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June 11, 2012, Vol 172, No. 11 >

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Research Letters | June 11, 2012

Consequences of Federal Patient Transfer Regulations: Effect of the 2003 EMTALA Revision on a Tertiary Referral Center and Evidence of Possible Misuse

David P. Kao, MD; Marina H. Martin, MD, MPH; Amar K. Das, MD, PhD; Stephen J. Ruoss, MD
Arch Intern Med. 2012;172(11):891-892. doi:10.1001/archinternmed.2012.1290.
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Emergency department (ED) use has risen steadily over the past 20 years, in part because patients are guaranteed medical attention under the Emergency Medical Treatment and Active Labor Act (EMTALA). EMTALA requires ED physicians to evaluate and stabilize all patients regardless of ability to pay, and hospitals must provide specialist care or arrange transfer to a tertiary care center when specialist care is unavailable.1- 2 Community hospitals have reported difficulty providing specialist coverage since the enactment of EMTALA, and the Centers for Medicare and Medicaid Services (CMS) published its “Final Rule” regarding EMTALA in September 2003, stating that hospitals with EDs are not required to guarantee specialist coverage at all times.3
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Figure 1. Trends in insurance status of patients with gastrointestinal (GI) bleeding admitted to Hospital J via emergency department compared with EMTALA (Emergency Medical Treatment and Active Labor Act) referral volume from Hospital J for GI bleeding. SUH indicates Stanford University Hospital.

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Figure 2. Annual number of endoscopies performed at Hospital J on patients admitted via emergency department.

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Country-Specific Mortality and Growth Failure in Infancy and Yound Children and Association With Material Stature

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