Legal Eagle Eye Newsletter for the Nursing Profession (4)14 Nov 96



   Quick Summary: The hospital must examine the person to determine if an emergency exists.

   Congress enacted the Emergency Medical Treatment and Active Labor Act (EMTALA) in response to reports of hospital emergency rooms refusing to accept and treat patients with emergency medical conditions or in active labor who did not have medical insurance.

   EMTALA applies to any person who comes to the emergency department of any hospital which participates in Medicare, even if the person is not uninsured or is not on Medicare.

   EMTALA does not say that the person has to come to the emergency room with an emergency medical condition, for EMTALA to apply.

   When a person comes to the emergency room and a request is made for an examination, the hospital must provide a medically-appropriate screening examination within the capabilities of the hospital’s emergency department to determine whether an emergency medical condition exists and to determine the appropriate treatment.  UNITED STATES COURT OF APPEALS, FIRST CIRCUIT (PUERTO RICO), 1995.


   Most of the litigation arising under the Emergency Medical Treatment and Active Labor Act (EMTALA) has involved patients who have come or been brought to hospital emergency rooms with obviously emergent medical conditions.

   However, in a recent case, the U.S. Court of Appeals for the First Circuit (Puerto Rico) drew attention to the fact the EMTALA applies to all persons who come to a hospital emergency department and request an examination, whether they report they have or actually have an emergency medical condition when they arrive at the emergency department.

   Hospitals which participate in Medicare must develop and uniformly follow medically-appropriate procedures for screening, examining and treating all persons who come to the emergency room.

   The policy of the hospital in this case was that a person reporting chest pain was automatically considered a critical case in need of prompt attention from a physician. A triage nurse would take the history and vital signs, make an initial assessment, and call the patient to the physician’s attention.

   Patients with only nausea and vomiting, however, were assumed to be non-emergency cases. Histories and vital signs were not taken on arrival, and they were not monitored while waiting. Nausea and vomiting in an elderly, hypertensive, diabetic patient, according to the court, can be very grave signs and symptoms. This patient began having chest pains while waiting in the ER, went into shock and died.

   It was wrong that the hospital did not promptly screen and examine this patient just like any other patient, merely because it seemed superficially she did not have an emergency medical condition when she arrived, the court ruled. Correa vs. Hospital San Francisco, 69 F. 3d 1184 (1st Cir., 1995).