Report No. 201

Emtala Regulations

"Regulation 489.24: Special responsibilities of Medicare hospitals in emergency cases

(a): "General: In the case of a hospital that has an emergency department, if any individual (whether or not eligible for Medicare benefits and regardless of ability to pay) comes by him or herself or with another person to the emergency department and a request is made on the individual's behalf for examination or treatment of a medical condition by qualified medical personnel (as determined by the hospital in its rules and regulations), the hospital must provide for an appropriate medical screening examination within the capability of the hospital's emergency department, including ancillary services routinely available to the emergency department, to determine whether or not an emergency medical condition exists.

The examinations must be conducted by individuals determining qualified by hospital by law or rules or regulations and who meet the requirements of section 482.55 concerning emergency services personnel and direction."

(b) We shall refer to some definitions in the Regulation

(A)'Comes to the emergency department' means, with respect to an individual requesting examination or treatment, that the individual is on hospital property. For purposes of this section, 'property' means the entire main hospital campus, including the parking lot, sidewalk and drive way, as well as any facility or organization that is located off the main hospital campus but has been determined to be a department of the hospital.

'Property' also includes ambulances, owner and operated by the hospital even if the ambulance is not on hospital grounds. An individual in a non-hospital owned ambulance on hospital property is considered to have come to the hospital's emergency department even if a member of the ambulance staff contacts the hospital on telephone or telemetry communications and informs the hospital that they want to transport the individual to the hospital for examination and treatment.

In these situations, the hospital may deny access if it is 'discretionary status', that is, it does not have staff or facilities to accept any additional patients. If, however, the ambulance disregards the hospital's instructions and transports the individual on to the hospital property, the individual is considered to have come to the emergency department.

(B) The regulations define 'Capacity' of a hospital as being its ability to accommodate the individual requesting examination or treatment of the transferred individual. Capacity encompasses such things as number and availability of quality staff, beds and equipment on the hospital's past practices of accommodating additional patient in excess of its occupancy limits.

(C) 'Emergency Medical Condition' means (1) a medical condition manifesting itself by acute symptoms of sufficient severity (including severe pain, psychiatric disturbances and/or symptoms of substance abuse) such that the absence of immediate medical attention could reasonably be expected to result in -

(a) placing the health of the individual (or, with respect toa pregnant woman, the health of the women or her unborn child) in serious jeopardy;

(b) serious impairment to bodily functions; or

(c) serious dysfunction of any bodily organ or part; or

(2) With respect to a pregnant woman who is having contradictions -

(a) that there is inadequate time to effect a safe transfer to another hospital before delivery or

(b) that transfer may pose a threat to the health or safety of the woman or the unborn child.

(D) 'Stabilized' means with respect to an 'emergency medical condition' as defined in this section means:

(i) that no material deterioration is likely, within reasonable medical probability, to result from or occurs during the transfer of the individual from a facility or with respect to an 'emergency medical condition'.

(ii)that the woman has delivered the child and the placenta.

(E)'To stabilize' means, with respect to an 'emergency medical condition:

(i) to provide such medical treatment of the condition necessary to assure, within reasonable medical probability, that no material deterioration of the condition is likely to result from or occurs during the transfer of the individual from a facility; or

(ii) with respect to an 'emergency medical condition', the woman has delivered the child and the placement.