Can an Uninsured Patient Be Denied Emergency Treatment?

Almost every hospital in the U.S. is required by law to provide necessary emergency medical treatment to anyone - with or without insurance coverage.

A federal law called the Emergency Medical Treatment and Active Labor Act (EMTALA) requires almost all hospitals to provide treatment to all patients who need emergency medical treatment regardless of whether the patients have health insurance. Read on to learn more about this law and how it works.

What Hospitals Does EMTALA Apply To?

EMTALA covers all hospitals that have emergency departments and that accept Medicare payments from the federal government. Since almost every hospital in the country has an emergency department and accepts Medicare payments, that means that EMTALA covers almost every hospital in the country.

Does the Patient Have to Go Into the ER?

No. EMTALA is an extremely patient-friendly law. As long as the patient goes onto hospital property, including the parking lot, sidewalk, driveway, or other areas within 250 yards of the main hospital buildings and requests emergency treatment, EMTALA requires the hospital to provide emergency treatment.

Even if a patient who is on hospital property does not specifically request emergency treatment, EMTALA requires the hospital to provide emergency treatment if a prudent lay person would believe, based on the patient’s appearance or behavior, that the patient needs emergency examination or treatment.

What is Considered an Emergency Condition?

An emergency medical condition is a problem that has arisen very quickly (known as an acute condition) in which the patient’s symptoms are so severe that failing to give the patient immediate medical attention could reasonably be expected to 1) place the patient’s health (or, with respect to a pregnant woman, the health of the woman or her unborn child) in serious jeopardy, 2) cause serious impairment to the patient’s bodily functions, or 3) cause serious dysfunction of any bodily organ or part.

The law has a second definition of emergency medical condition that applies to pregnant women who are having contractions in the emergency room (i.e., a woman in active labor). In that case, an emergency medical condition exists if 1) there is not enough time to safely transfer the woman to another hospital before delivery, and 2) transferring the woman may pose a threat to the health or safety of the woman or the unborn child.

As you can see, these definitions are rather broad. While someone with the flu or a sprained ankle would not have an emergency medical condition under EMTALA, a broken bone (even a broken finger) would probably qualify because failing to get the broken bone casted or splinted would probably cause serious dysfunction to the bone. However, a pregnant woman who is not in active labor does not qualify under EMTALA unless she has some other serious medical condition.

What are the Hospital’s Obligations Under EMTALA?

For any patient that comes onto the hospital’s premises seeking emergency medical care, or who appears to require emergency care, the hospital must conduct a medical screening examination to determine whether or not the patient has an emergency medical condition. If the hospital screener determines that the patient does not have an emergency medical condition, the hospital has no further obligation to the patient if the patient does not have medical insurance.

If the patient is deemed to have an emergency medical condition, the hospital then must either provide what is called necessary stabilizing treatment or, in certain circumstances, transfer the patient to another hospital, or both. Stabilizing treatment is defined as whatever medical treatment is necessary to assure that no material deterioration of the patient’s condition is likely to result from or occur during the transfer of the patient to another hospital. Stabilizing a pregnant woman in labor means to deliver the baby and the placenta.

A hospital may transfer a patient who has not been stabilized or a pregnant woman in labor who has not delivered the baby only under certain conditions. A non-stabilized patient may only be transferred if the patient makes a written request for transfer after being informed of the risks, or if a physician certifies that the benefits of the transfer to the patient outweigh the risks.

Where Can the Patient Be Transferred?

A hospital cannot just transfer a non-stabilized emergency patient anywhere. In order for the transfer to be legal, the hospital must first attempt to stabilize the patient as much as possible within the limits of its capabilities, and then may only transfer the patient, along with the patient’s medical records, to another hospital that has agreed to take the patient.

Can a Legal Claim Be Made?

If a denial of treatment lead to further injury, illness, or death of the patient, it's possible to recover damages similar to those in a medical malpractice claim. Under EMTALA, the patient may recover, "those damages available for personal injury under the law of the State in which the hospital is located, and such equitable relief as is appropriate."

If you believe that you were denied emergency treatment by a hospital, you should contact a qualified medical malpractice lawyer immediately to learn more about your legal rights.

Does EMTALA Apply To Doctor’s Offices?

EMTALA does not apply to doctor’s offices. It only applies to hospitals.

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