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Congre s&ona R Fesedrch Sen/ic
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March 21, 2023
Overview of the Emergency Medical Treatment and Active
Labor Act (EMTALA) and Emergency Abortion Services
The Emergency Medical Treatment and Active Labor Act
(EMTALA, largely codified in Section 1867 of the Social
Security Act, 42 U.S.C. § 1395dd) is a federal law that
generally compels Medicare-participating hospitals to
provide emergency care to any individual, irrespective of an
individual's ability to pay. Enacted in 1986 amid reports of
hospital emergency rooms refusing to treat poor or
uninsured patients, the Act requires hospitals, as a condition
of federal Medicare funding, to provide services to any
individual presenting at an emergency department or face
potential enforcement action.
Following the Supreme Court's decision in Dobbs v.
Jackson Women's Health Organization, questions have
arisen about EMTALA and its relationship to state law,
particularly in the context of emergency abortion services.
This In Focus outlines EMTALA's central requirements
and enforcement mechanisms; highlights the Act's
preemptive scope and recent issues related to emergency
abortion; and concludes with considerations for the 118th
Congress.
Con. Requirenents: Screening, Stabilization, and
Transfer
EMTALA has three main components. First, hospitals with
an emergency department (including critical access
hospitals and, effective January 1, 2023, rural emergency
hospitals) must screen patients. Specifically, if an
individual comes to the hospital's emergency department
with a request for examination or treatment, hospitals must
provide an appropriate medical screening examination by
qualified medical personnel within the capability of its
emergency department. The goal of this screening is to
determine if an emergency medical condition exists. The
Act does not expressly address the scope of the required
examination or what constitutes appropriate screening.
However, agency guidelines and several lower court
decisions indicate that hospitals must follow the same
screening procedures for all individuals presenting at the
emergency department with the same signs and symptoms,
regardless of an individual's payment status or other
factors.
Second, if a hospital determines that an individual has an
emergency medical condition, the hospital must either
provide further medical examination and treatment to
stabilize the patient using available staff or facilities, or
transfer the patient to a different medical facility with more
specialized capabilities. As defined in federal regulations,
required stabilization involves treatment for an emergency
medical condition as may be necessary to assure, within
reasonable medical probability, that no material
deterioration . . . is likely to result from or occur during the
transfer ... from a facility. Accordingly, for EMTALA
purposes, stabilization generally depends on whether a
patient's emergency condition would decline because of a
facility transfer; a patient may be stabilized even if the
patient's medical condition remains unresolved or the
patient requires further medical treatment. EMTALA
guidance offers an illustrative example:
[A]n individual presents to a hospital complaining
of chest tightness, wheezing, and shortness of
breath and has a medical history of asthma. The
physician completes a medical screening
examination and diagnoses the individual as having
an asthma attack that is an emergency medical
condition. Stabilizing treatment is provided
(medication and oxygen) to alleviate the acute
respiratory symptoms. In this scenario, the
[emergency medical condition] was resolved and
the hospital's EMTALA obligation is therefore
ended, but the underlying medical condition of
asthma still exists.
Third, EMTALA restricts hospitals from transferring
unstable patients unless the transfer is appropriate and
meets certain conditions. Among these conditions, a
transfer may occur if the hospital informs the patient of its
EMTALA obligations and the risks of transfer, and the
patient makes a written request for the transfer to another
medical facility.
Notably, courts have generally concluded that EMTALA's
core requirements are distinct from state medical
malpractice requirements. While the Act requires hospitals
to furnish medical services to patients, the statute does not
impose professional standards of care or liability on
hospitals or physicians that provide poor-quality care to
patients. In other words, hospitals and physicians that fail to
employ the proper procedures to screen or stabilize patients
may violate EMTALA, while health care providers that, for
instance, negligently misdiagnose a patient may violate
state medical malpractice laws but not violate EMTALA.
Emergency Medical Condition
As noted, EMTALA obligations to treat a patient depend
upon whether a patient has an emergency medical
condition. Under the Act, this condition is one in which an
individual exhibits acute symptoms . . . such that the
absence of immediate medical attention could reasonably
be expected to jeopardize an individual's health or result in
serious impairment to bodily functions or dysfunction to
bodily organs or parts. Pursuant to the Act and
accompanying regulations, elements of an emergency](ViewImageLocal?handle=hein.crs/govekyp0001&div=1&collection=&method=preview&ext=.png&size=3)