BLOG: How much should you worry about the Emergency Medical Treatment and Labor Act?
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Key takeaways:
- The Emergency Medical Treatment and Labor Act only applies in hospitals when a patient “presents to the emergency department” and until the patient is stabilized.
- The law requires hospitals have an on-call list.
The Emergency Medical Treatment and Labor Act, or EMTLA, was passed to protect patients without insurance who were experiencing medical emergencies.
The law requires hospital EDs to provide stabilizing treatment to a patient in labor or with an illness or injury that threatens life or limb. The hospital, and the physicians who work there, must screen patients and provide enough care to stabilize the patient. Hospitals are not allowed to inquire about a patient’s insurance status if that query would delay treatment, and the hospitals must stabilize the patient regardless of the patient’s ability to pay.
Because physicians can and do face liability in the form of fines under EMTLA, it is important to understand how it operates.
Requirements
First, the law only applies in hospitals when a patient “presents to the emergency department” and only until the patient is stabilized. There are cases that definite the ED broadly. It is safest to assume that a patient who is on hospital grounds trying to seek emergency care is covered by the law.
EMTLA requires hospitals to have an on-call list. The law recognizes that some facilities will not have a specialist on call at all times. A small hospital with one orthopedic surgeon is not required to have that surgeon on-call 24 hours a day, 365 days a year. The hospital and physician can agree to the times that the physician will be on call. However, if the physician is on call and fails to come in when asked, the physician may face fines under EMTLA. Note that in situations where a medical professional in the hospital asks the on-call physician to come in, the fact that the on-call physician feels that the situation can be addressed by phone will not prevent EMTLA liability. If the professional in the hospital asked the on-call physician to come in, failure to do so can most definitely result in a fine.
Important points
At Orthopedics Today Hawaii last month, an attendee asked about a Medicaid patient who presented to the ED with an open fracture. The ED physician called the orthopedic surgeon for advice. The surgeon instructed the emergency physician to do a superficial wound cleaning and splint the fracture and have the patient call the office the next morning to set up an appointment. The surgeon asked, “If my staff informs the patient that the clinic does not accept Medicaid and that the patient must go elsewhere, will we have violated EMTLA?”
Because the patient was stabilized at the hospital, and the clinic is not a hospital, there will not be any violation of EMTLA. That does not mean, however, refusing to see the patient is risk-free. First, the hospital bylaws may require physicians to provide follow-up to patients seen in the ED. If they do, a physician’s refusal to see the patient could result in discipline up to removal from the medical staff and reporting to the medical board. In addition, there is some risk that patients could claim they are being abandoned. That risk is lower if the physician never saw the patient, but there is still some risk.
This question is an excellent illustration of an important point. When you seek advice from counsel, it can be advantageous to ask a more general question. If you ask your lawyer the specific, “Is this a problem under EMTLA?” rather than “Is this a problem?” the lawyer may fail to explain the important medical staff and abandonment issues.
Another question that was asked At Orthopedics Today Hawaii was whether a physician can face liability if he or she provides advice to an emergency physician on the phone but never sees the patient. While some courts have disagreed when answering this question, the recent trend has been to extend liability to professionals who provide advice without actually seeing the patient. In a case in Minnesota, a hospitalist refused to admit a patient over the recommendation of the treating nonphysician practitioner. The patient subsequently died and there was a claim against the hospitalist. Given those particular facts, it may not be surprising that the Minnesota Supreme Court ruled that the hospitalist had an obligation to the patient and could face liability. The good news is that malpractice insurance will cover this sort of claim, but physicians understandably want to avoid situations where they are being sued.
In my experience, physicians worry much more about malpractice liability than a wide range of other potential legal concerns that may pose a bigger financial risk. That will be the topic of my next blog post.
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