Can an Uninsured Patient Be Denied Emergency Treatment?

If you don't have health insurance, you still have a right to receive emergency medical care at most hospitals, and the denial of necessary urgent care could form the basis for a medical malpractice lawsuit.

In this article, we'll discuss a federal law called the Emergency Medical Treatment and Active Labor Act (EMTALA), which requires almost all hospitals to provide treatment to patients who need emergency medical treatment, regardless of whether the patient has health insurance.

Which Hospitals Are Covered Under the EMTALA?

EMTALA covers all hospitals that:

• have emergency departments, and
• accept Medicare payments from the federal government.

Since most hospitals meet both of these requirements, EMTALA covers almost every hospital in the country.

Does EMTALA Apply To Doctor's Offices?

EMTALA does not apply to individual doctor's offices or medical groups that have no emergency department or emergency room (ER). It only applies to hospitals that meet the two requirements outlined above.

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 that treatment.

Even if a patient on hospital property does not specifically request emergency care, EMTALA requires the hospital to provide 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 quickly (also known as an "acute condition") and for which the patient's symptoms are so severe that failing to give immediate medical attention could reasonably be expected to:

• place the patient's health (or, with respect to a pregnant woman, the health of her unborn child) in serious jeopardy
• cause serious impairment to the patient's bodily functions, or
• 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:

• there is not enough time to safely transfer the woman to another hospital before childbirth, and
• 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 fairly broad. While someone with the flu or a sprained ankle probably 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 cast 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 who comes onto hospital 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 must either provide "necessary stabilizing treatment" or, in certain circumstances, transfer the patient to another hospital, or both.

"Necessary 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 delivering 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 transfer a non-stabilized emergency patient just anywhere. In order for the transfer to be lawful, 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.

What Penalties Result From an EMTALA Violation?

When an EMTALA violation is found to have taken place, a number of penalties are possible depending on the circumstances, including:

• individual physician fines of up to $50,000 per violation
• hospital fines of $25,000 (for facilities with less than 100 beds) or up to just over $100,000 (for larger facilities), and
• potential termination of the hospital or physician's status as a Medicare provider.

Can an EMTALA Violation Lead to a Lawsuit?

If a denial of emergency treatment leads to greater harm or death, the EMTALA states that 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."

That means the denial of necessary medical care in violation of the EMTALA can form the basis of a medical malpractice lawsuit. Proving medical malpractice means showing that the health care provider failed to act in line with the accepted medical standard of care under the circumstances, and a provider's failure to comply with a federal law like the EMTALA would certainly qualify as sub-standard care if a patient ends up suffering additional and avoidable harm. Learn more about when it's medical malpractice (and when it isn't) and the importance of working with a medical malpractice lawyer if you think you have a case.