New EMTALA Regulations Take Effect On Nov. 10, 2003

New regulations that clarify and in some instances change the current interpretation of the Emergency Medical Treatment and Labor Act (EMTALA) take effect on Nov. 10, 2003.

The new rules clarify when the EMTALA requirements apply and address confusion over on-call requirements. The new EMTALA rules continue to require that physicians and hospitals screen, treat and stabilize when a patient presents with an emergency medical condition (EMC) to a dedicated emergency department (DED). 

The final regulations define the DED as 1) the entity defined by the state as the ED; 2) an entity which holds itself out to the public as an ED, or 3) an entity which during the preceding calendar year provided at least 1/3 of its outpatient visits for the treatment of EMCs. However, in what is considered a major, and applauded, change in the guidelines, the rules state EMTALA requirements do not apply automatically when a patient comes to a provider based entity, unless it meets the requirements of a DED.

The rules also make clear that EMTALA requirements end once a patient is admitted to a hospital. At that point the patient is protected by hospital condition of participation rules as well as laws against “patient dumping” and “abandonment”.
The rules also discuss the scenario where a visitor to the hospital experiences a medical emergency. In this case, the hospital is obligated to treat according to EMTALA guidelines. The rules also codify that the prudent layperson standard applies to emergency presentations.

Regarding on-call requirements, the rules clarify that, as a condition of participation hospitals must maintain an appropriate list of physicians who take call and that physicians who agree to be on the list must show up.  

The on-call standard for hospitals through the EMTALA rule is that which “best meets the needs of patients who are receiving services required under EMTALA in accordance with the capability of the hospitals, including the availability of on-call physicians.”  

If a hospital is unable to provide on-call coverage for a specific specialty (e.g. specialty not available or physician is unable to respond based on circumstances beyond his or her control), it should then have written polices and procedures that respond to those situations.

The EMTALA rules do not require physicians to take call. However, the preamble to the rule states that while physicians are not required to take call through EMTALA, physicians with staff privileges to a hospital may not refuse to be listed on the on call roster. 

Two points:  (1) preambles to rulemakings do not carry the weight of law, they are interpretative; and (2) while EMTALA per se could not be used to force a physician to take call, medical staff rules, guidelines and bylaws do apply and may require otherwise.  Of note, the on-call provisions continue to be debated and may be the focus of a national EMTALA Commission pending passage of Medicare reform legislation.

-- Alex. Calcagno
MMS Government Relations

Note: This information is intended to serve as a general resource and guide. It is not to be construed as legal advice. Attorneys with knowledge of the EMTALA laws should be consulted regarding the application of these laws to specific situations.