The analysis provided by Solis & Guyer of Moses v.

Providence Hospital and Medical

Centers, Inc is an interesting discussion on EMTALA. The case attempts to determine if

EMTALA covers psychiatric patients after discharge from a hospital and what liability

remains if the patient harms another person.

EMTALA provides an individual with emergency treatment in a hospital that

participates in Medicare and has an emergency department must be screened and evaluated to

determine if an emergency medical condition exists; if so, the hospital must treat and stabilize

the patient, either in its own facilities or by transfer to an outside facility (Solis & Guyer,

2010). EMTALA is a needed statute as it protects possibly vulnerable patient populations in

emergency situations. Under the statute, gunshot wound victims are treated and stabilized

before the ability to pay is determined just as pregnant women and their unborn children. This

statute protects all people seeking healthcare in emergent situations and ensures treatment

leading to life-saving scenarios.

The facility’s obligation under EMTALA does not end when the patient leaves the

emergency department as critical and stabilizing care also happens in the operating room and

on the floor. As far as the facility’s obligation under EMTALA after the patient leaves the

facility is another question. Solis & Guyer point to the fact that, for medical issues, hospitals

have tools to determine if a patient has been stabilized enough for discharge (ie. Labs, scans

and other tests). In medical cases, it would seem to be apparent if the patient is stable or not.

With psychiatric patients, however, validity of stabilization is more difficult to obtain and

leaves hospitals at higher risk for liability (Solis & Guyer, 2010). Holding hospitals liable for

a patient’s future actions, especially in the case of psychiatric concerns, is an interesting

discussion that has many possible consequences such as what stabilization entails and how

long after discharge that stabilization documentation is valid.

Solis, l. & Guyer. M. (2010). Hospitals' Obligations Under the Emergency Medical Treatment

and Active Labor Act (EMTALA).The Journal of the American Academy of Psychiatry and

the Law; 38(4) 610-612. http://jaapl.org/content/38/4/610

Zuabi, N., Weiss, L., & Langdorf, M. (2016). Emergency medical treatment and labor act

(EMTALA) 2002-2015: review of office of inspector general patient dumping

settlements. The Western Journal of Emergency Medicine, 17  (3), 245-251. doi:

10.5811/westjem.2016.3.29705

Barbara,

I find it interesting that EMTALA ends when the patient leaves the emergency room and is

admitted. Even without EMTALA, different facilities have different definitions of when a

patient is technically admitted. I know that the courts have decided that being “admitted” is

when EMTAL ends but when a patient is admitted is sometimes tricky. Patients in L&D and

observation statuses are not admitted so they fall under EMTALA. Also, where do OR

patients stand with EMTALA? For example, I work at a trauma facility. Under EMTALA, a

GSW patient must be seen and stabilized. The GSW to taken from the ED directly to the OR

and then to PACU. Did EMTALA end for this patient? I can see how this is confusing even

still. Great post!

Trina,

It is interesting that in the eyes of the court EMTALA does not end with admission but CMS

continues to state that EMTALA does end with admission. How confusing! In my opinion,

EMTALA should not end at admission. As I wrote in a previous post, I work at a trauma

facility. Under EMTALA, a GSW patient must be seen and stabilized in the ED. The GSW to

taken from the ED directly to the OR for stabilization. Where does EMTALA end for this

patient as the operation was needed for stabilization. I can see why the courts are still fighting

over this. Great post!