Emergency Medical Treatment and Active Labor Act - Term Paper Example

Emergency Medical Treatment and Active Labor Act Introduction The US Congress enacted the Emergency Medical Treatment andActive Labor Act (EMTALA) in the year 1986 as a section of the Consolidated Omnibus Reconciliation Act (COBRA), much of which addressed Medicare and health issues. The primary goal of the act was to ensure patient’s access to emergency Medicare and to avert the practice of patient dumping. These were cases where uninsured patients were moved from private to public hospitals without reflection of their medical state or solidity for the transfer exclusively for financial reasons. EMTALA has generated a storm of argument over the resulting 15 years, and it is now deemed one of the most all-inclusive acts assuring non-discriminatory access to emergency Medicare and consequently to the health care system. Although its primary language covered the care of emergency medical situations, through explanations by the Centers for Medicare and Medicaid Services, the body that supervises EMTALA implementation, in addition to several court decisions, the decree now potentially applies to practically all features of patient care in hospital settings (Zibulewsky, 1). Angelini and Mahlmeister assert that EMTALA was initiated in reply to concerns that some hospital and emergency divisions were refusing to attend to medically destitute or uninsured patients. It is valid to all hospitals that engage in Medicare. The function of the act is to guarantee that hospitals do not deny patients with medical emergencies as well as women in labor treatment on any grounds other than those that echo the hospitals capability to inspect, conduct tests and treat emergency conditions. Courts have constantly applied EMTALA to forbid any prejudiced treatment of patients, regardless of intention (1). The legal consents of EMTALA insist that all psychiatrists and psychiatric emergency staff be trained about this vital federal legislation, whether they work in a hospital, in an emergency service, in an outpatient clinic or as on-call experts. As a lawful act, EMTALA rules that every patient who comes to the emergency section for emergency care get sufficient medical screening test to establish the presence of an emergency medical situation, without considering his or her capability to pay. The directives further direct that the test must not be postponed for financial reasons. In addition, if a screening test discloses an emergency medical condition, doctors must sufficiently calm it using all accessible hospital services before the release of the patient, and if they designate a transfer, it must be a suitable transfer as the directives dictate (Quinn, et al, 4). Angelini and Mahlmeister agree that EMTALA inflicts precise responsibilities on health care providers who offer medical care. These include carrying out medical screening tests to establish the existence of a medical condition; providing essential stabilizing treatment when there is an emergency medical condition; and in the event that the medical doctor establishes the fact that the benefits of transfer overshadow the dangers, organizing for suitable transfer to another hospital. EMTALA also forbids hospitals from holding up the screening test and stabilizing treatment to query concerning the patients methods of payment or insurance coverage (3). Although the act indicates that only hospitals with emergency sections are subject to its rules, successive directives and court rulings have enormously expanded the meaning of emergency section. It is not bound to a selected physical space in the hospital but can refer to any section in the hospital where patients can be admitted for tests and treatment of emergencies. Furthermore, patient dumping is not a practice bounded to emergency rooms. If a hospital decides that a patient on the ward has an emergency medical condition, it may panic that the price of treatment will outdo the patients capabilities hence seek to transfer the patient. Therefore, private clinics, urgent care facilities, in-hospital wards, psychiatric facilities, labor and delivery as well as outpatient surgery centers might be included (Zibulewsky, 3). The act identifies the patients right to decline treatment. For instance, when an expectant woman is established to have an emergency medical condition, the hospital should offer additional test and treatment within its potential. The physician must notify the woman of the dangers and advantages of such a test and treatment to both her and her unborn child. If the mother then declines care, the hospital must take all sensible steps to give her a written informed denial. Law experts who understand the act advocate that the doctor come to the hospital to get a written informed refusal from the woman. The midwife ought to document cautiously the precise risks and benefits conversed with the woman before the physicians arrival and the steps taken to attain the womans approval to further tests and treatments. The consulting doctor must attach a thorough note documenting that the mother positively refused the original request for test and treatment when she first arrived at the hospital (Angelini & Mahlmeister, 4). In spite of its primary intention as a no prejudice bill, the act has extensive repercussions for all features of emergency care of patients. Though explicit in its intention, it is intrinsically unclear in its analysis and has as many unanticipated implications as there are unlimited appearances of disease in the emergency sections. One significant outcome is the financial outcome. According to the American Hospital Association (AHA), in 1996, about 16% of emergency department patients were without insurance cover. The emergency department is the entry for as many as 3 of every 4 uninsured patients in the countrys hospitals. Traditionally, uncompensated care was reversed by increasing payments for services for the insured. Through such cost-shifting, health care systems were able to give care for the needy and remain financially solvent. Nevertheless, diagnosis-related groups, health preservation associations and potential payment schemes have hampered hospitals capabilities to go on with this system. There were up to 426 million dollars estimated uncompensated costs to emergency physicians for services provided under EMTALA in 1996. This puts financial strains to hospitals especially private clinics since they have to pay for these costs (Zibulewsky, 6). Zibulewsky further indicates that participating physicians and hospitals that carelessly infringe the act are subject to a civil financial penalty not to go beyond $50,000 or $25,000 for hospitals with less than one hundred beds for each infringement. Since one patient encounter may lead to more than one infringement, fines can exceed $50,000 per patient. Consequently, majority of doctor’s misconduct policies will not cover such directorial penalties; thus, the physician may have to pay them out of his or her own pocket. The protection costs to the doctor may be covered. More significantly, physicians and hospitals are liable to be denied contribution in the Medicare program, an unusually introduced but potentially lethal loss for hospitals. Since 1986, thirteen hospitals have been closed from providing Medicare, and all but one closure happened before 1993. Up to now, an examination of approximately 33% of all US hospitals has revealed claimed infringements of EMTALA law (5). Conclusion Emergency medical treatment and active labor act (EMTALA) has been a crucial step towards guaranteed medical examination and test for emergency cases. Since its enactment, it has helped to terminate undesired medical practices for emergency treatment. The act however is not fully accepted by some medical practitioners. This is because it inflicts high financial strain to the hospitals. Others feel that its requirements are very strict and that it is very hard for them to comply with its regulations. In addition, the regulations of the act have led to the closure of various hospitals and heavy fines have been imposed on the violators of the law. This law needs to be strengthened further if emergency responses in hospitals are to be realized. By so doing, there will be fewer cases of patient dumping and delayed tests and treatments on grounds of financial capabilities. Works Cited Angelini, Dianne & Mahlmeister, Laura. “Management of EMTALA regulations and common obstetric risks: EmergencyMedical Treatment and Active Labor Act.” Midwifery Women’s Health Journal, 50.6 (2005): 472-478. Print. Quinn, Diana. et al. “The Emergency Medical Treatment and Active Labor Act of 1985 and the Practice of Psychiatry.” American Psychiatric Association, 53.10 (2002): 1301-1307. Print. Zibulewsky, Joseph. “The Emergency Medical Treatment and Active Labor Act (EMTALA): what it is and what it means for physicians.” Baylor University Medical Center Journal, 14.4 (2001): 339–346. Print. Read More