Must Emergency Rooms treat uninsured destitute patients?
If so, how long?
Emergency Medical Treatment & Labor Act (EMTALA)

Introduction
Care required in an emergency

In an emergency Hospitals are  required to provide stabilizing treatment for patients with Emergency Medical Conditions EMCs without discrimination.  If a hospital is unable to stabilize a patient within its capability, or if the patient requests, an appropriate transfer should be implemented.  ^Wikipedia *   ^CMS.gov

The  public must have access to emergency services regardless of ability to pay.  Under Federal Law there are  specific obligations on Medicare-participating hospitals that offer emergency services to provide:

a medical screening examination (MSE) when a request is made for examination or treatment for an emergency medical condition (EMC), including active labor, regardless of an individual’s ability to pay.   ^{SSA.Gov * CMS.gov * House.Gov *} 

Definitions

emergency department as “a specially equipped and staffed area of the hospital used a significant portion of the time for initial evaluation and treatment of outpatients for emergency medical conditions .”^[9] This means, for example, that outpatient clinics not equipped to handle medical emergencies are not obligated under EMTALA and can simply refer patients to a nearby emergency department for care.^[9]

An emergency medical #condition (EMC) is defined as “a condition manifesting itself by acute symptoms of sufficient severity (including severe pain) such that the absence of immediate medical attention could reasonably be expected to result in placing the individual’s health [or the health of an unborn child] in serious jeopardy, serious impairment to bodily functions, or serious dysfunction of bodily organs.” For example, a pregnant woman with an emergency condition must be treated until delivery is complete unless a transfer under the statute is appropriate.^[9]

Patients treated under EMTALA may not be able to pay or have insurance –

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or other programs like Medi-Cal pay for the associated costs but are legally responsible for any costs incurred as a result of their care under civil law.

A patient is defined as “stable,” therefore ending a hospital’s EMTALA obligations, if:

• The patient is conscious, alert, and oriented.
• The cause of all symptoms reported by the patient or representative, and all potentially life-threatening, limb-threatening, or organ-threatening symptoms discovered by hospital staff, has been ascertained to the best of the hospital’s ability.
• Any conditions that are immediately life-threatening, limb-threatening, or organ-threatening have been treated to the best of the hospital’s ability to ensure the patient does not need further inpatient care.
• The patient is able to care for himself or herself, with or without special equipment, which if needed, must be provided. The required abilities are:
  • Breathing
  • Feeding
  • Mobility
  • Dressing
  • Personal hygiene
  • Toileting
  • Medicating
  • Communication
  • Another competent person is available and able to meet the patient’s needs following discharge.   ^Wikipedia

The “prudent layperson” definition of an emergency medical condition is any medical or behavioral condition of recent onset and severity, not limited to severe pain, that would lead a typical person possessing an average knowledge of medicine and health to believe that his or her condition, sickness, or injury is of such a nature that failure to obtain immediate medical care could jeopardize life, limb, or mental health. The presenting sign or symptom is paramount, not the final diagnosis, when determining whether to pay emergency medical claims.  ^{RAC Monitor Hospitals must screen patients who come to the ER} *

Problems with this definition and how expenses health care inflation have increased  CMS.gov 100 – 07 Emergency Cases   *  acepnow.com/prudent-layperson-standard-emergency-medicine-attack/  *

Links & Resources

• Medi-Cal Eligibility – Coverage  can be backdated 3 months!
  • Estate Recovery?
• Wikipedia Emergency Medical Treatment Act
• Medical Repatriation – Deportation
• Attorney Website  Injury Claim Coach

 Call 988 for Mental Health Emergencies

Mid July 2022 there is supposed to be a new # to call, just like 911 for Mental Health Emergencies, but the funding doesn't see to be there for California.

• Millions have used the 988 mental health crisis line, but most say they wouldn’t turn to it again  CNN
• allotsego.com/mental-health-emergency-number-coming-in-july
• Miles Hall Lifeline and Suicide Prevention Act
• usnews.com/988-mental-health
• nbc new york.com/new-national-suicide-hotline--lacks-funding

What happens if you have a severe chronic condition or major accident, you can’t qualify for Medi-Cal as you are not lawfully present, must a hospital treat you if you show up in the ER Emergency Room?

You could get deported!

In an emergency, hospitals, by law –  EMTALA – must treat any patient in the U.S. until he or she is stabilized , regardless of the patient’s immigration status or ability to pay.

Yet, when it comes time for the hospitals to discharge these patients, the same standard doesn’t apply. Though hospitals are legally obligated to find suitable places to discharge patients (for example, to their homes, rehabilitation facilities or nursing homes), their insurance status makes all the difference. After reaching the patient’s family in Mexico, and discussing issues with the Mexican consulate, the case manager began making travel arrangements to a rehabilitation hospital in Mexico. Medical air transport to another country is an expensive proposition — roughly $50,000, depending on the equipment needed and the distance to the receiving facility in the patient’s home nation. From the hospital’s point of view, it was easy to see that this large one-time expense would be worthwhile. The transfer to Mexico would put a stop to the indefinite, uncompensated costs of continued hospitalization. Further, the transfer would open up the patient’s bed to a new (and presumably insured) patient.    ^{NPR 4.9.2016}  *

Some hospitals have been deporting illegal immigrants even though the U.S. government is the only authority that can perform this action.  Medical repatriation is considered a human rights violation mainly because many of these hospitals act as “unauthorized immigration officers.”    ^{Medical news today 4.23.2014 * Forbes 2.26.2018 *}

Public Charge USCIS * Some places where undocumented can go   US News 11.2.2016 *

Links & Resources

• Our page on ER’s having to treat you till your stabilized.
• News report of hospital sending uninsured patient back to his country  * Wikipedia  *
• Hospitals ‘Deport’ Sick, Undocumented Immigrants VIDEO
• See our webpage on lawful presence