Hospital Emergency Department Transfers
New Jersey laws require hospitals to provide necessary medical care to all patients who request it, regardless of patients’ ability to pay (See Your Right to Hospital Care). There are also state and federal laws that prohibit hospitals and hospital emergency departments from transporting or referring patients with emergency medical conditions to other hospitals because they cannot pay for their care.
The following are brief summaries of important laws that protect patients’ rights to promptly receive necessary and comprehensive emergency treatment, regardless of their income status, or for any other non-medical reason. Legal citations are included.
EMTALA (Emergency Medical Treatment and Active Labor Act)
EMTALA is a federal law that was passed in 1986 to address hospitals’ “dumping” poor and uninsured patients by refusing to treat them in their emergency departments or transferring them to other health facilities. EMTALA is also called the “anti-dumping act.”
The Act requires hospitals with Medicare agreements to provide comprehensive screening and treatment for all individuals who present at a hospital and seek help for an emergency medical condition, including active labor, without regard to ability to pay. EMTALA also requires hospitals to stabilize patients’ emergency conditions and to transfer the patient to another facility only when the physician certifies that the need to transfer the patient is greater than the added risks to the patient’s health.
EMTALA has also protected patients who have been admitted for in-patient hospital follow-up treatment. The Act has traditionally been interpreted to prohibit hospitals from discharging patients without appropriate plans for their necessary care after leaving the hospital
The Act also imposes serious penalties on hospitals and physicians who violate the Act’s requirements. A hospital with more than 100 beds can be fined up to $50,000 for each violation, and a hospital with fewer beds may be fined to a maximum of $25,000 per violation. The law also allows Medicare to revoke its agreement with a hospital that violates the Act. Not surprisingly, hospitals take accusations of an EMTALA violation very seriously.
Enforcement of EMTALA lies mostly with the US Department of Health and Human Services, Office of the Inspector General, and with the Centers for Medicare and Medicaid Services (CMS), a division of the Department. Violations of EMTALA can be reported to these agencies for investigation.
In 2003, final federal rules were published that revised the existing regulations. The new rules have modified hospitals’ responsibilities in some instances and expanded them in others. Guidance issued by CMS and the Office of the Inspector General continues to protect emergency department patients but no longer guarantees appropriate discharge protection under EMTALA for patients who have been admitted as inpatients. (42 U.S.C. §1395dd; 42 C.F.R. §§ 413, 482, 489.)
Waiting for Emergency Treatment
A qualified medical professional must evaluate every person who requests care at a hospital emergency department in New Jersey. The person cannot be discharged or transferred to another facility until the evaluation has been completed. “The evaluation shall occur within four hours of the patient coming to the emergency department.” (N.J.A.C. 8:43G-12.7[g].)
Emergency Department Records
When discharge from the emergency department occurs, following a medical screening examination, the patient or the patient’s representative must be given written instructions and an oral explanation of the instructions. The following information must be noted “legibly” in the patient’s medical record: the name of the doctor who ordered the instructions, the name of the person who explained them, and the name of the patient or person who received the instructions. (N.J.A.C. 8:43G-12.7[n].)
Note: If you think that a hospital emergency department has violated these state laws, you may report it to the NJ Department of Health and Senior Services, the agency that licenses hospitals and health facilities in the state. You can contact them through their 24-hour Complaint Hotline (1-800-792-9770) or at their Web site.
This information last reviewed 10/26/11