EMTALA Regulations Governing On-Call Physicians
Emergency Medical Treatment and Active Labor Act Regulations Governing On-Call Physicians
The Emergency Medical Treatment and Active Labor Act (EMTALA) was enacted to provide access to emergency medical services regardless of a person’s ability to pay for those services. Often referred to as the “anti-dumping” law, EMTALA restricts a hospital’s ability to transfer or discharge a patient who appears at a hospital’s emergency department suffering from an emergency medical condition. EMTALA has regulations that govern the staffing of on-call physicians and the obligations of those physicians in providing stabilizing treatment to emergency room patients.
EMTALA requires that hospitals provide appropriate medical screening for all patients who appear in their emergency rooms. If the screening discloses that the patient is medically stable, or is not a woman in active labor, then the hospital or physician can discharge or transfer the patient. If, however, the patient is not stable or is in active labor, the hospital is required to provide treatment to the patient.
EMTALA requires hospitals to maintain a list of physicians who are on-call to provide necessary treatment after an initial patient screening. Hospitals are, however, only required to provide treatment for emergency medical conditions consistent with the hospital’s capabilities. This means that if a hospital does not have a specialist of the type needed on-call, it can transfer the patient to a hospital which has the needed specialist on-call.
EMTALA does not require that hospitals have physicians of all specialties on-call at all times of the day and night. Hospitals can design their own on-call schedule in a way that best meets its patients needs and takes into consideration the availability of specialists. Hospitals are required to have policies and procedures in place to cover situations when a particular specialty is not available.
EMTALA does not require physicians to serve on-call. The obligation to serve on-call is part of the physician’s employment agreement with the hospital. EMTALA allows physicians to be on-call at more than one hospital at the same time and allows them to perform elective surgeries while on-call. If, however, a physician is on a hospital’s on-call list for a particular time and fails or refuses to respond to a call, that could constitute an EMTALA violation.
Whether a hospital’s on-call procedures are in compliance with EMTALA depends on a number of factors, including: the number of physicians on staff at the hospital; the number of patients the hospital serves; other demands on the physicians; and how often the population served by the hospital requires the services of certain specialists. The Centers for Medicare and Medicaid Services (CMMS), which are responsible for developing EMTALA rules and regulations, have not identified set numerical ratios for the provision of on-call services. Instead, the CMMS look to the facts regarding each particular hospital and case to determine whether an EMTALA violation has occurred.
Copyright 2011 LexisNexis, a division of Reed Elsevier Inc.