EMTALA Transfer Rules

Author: Michelle Lin, MD
Updated: 9/14/2012

EMTALA Transfer Rules

The Emergency Medical Treatment and Labor Act (EMTALA) is a federal law that requires anyone coming to an ED be stabilized and treated, regardless of their insurance status or ability to pay

  • Known as “anti-dumping law”
  • Goal: Ensure “adequate first response to a medical crisis for all patients”

Rules for the transferring ED

Medically screen patients to determine whether a medical emergency exists (regardless of insurance). This goes beyond a triage assessment. Stabilize patients with medical emergencies to reasonably ensure that no deterioration will result from patient's transfer. Restrict transfer of non-stabilized patients to 2 circumstances:

  1. Patient requests a transfer in writing after being informed of the risks involved and the hospital’s duty to treat under EMTALA, or
  2. A physician certifies that the medical benefits expected from transfer outweigh the risks involved in the transfer (e.g. need higher level of care)

Pregnancy: When having contractions, an emergency medical condition exists when:

  • Inadequate time for safe transfer to another hospital before delivery, or
  • Transfer may pose a threat to the health/safety of patient or unborn child

Steps when transferring a patient

  1. Provide medical treatment to minimize the risk of transfer
  2. Obtain patient’s written consent for transfer
  3. Provide signed certificate of transfer
  4. Assure that the transfer takes place with qualified personnel and equipment
  5. Send copies of medical records related to the emergency condition

Obligation of receiving ED

If have available space and qualified personnel for treating the patient:

  1. Agree to accept transfer of the patient and to provide appropriate medical tx
  2. Regional referral centers and hospitals with specialized capabilities cannot refuse to accept an appropriate transfer if they have the capacity

Fines under EMTALA

A physician can be fined for:

  • Failing to respond to an emergency while on-call
  • Failing to perform a screening exam
  • Failing to inform emergency patients of the risks and benefits of transfer
  • Signing a transfer certification when he or she can reasonably be expected to know that the risks outweigh the benefits

Fine = $25,000 or $50,000 per violation (hospital with <100 beds vs ≥100 beds)