From the Guidelines
No, EMTALA does not require emergency departments to perform any screening test requested by a patient. EMTALA requires hospitals to provide an appropriate medical screening examination to determine if an emergency medical condition exists, as stated in the most recent study 1. The hospital must use the resources reasonably available to determine if an emergency condition is present. The screening examination should be consistent with the hospital's capabilities and what would typically be provided to patients presenting with similar symptoms.
Key Points to Consider
- The medical professionals, not the patient, determine which tests are medically necessary for proper screening, as emphasized in 1 and 1.
- While patients may request specific tests, the emergency department physicians have the clinical discretion to determine which diagnostic tests are appropriate based on the patient's symptoms, medical history, and clinical presentation.
- The purpose of EMTALA is to ensure patients receive necessary emergency care regardless of their ability to pay, not to guarantee that any requested test will be performed, as clarified in 1.
Clinical Implications
- Emergency departments should prioritize providing an appropriate medical screening examination to determine if an emergency medical condition exists, rather than fulfilling patient requests for specific tests.
- The use of resources should be guided by the hospital's capabilities and the patient's clinical presentation, as recommended in 1 and 1.
- The goal of EMTALA is to prevent the "dumping" of medically unstable patients, particularly those who are indigent, and to ensure that all patients receive necessary emergency care, as stated in 1.
From the Research
EMTALA Requirements
- The Emergency Medical Treatment and Active Labor Act (EMTALA) requires hospitals to provide a medical screening examination to determine whether an emergency medical condition exists 2.
- The Act does not require the Emergency Department (ED) to perform any screening test requested, but rather to provide a medical screening examination to determine whether an emergency medical condition exists 2.
- If a patient is found to have an emergency medical condition, the ED must stabilize the patient, which may involve consulting with an on-call physician to administer necessary stabilizing treatment 2.
Screening Examinations
- EMTALA requires that all patients who seek emergency treatment be given an adequate medical screening examination 3.
- The medical screening examination must be performed to determine whether an emergency medical condition exists, but it does not require the ED to perform any specific screening test requested by the patient or others 2.
- Recent trends in federal case law interpreting EMTALA suggest that a medical screening exam is not required for patients brought by police specifically for a blood or urine sample unless either the arrestee requests medical care or a prudent observer would believe medical care was indicated 4.
Compliance with EMTALA
- Hospitals and physicians must comply with EMTALA's requirements, which include providing a medical screening examination and stabilizing patients with emergency medical conditions 5, 3.
- Failure to comply with EMTALA's requirements can result in sanctions, including fines, damages awarded in civil litigation, and exclusion from Medicare 5.