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ABSTRACT The Emergency Medical Treatment and Labor Act was enacted in 1986 to prevent hospitals from turning away patients with emergency medical conditions, often because they were uninsured-a practice commonly known as "patient dumping." Twenty-five years later, Denver Health-a large, urban, safety-net hospital-continues to experience instances in which people with emergency conditions, many of whom are uninsured, end up in the safety-net setting after having been denied care or receiving incomplete care elsewhere. We present five case studies and discuss potential limitations in the oversight and enforcement of the 1986 law.We advocate for a more effective system for reporting and acting on potential violations, as well as clearer standards governing compliance with the law.
Enacted in 1986 in response to widespread evidence of the denial of care to patients experiencing medical emergencies, typically because they were uninsured, the Emergency Medical Treatment and Labor Act (EMTALA) realigned the legal relationship between hospitals and patients. Under the act, hospitals are obligated to act as a safety net in times of medical emergency by providing a screening examination and stabilization care or an appropriate transfer to another facility, regardless of the patient's ability to pay.
Although EMTALA builds on common law and state legislative precedent, there has been extensive litigation over its meaning and scope since its enactment. A Lexis search in May 2011 found more than 300 federal court decisions alone between 1986 and 2011. Amendments to the Internal Revenue Code in 2010 as part of the Affordable Care Act require nonprofit hospitals to have a written policy demonstrating compliance with EMTALA's basic mandate, as a condition of maintaining federal tax-exempt status.
However, we argue that EMTALA is a law whose reach is limited and whose application has been relaxed as a result of revised regulations issued in 2003.1 The Department of Health and Human Services, which oversees the enforcement of EMTALA, maintains no ongoing transparent and public reporting system for potential violations. Furthermore, the department's internal enforcement system,2 which reports on case resolutions,3 has been criticized by the Government Accountability Office and the department's own inspector general as inconsistent and weak.4 Although EMTALA empowers both patients and hospitals that believe they have experienced violations of the law to file lawsuits on that basis, in addition...