EMTALA Emergency Medical Care Calculator

How does this EMTALA emergency medical care calculator work?

This is a health tool that is designed based on the EMTALA (Emergency Medical Treatment and Active Labor Act) as a checklist for chart review purposes.

The EMTALA is a law published in 1986 aimed at creating the framework against discrimination in the medical care field, specifically to protect uninsured population from being denied medical care.

Nowadays, the main purpose has moved more towards insuring that emergency patients receive a screening evaluation about their medical condition, that if needed, they are stabilized and/ or transferred appropriately. It also states that hospitals need to take on a transfer patient if they have the capacity and offer the medical services needed.

The following explains some of the parts in the 42 U.S. Code § 1395dd - Examination and treatment for emergency medical conditions and women in labor and underlines the emergency medical condition rules under point e) which are also used in this EMTALA emergency medical care calculator.

a) Medical Screening Requirement – the hospital must provide appropriate medical screening examination in order to determine the nature and/or existence of an emergency medical condition.

b) Necessary stabilizing treatment - for emergency medical conditions and labor containing some in general observations, refusal to consent to treatment or transfer.

c) Restricting transfers - until individual is stabilized containing the application rules and appropriate types of transfer.

d) Enforcement – through civil money penalties or civil enforcement for personal harm, financial loss to other medical facility and limitations on actions.

e) Definitions and what consists an “emergency medical condition”:

■ (A) a medical condition manifesting itself by acute symptoms of sufficient severity (including severe pain) such that the absence of immediate medical attention could reasonably be expected to result in—

(i) placing the health of the individual (or, with respect to a pregnant woman, the health of the woman or her unborn child) in serious jeopardy,

(ii) serious impairment to bodily functions, or

(iii) serious dysfunction of any bodily organ or part; or

■ (B) with respect to a pregnant woman who is having contractions—

(i) that there is inadequate time to effect a safe transfer to another hospital before delivery, or

(ii) that transfer may pose a threat to the health or safety of the woman or the unborn child.

f) Preemption.

g) Nondiscrimination.

h) No delay in examination or treatment.

i) Whistleblower protections.

The rule of the thumb is that in case at least one of the described in the above point e) is present then it can be established that an emergency medical condition is present.

Although there are specific patient risk stratification tools such as the Glasgow Coma Scale or in case of trauma in the ER, the Revised Trauma Score, the EMTALA provides a provision for a quick decision whether emergency care needs to be provided on the spot.

It is interesting to mention that within this federal law, the condition of active labor is classes as unstable and therefore, EMTALA needs to be applied in the perinatal and neonatal nursing units.

Some of the most common malpractice claims around emergency care and after it are listed below:

■ Negligent non-disclosure;

■ Breach of standard of care;

■ Failure to diagnose;

■ Delay in diagnosis;

■ Failure to follow-up on tests (laboratory, x-ray);

■ Failure to monitor or inadequate coverage.

Also, emergency medicine tends to portray certain pitfalls such as misinterpreting or lack of monitoring of abnormal vital signs, labeling patients and stereotyping or inappropriate transfers.

References

1) 42 U.S. Code § 1395dd - Examination and treatment for emergency medical conditions and women in labor.

2) Zibulewsky J. (2001) The Emergency Medical Treatment and Active Labor Act (EMTALA): what it is and what it means for physicians. Proc (Bayl Univ Med Cent); 14(4): 339–346.

3) Glass DL, Rebstock J, Handberg E. (2004) Emergency Treatment and Labor Act (EMTALA). Avoiding the pitfalls. J Perinat Neonatal Nurs; 18(2):103-14; quiz 115-6.

4) Mercado-Alvarado J, Oliveras García C. (2009) EMTALA: what it is, its origins, and how it functions in Puerto Rico. Bol Asoc Med P R; 101(3):19-21.