The Emergency Medical Treatment and Active Labor Act (EMTALA) is a Federal law that requires anyone coming to an emergency department to be stabilized and treated, regardless of their insurance status or ability to pay. Enacted in 1986, the law was intended to keep hospitals from dumping patients because they could not afford care. However, studies continue to show that a significant portion of hospitals fail to comply with EMTALA outright or make discharge and transfer decisions based on ability to pay in contravention of the spirit of the law. These violations can result in significant fines for hospitals and doctors as well as give rise to personal injury lawsuits particularly if there were any adverse outcomes due to the failure to provide appropriate screening and care. Because such cases turn on detailed medical evaluations of patients and their treatment, medical expert witnesses are a necessity to establish liability.
EMTALA (42 USC 1395dd) requires that patients who go to a hospital emergency department (ED) undergo an appropriate medical screening examination (MSE) by a physician or qualified medical person to determine whether they have an “emergency medical condition” (EMC). An emergency medical condition is defined as “a 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 placing the individual’s health [or the health of an unborn child] in serious jeopardy, serious impairment to bodily functions, or serious dysfunction of bodily organs.” If an emergency medical condition exists, treatment must be provided until the emergency medical condition is resolved or stabilized.
In a 2018 study, 30% of hospitals were found to have violated EMTALA. The three most common violations were failing to conduct thorough medical screenings, not transferring patients properly, and not following Emergency Department log standards. A frequently litigated issue concerns what constitutes an “appropriate” MSE. Generally, a compliant medical screening examination is considered to be an exam that can be reasonably expected to identify critical emergency medical conditions in a patient who comes to an emergency department for evaluation. Proving or defending against a claim of an inadequate medical screening exam necessitates relying on expert testimony by Emergency Medicine physicians. Emergency medicine is a field of medicine specializing in the treatment of acutely ill and injured people. Such experts can discuss whether the exam complied with EMTALA and met generally accepted standards of practice. In the event that the exam was non-compliant or otherwise missed potential problems which resulted in delayed treatment or other harm to the patient, Emergency Medicine doctors can also testify regarding causation and damages.
Similarly, Emergency Medicine specialists are needed when there are questions related to whether the patient was properly stabilized, particularly if the Emergency Medicine team consulted with an admitting physician before discharging the patient or transferring them to another facility. In this respect, expert witnesses in Hospital Medicine may also be helpful. A Hospital Medicine specialist or “Hospitalist” is a physician whose practice focuses on the care of hospitalized patients, including handling the admission and day-to-day care of hospitalized patients, patient discharge, and quality assurance.
Since hospitals and physicians can be fined for an EMTALA violation regardless of whether there was an adverse patient outcome, it is essential for hospitals to properly document medical decision-making to establish they met EMTALA’s requirements. If a patient was injured, the documentation is necessary in a malpractice action as well. Expert witnesses can also be invaluable in assessing the adequacy of the hospital’s recordkeeping and procedures.
If you are involved in an EMTALA related action by the government or a private lawsuit, Elite Medical Experts can assist you in securing nationally recognized university experts in Emergency Medicine or Hospital Medicine for your case. Contact us today for a complimentary consultation with our physician-led Case Strategy team.
