EMTALA was amended in 2003 to clarify when an individual is considered to have presented to an Emergency Department (ED) for a Medical Screening Exam (MSE)
A notable case leading to this clarification occurred in 1998. Christopher Sercye, a 15-year-old, was shot near a hospital. Despite Christopher collapsing just thirty feet from the hospital entrance, staff did not assist him due to hospital policy regarding response to events that occurred outside of the hospital. He was eventually brought inside the hospital by police, but succumbed to his injuries shortly after arrival.
Under the clarified EMTALA regulations, an individual is considered to have presented to the ED under EMTALA if any of the following conditions are met:
- The individual, or someone acting on their behalf, requests examination or treatment at the ED.
- The individual requests care while on hospital property, including areas within 250 yards of the main campus, such as parking lots, sidewalks, or driveways.
- The individual is approaching the ED.
- The individual arrives via a hospital-owned or operated ambulance (ground or air) unless the ambulance is redirected to a closer facility.
ADDITIONAL EMTALA REQUIREMENTS
Central Log
Hospitals must maintain a central log documenting all individuals who presented to the ED for treatment. This includes other departments considered EDs or part of the ED, such as pediatrics and labor and delivery. The hospital may maintain the log in a format that best meets the needs of the hospital.
The Central log must contain (at a minimum):
- The individual’s name
- The individual’s disposition, categorized as:
- Treated and released.
- Treated and admitted.
- Stabilized and transferred.
- Transferred
- Discharged
- Refused treatment.
- Left against medical advice (AMA)
- Expired
On-Call Physicians
Hospitals are required to maintain a list of on-call physicians to ensure adequate coverage. While EMTALA does not mandate that physicians accept call duties, it does require hospitals to ensure sufficient coverage.
The on-call list must:
- Be immediately accessible to staff.
- Include individual physician names and contact numbers; group names with a single phone number are not acceptable.
On-call physicians must respond to ED consultation requests within a reasonable time period, typically within 30 minutes. This response includes appearing in person or directing a qualified medical professional to assess and stabilize the individual. Failure to respond appropriately may result in EMTALA violations for the physician and the hospital.
CMS interpretive guidelines for EMTALA prohibit referring emergency cases to physicians' offices. Evaluations and stabilizations must occur within the ED or hospital setting. A patient may be moved to a different area in the hospital where equipment is readily accessible to assist in stabilization.
Policies and Procedures
Hospitals must establish and maintain policies and procedures addressing EMTALA requirements.
- Definition of a “Qualified Medical Person”
- On-call physician response time (telephone and in person)
- Procedures for handling unavailable specialties, unresponsive on-call physicians, and on-call physicians who cannot respond due to circumstances beyond their control.
- Policies for providing emergency services when on-call physicians are permitted to schedule elective surgery or have simultaneous on-call duties.
- Policies for participation in formal community call plans, including:
- Geographic scope of the plan
- Integration with local and regional EMS protocols
- Clear delineation of on-call responsibilities among participating hospitals
- A statement specifying that even if an individual arrives at a hospital that is not designated as the on-call hospital, that hospital has an obligation to provide MSE and stabilizing treatment within its capabilities.
- Signatures from authorized representatives of each participating hospital.
- An annual assessment of the plan.
Signage
Medicare-participating hospitals must post signage outlining patients’ rights under EMTALA. The signs must be posted in the emergency department and areas where patients will be examined, treated, or await care.
Signage must:
- Clearly state the rights of individuals with EMCs and women in labor.
- Indicate whether the facility participates in Medicaid.
- Use language that is easily understood by the population served; and
- Be prominently displayed in areas likely to be noticed by all individuals entering the emergency department and those waiting for examination and treatment (e.g., entrance, admitting area, waiting room, treatment area).
CMS Update (August 13, 2024)
The Centers for Medicare and Medicaid Services (CMS) released an updated version of the required sign, which includes:
- Clarified language regarding Medicaid participation.
- A QR code linking to information about an individual's rights under EMTALA and complaint procedures.
- Versions available in both English and Spanish.
REFERENCES
The Future of Emergency Department Liability After the Ravenswood Hospital Incident: Redefining the Duty to Treat
https://www.cms.gov/medicare/regulations-guidance/legislation/emergency-medical-treatment-labor-act
42 CFR 489.24 (up to date as of 7/06/2025)
For questions or to learn more, contact the C&A team at 704-573-4535 or email us at info@courtemanche-assocs.com.
