EMTALA: Always a Hot Topic

Discussing on-call issues with other specialists is always fun.  I am part of an email group of several plastic surgeons from around the country, and one issue that always brings a lively exchange is EMTALA.

For those unfamiliar with medical alphabet soup, EMTALA is the Emergency Medical Treatment and Active Labor Act of 1986.  Sometimes it is called “the anti-patient dumping law”. 

What it is supposed to do (and generally does pretty well), is to make sure that hospitals do not turn away emergency patients or those in active labor.  They must provide a screening exam and stabilizing treatment, regardless of ability to pay. 

There are many nuances involved with specialists taking emergency call, and the law can be ambiguous in terms of what is and what is not acceptable.  Each type of specialty has its own particular difficulties which arise when they are on-call.  Plastic and hand surgery seem to frequently involve EMTALA concerns.   

One common situation is the patient with a fracture or cut tendon, something which needs to be definitively fixed, but can be treated first by the E.R. staff and then sent to the specialist’s office where definitive treatment can be arranged.   In some cases, specialists refuse to see these patients if they are uninsured.  Ethical concerns aside, such a situation likely violates EMTALA, and the E.R. can be cited for failing to require the specialist to come in for the “unstable” tendon. 

There are plenty more examples, but it seems that private specialists are reducing their on-call exposure.  As margins tighten for private practices, losses from taking call need to be reduced.  More hospitals are paying for specialists to be on-call, which is itself another hotly debated topic. 

E.R. specialist staffing may become less of a problem in the future, if the trend towards clinical integration continues.  For now, with a patchwork of coverage from various private specialists, the EMTALA questions will continue. 

Read more about EMTALA:



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2 responses to “EMTALA: Always a Hot Topic”

  1. seattleskindoc says :

    TP- Enjoying the blog- thanks for posting. I personally find the EMTALA issue, as it relates to specialists, one of the most interesting topics in medicine today- so many facets to this problem, issues that most non-physicians don’t even think about. For example, the concept of out-of-network status that treating specialist in the ED might have relative to their patients, and how these issues can’t even be discussed with patients prior to treatment.

    Agree with your comments about clinical integration- as soon as the local medical centers hire a plastic surgeon, the burden of call on the private docs will be partially relieved. Waiting for that to happen in my region…

    • Thomas Pane says :

      Scott, thanks for your comment.

      The payment issues with out-of-network specialists providing on-call care is a topic in and of itself. And it is not only the Emergency Department that sees these issues. There are incidents where patients in labor have services provided by on call, out-of-network anesthesiologists, and are quite surprised when they receive balance bills after their delivery.

      Greater transparency in health care can help to reduce these kinds of issues, but implementation has been slow.

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