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Emergency Medical Treatment and Active Labor Act (EMTALA) EMTALA for Physicians and other ED Staff The final rule clarifies that EMTALA doesn't apply to inpatients, and that it ceases to apply once the ED sees, screens, and admits an individual as an inpatient. Hospitals must admit individuals in good faith-not as a means to avoid EMTALA requirements. Hospitals that admit patients only to discharge them untreated may violate EMTALA. Hospitals must screen and stabilize individuals who "come to" a dedicated ED requesting, or appearing to require, treatment for any medical condition. An individual can "come to" the ED in one of two ways:
EMTALA and psychiatric patients Question: I know EMTALA applies to anyone who presents at the ED seeking medical attention, but how about a psych patient that presents for attention that does not have a burning medical issue? Do they also fall under the EMTALA regs? We are a small rural facility with no psych care available at the local level. It seems we have lots of issues getting facilities to accept our psych patients for care - sometimes even after they have agreed to see the patient. Sometimes they release the patient (often against the will of the family or caregivers). We have a concern about EMTALA and these patients. Answer: EMTALA does apply to psychiatric patients who do not present with physical emergency medical conditions. The EMTALA regulations specify that the term “emergency medical condition” includes “psychiatric disturbances and/or symptoms of substance abuse.” For the patient presenting to the ED with psychiatric issues, your ED physician, or designated appropriate staff, should screen for both a physical emergency medical condition and a psychiatric emergency medical condition. If, after screening, it is determined that no emergency medical condition exists, then EMTALA does not apply. If it is determined, however, that an emergency medical condition is present, you must admit and treat or stabilize the patient for transfer to another facility better able to provide appropriate care. After the facility to which you are transferring accepts the patient and the patient is in transit through appropriate means, EMTALA is satisfied for your facility. Some important definitions relating to EMTALA and psychiatric patients: A psychiatric emergency medical condition is when the patient is a danger to self or others or there is risk that they could be a danger to self or others. A psychiatric emergency medical condition is considered “stable” when the patient is no longer a threat to self or others. The patient can be considered “stable for transfer” when they are protected from harming self or others. ED physicians and staff should appropriately document any symptoms on which the determination that an emergency medical condition exists is based. Items to screen for: Does the patient have a history of violence to himself or others? Has the patient made a suicide attempt or voiced suicidal ideations? Is the patient a potential danger to others through violent actions or threats? Is substance abuse present that could impair their judgment or are they showing signs of confusion for which a reason cannot be determined? This question was answered by Cynthia A. Moore, BSN, RN, CHC, compliance officer at Mt. Carmel Regional Medical Center, Pittsburg, KS. Final EMTALA Regulations Published 9/9/2003 EMTALA and the Front Line - 2004 |
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