Emergency Medicine Expert Witness On EMTALA Part 1

In EMTALA What is the “Appropriate Medical Screening Examination,” emergency medicine expert witness Dainius A. Drukteinis writes:

Chances are if you are an emergency medicine physician or nurse you have probably heard of the acronym EMTALA. Even without knowing what it stands for, you likely shudder at the mere mention of the word, with its authoritative ring as if bellowed from a voice up above . . . E-M-T-A-L-A. If a senior physician tells you, “That violates EMTALA,” you don’t ask questions. You simply look down and respond “Yes, Sensai, it will not happen again.” If you have been in the emergency medicine field a few years, you probably know that EMTALA prohibits a hospital from turning patients away from the Emergency Department, and it also prohibits transferring unstable patients to another facility. You know that a violation of EMTALA means bad things will happen. What those bad things are, however, you are not sure. This is usually the extent of people’s knowledge because to know more would require reading the EMTALA statute, both boring and confusing, or court case opinions, more boring and more confusing.

This article introduces the basic concepts of EMTALA by providing a brief history of the statute with its original purpose, a discussion of the statute’s actual form, and subsequent interpretations of EMTALA based on cases. It is written in non-legal fashion, with details in the endnotes for those of you for whom “seeing is believing.” It then challenges your understanding of EMTALA by having you work through a real case before being given the Court’s rationale for its opinion. It will hopefully answer basic questions you have regarding the application of EMTALA, specifically the requirement to perform an “appropriate medical screening examination.” It does not discuss details regarding transferring unstable patients. Do not read this article if you think it will give you EMTALA peace. It will only lead to more questions, as any discussion of legal principles invariably leads to more questions than answers. For the obsessive-compulsive, welcome to the EMTALA black hole.

Dainius A. Drukteinis, M.D., J.D., is a Board Certified Emergency Medicine Physician. He is an Assistant Professor of Emergency Medicine at Tampa General Hospital in conjunction with the University of South Florida.