EMTALA and Patient Transfers

Excerpt

The United States Congress passed the Emergency Medicine Treatment and Active Labor Act (EMTALA) in 1986. EMTALA was part of the Consolidated Omnibus Reconciliation Act (COBRA), which Congress enacted to address Medicare issues. The original intent of the EMTALA law was to attempt to prevent discrimination against patients in the form of "patient dumping." Patient dumping is the practice of involuntarily transferring uninsured patients from one hospital to another strictly for financial reasons.

This forced moving of uninsured patients was a common practice as private hospitals routinely transferred such patients to public hospitals without adequately considering their emergency medical condition or even if they were medically stable enough for safe discharge.

This situation occurred in most large cities, such as Chicago, New York, and Dallas, where public hospitals received more transfers of uninsured and underinsured patients strictly for financial reasons. Several scathing reports by medical professionals and the lay press described the problem of patient dumping at the time. The growing attention from these reports, the outrage they produced, and the increasing presence of the federal government in healthcare delivery led to the development of the EMTALA law.

In any given year, between 4% and 5% of hospitals in the US are cited for an EMTALA violation. Large, urban, for-profit hospitals with a significant Medicaid population and high emergency department (ED) volumes are the most likely to have such violations. Not surprisingly, for-profit hospitals have more than twice as many violations per one million ED visits as nonprofit facilities.