WORLD JOURNAL OF ADVANCE
HEALTHCARE RESEARCH

*Dr. Shinu Kuriakose DHSc PA-C

ABSTRACT

The United States Congress, in 1986, passed the Emergency Medicine Treatment and Labor Act (EMTALA) as part of Consolidated Omnibus Budget Reconciliation Act (COBRA) of the Social Security Act to ensure that emergency care was available to the public regardless of the ability to pay (CMS.gov, 2015). This act required that all hospitals, which accepted Medicare reimbursements from the government with emergency services, to provide emergency medical screenings when requested and offer emergency medical treatment as needed including stabilization of active labor to all needful patients regardless of the financial resources of the patient; although, it does not prohibit the hospital from asking about the patients insurance status or payment method, if any. In cases of active labor, this act insists that hospitals stabilize patients until delivery is complete including discharge of the placenta. The origins of this law was based on practices noticed in Cook County Hospital (a public institution) in Chicago were the physicians noticed that an inordinate number of patients were transferred there from private hospitals in Chicago with the vast majority being minorities and unemployed and 87% of them lacking health insurance (Zibulesky, 2001). Furthermore, only 6% had signed informed consent paperwork and 24% were medically unstable at the time of transfer (Zibulewsky, 2001). The United States Congress took it upon themselves to pass this law (a rare show of bipartisanship) to prevent such outrageous behavior by hospitals for monetary gain. Hospitals were not only obligated to stabilize patients medically but also transfer them to other appropriate venues as medically indicated upon the patients request. In essence, due to the vast majority of hospitals accepting reimbursement from the Centers of Medicare and Medicaid, this act basically applies to virtually every hospital in the United States. There are specific sub-statues in EMTALA: a) a hospital is bound by affirmative duty to treat any existing emergency medical condition b) a hospital is obliged to conduct a medical screening exam to rule out any emergent medical condition c) a hospital is restricted from transferring any patient who presents with active labor or any emergent medical condition (Emtala.com, 2015). Another important mandate, which the EMTALA requires is that no hospital deny transfer of patients to its facility regardless of payment if they have specialized (burn unit, neonatal intensive care unit), services to treat patients needing such services and if there is available capacity at the hospital.

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