EMTALA lacks anti-patient dumping enforcement

Even under health reform, uninsured Americans are still at risk for being turned away from the emergency room or transferred to another facility, known as patient dumping. According to a study in Health Affairs, the Emergency Medical Treatment and Labor Act (EMTALA)--the 1986 law that banned denying emergency patients care--lacks oversight with noncompliant hospitals escaping punishment.

In particular, five instances demonstrate possible EMTALA violations, in which patients were denied care or transferred and ended up at the safety-net Denver Health, study authors noted.

For more than two decades, it's been illegal to turn away uninsured patients who need emergency care. EMTALA requires hospitals to screen and stabilize patients regardless of their ability to pay. However, study authors, like the Government Accountability Office and the Office of Inspector General, criticized the U.S. Department of Health & Human Services for lax oversight, specifically over a lack of a public reporting system in which people could report potential violations.

"Federal and state investigators must do a better job of identifying violators of the law and enforcing the ban on patient dumping. If we do not start aggressively enforcing the law, millions of uninsured Americans will continue to get no care at all or incomplete care," lead investigator Sara Rosenbaum, a professor at George Washington University School of Public Health and Health Services in Washington, D.C., told Medical News Today.

Although the study called out incidents at Denver Health, authors suggested EMTALA violations can happen anywhere. Medical staff at receiving hospitals often are unwilling to file complaints about transferring hospitals for fear they themselves will be accused of violating EMTALA, the study states. Medical staff also think reporting is a fruitless process.

The study authors recommended regulators:

  • Create clearer standards on what constitutes appropriate screening and stabilization practices
  • Curb provider demands asking for evidence of insurance when patients are seeking emergency care
  • Establish objective standards for measuring the adequacy of on-call specialists in hospitals
  • Make records comparing a hospital's previous provision of specialty services for the same complaint easily accessible to regulators and to enforcement
  • Evaluate transfer requests by hospitals with specialized capabilities

For more information:
- read the Medical News Today article
- see the study abstract

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