LEGAL ISSUES
■ Can be performed by anyone the hospital designates as its standard of
practice; in practice, this is usually the physician, but it can be a delegate,
ie, nurse, physician assistant, etc.
Transfers, When the EMC Is Not Yet Stabilized, Cannot Take Place Unless:
■ The patient or representative requests it, knowing the risks and the hospi-
tal’s EMTALA obligations, or
■ The transferring physician certifies the benefits outweigh the risks, and
■ The transfer is medically appropriate
An Appropriate Transfer Includes the Following Elements:
■ The transferring hospital must do all it can to minimize the risks of transfer.
■ The receiving hospital has available space and personneland has agreed
to take the case.
■ The transferring hospital sends copies of records, including the name and
address of any on-call physician who has refused or failed to appear within
a reasonable time to help stabilize the patient.
■ The transfer must use qualified personnel and equipment.
■ Medical records must be maintained by the hospital for a period of 5 years
from the date of transfer.
If a receiving hospital, such as burn or shock-trauma units, has capacity, it
cannot refuse “appropriate transfers.” This leaves open the possibility of reject-
ing inappropriate transfers, but many authorities point to the difficulty of
proof and suggest a “Just Say Yes” policy.
The New Regulations of 2003 Made the Following Modifications:
■ Adedicated emergency departmentis any hospital-owned or controlled
facility that is:
■ Licensed by the state as an emergency department
■ Held out to the public or advertised as seeing emergency medical con-
ditions without appointment, or
■ One-third or more of its outpatient visits in the previous year were for
EMCs without appointment.
■ Previous amendments to the regulation considered all hospital-owned
and operated ambulancesand any property within 250 yards of the
campusas “coming to the hospital”
■ On-call requirementsfor hospitals were relaxed; allow for one specialist to
take call for several hospitals simultaneously as long as there is a backup
plan in case the specialist is unavailable.
■ A hospital’s EMTALA obligation ends with hospital admission.
■ Nonemergent conditions do not invoke an EMTALA obligation. For
example, patients coming for suture removal are exempt from EMTALA.
■ Normal registration processes may be followed as long as screening and
stabilizing treatment are NOT delayed.
■ Hospital ambulancesarenotsubject to community-wide EMS protocols
on hospital diversion.
■ Bioterrorism emergenciesareexemptfrom EMTALA regulations.
EMTALA Violations
Enforcement of EMTALA is complaint driven. To that end, the law requires
hospitals receiving transfers to report violations within 72 hours. EMTALA is
enforced by the Office of the Inspector General. Civil penalties include:
Referral center hospitals, eg,
burn centers, with capacity
cannot refuse transfers.Civil monetary penalties are
not covered by malpractice
insurance.