conditions in a non-discriminatory manner, regardless of the patient's ability to pay, insurance status, national origin, race, creed, or color. An individual requesting emergency care must receive a medical screening examination (MSE) to determine whether an emergency medical condition (EMC) exists, and the hospital cannot delay examination and treatment to inquire about methods of payment, insurance coverage, citizenship, or legal status.

Patient rights

While there is no nationwide bill of patient rights, federal and state laws outline the rights of patients in emergency departments. These rights include:

Right to a medical screening examination

The Emergency Medical Treatment and Labor Act (EMTALA) gives everyone in the U.S. the right to a medical screening examination, regardless of their ability to pay. This examination must be timely and performed by a qualified professional, such as a doctor or advanced practice nurse. It is different from triage, where a nurse takes vital signs to decide the order in which to see patients.

Right to emergency treatment and stabilization

If a patient has an emergency medical condition, the hospital must offer treatment to stabilize the patient so that their condition does not materially worsen. This includes providing treatment for conditions like contractions and, according to the HHS, abortion care to stabilize a pregnant person in an emergency.

Right to transfer to another facility

If a hospital cannot stabilize a patient, they must arrange an appropriate transfer to another facility that can provide the necessary care.

Right to information and informed consent

Patients have the right to be informed about their diagnosis, treatment options, and associated risks and benefits. They can advocate for their preferred care plan and make decisions based on this information.

Right to protection from unfair treatment and discrimination

Federal laws protect patients from unfair treatment and discrimination. Patients can file a civil rights complaint with the Department of Health and Human Services if they have experienced discrimination.

Right to cost transparency

The No Surprises Act requires in-network facilities to provide a "good faith estimate" of the expected charges for scheduled healthcare services. This helps patients understand the potential costs of their care and make informed decisions.

It is important for patients to be aware of their rights and to speak up if they feel their rights are being violated, as this can help ensure their safety and well-being during their time in the hospital.

Hospital definitions

The presence of an emergency department is not mentioned in the Merriam-Webster definition of a hospital. However, most payer and Medicare definitions of a hospital do include an emergency department as a requirement.

In the US, the Emergency Medical Treatment and Labor Act (EMTALA) protects everyone in the country. This law prevents any hospital emergency department that receives Medicare funds (which includes most US hospitals) from refusing to treat patients. EMTALA also requires hospitals to screen and stabilize patients with emergency medical conditions.

In Canada, the concept of a duty of care was first introduced in the 1932 case of Donoghue v. Stevenson. A hospital-patient relationship begins when the patient signs in at the emergency department, but a hospital can also be deemed to have accepted a person as a patient by detaining them before deciding to reject and send them elsewhere.

In Connecticut, the only state regulation governing emergency services requires each general hospital to provide adequate care at all times for people with acute emergencies.

EMTALA regulations have been updated over time to address concerns related to on-call specialist coverage and clarify the obligations of hospitals for off-campus facilities.

Duty of care

While the Merriam-Webster dictionary's definition of a hospital does not mention an emergency department, most payer and Medicare definitions of a hospital do include one. Hospitals that receive federal government funding must abide by the Emergency Medical Treatment and Active Labor Act (EMTALA). This Act, passed in 1986, was designed to prevent "patient dumping", where patients were turned away from private hospitals and ended up overcrowding public hospitals.

EMTALA gives everyone in the U.S. certain protections in emergency rooms. It prevents any hospital emergency department that receives Medicare funds from refusing to treat patients. A qualified professional must check patients for an emergency medical condition, and the hospital must offer a screening exam, regardless of insurance status. If a patient has an emergency medical condition, the hospital must treat it so that it does not materially worsen, and if it cannot be stabilized, the patient must be appropriately transferred to another hospital.

The concept of a duty of care as applied in Canada was first articulated in the 1932 case of Donoghue v. Stevenson, which held that "You must take reasonable care to avoid acts or omissions which you can reasonably foresee would be likely to injure your neighbour." Following the Fleuelling incident, where an 18-year-old with asthma died due to ambulance redirection, the Toronto ambulance dispatch centre changed its policy to transport critically ill patients to the nearest hospital. This duty of care is one component of the law of negligence.

The duty to provide emergency medical care initially only applied to emergency departments within hospitals, but now covers a wide range of medical venues, including departments within a hospital, urgent care facilities, outpatient surgery centers, psychiatric facilities, and ambulances. The Act requires hospitals to provide the same care to all patients, regardless of citizenship or immigration status, and to stabilize and treat emergency medical conditions or transfer patients to a facility that can.

EMTALA regulations

EMTALA, or the Emergency Medical Treatment and Labor Act, is a federal law enacted by Congress in 1986. This law gives everyone in the U.S. protection and ensures public access to emergency services regardless of their ability to pay. EMTALA regulations apply to Medicare-participating hospitals that offer emergency services.

EMTALA requires that anyone who comes to an emergency department requesting evaluation or treatment of a medical condition must receive a medical screening examination (MSE). This examination must be conducted by a physician or qualified medical person to determine whether the patient has an "emergency medical condition." The hospital must offer this screening exam even if the patient cannot provide proof of insurance.

If the patient is found to have an emergency medical condition, the hospital must provide stabilizing treatment. This means that the patient's condition must be treated so that it does not materially worsen or get significantly worse. If the hospital does not have the necessary resources or specialized capabilities to stabilize the patient, they must provide an appropriate transfer to another hospital that can provide the required treatment.

Failure to comply with EMTALA regulations can result in significant financial and legal consequences for hospitals and EMS systems. Individuals who believe their EMTALA rights have been violated can file a complaint with the Department of Health and Human Services. The Health and Human Services Office of Inspector General (HHS-OIG) may seek a Civil Monetary Penalty (CMP) against hospitals found to have negligently violated EMTALA obligations.

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