An emergency department must treat all patients presenting with life-threatening emergencies or in active labor regardless of their ability to pay, according to EMTALA regulations. Hospitals found violating EMTALA can face fines in excess of $70,000 as well as lose Medicare/Medicaid funding for repeated violations.
As an individual in the United States, each person has certain rights when visiting a hospital. Individual state laws may provide additional safeguards.
Emergency Medical Treatment and Active Labor Act
Congress adopted the Emergency Medical Treatment and Active Labor Act (EMTALA) in 1986 to guarantee access to emergency care regardless of ability to pay. Under its provisions, hospitals must offer medical screening examinations when considered necessary to assess whether someone may have an EMC; treating those identified with an EMC until stabilization occurs or transferring them to another facility capable of providing appropriate care; the law prohibits patient “dumping,” where uninsured patients are moved out for financial reasons alone.
Though EMTALA is a federal law, many states have their own versions or similar legislation protecting indigent patients. Over the years, amendments to EMTALA have expanded its coverage into emergency health care issues including patient rights.
As per current law, hospitals must perform a medical screening exam on every person who enters their emergency department regardless of insurance status or ability to pay. “Coming into” an emergency department means entering any part of hospital property such as its parking lot, clinic operated under Medicare provider number or ambulances owned and operated by them – even if these may not physically be located on hospital property.
Hospitals who violate the law face stiff fines and could lose Medicare reimbursement, while any staff who commit violations could even face criminal prosecution.
Given the potential liability, all staff at hospitals with emergency departments (ED) should understand their legal responsibilities and obligations under state laws. This applies to nurses and physicians working at satellite clinics affiliated with the hospital network as well as any facilities within it. Communicating directly with patients regarding insurance or payment status could constitute violating state laws – this may delay fulfilling an obligation to perform medical screening examinations on them.
Medical Malpractice
Under EMTALA, hospitals cannot refuse treatment to those experiencing a medical emergency regardless of whether or not they have insurance or can pay for the care. But that does not obligate hospitals to treat every individual that walks through the door – for example if someone presents themselves due to intoxication or a communicable disease they could legally refuse care – similarly they could turn down treatment of anyone engaging in persistent drug-seeking behavior or who poses threats to other’s safety.
However, hospital refusal to treat patients without insurance could constitute medical malpractice if it results in injuries to either themselves or their families. A patient or their family would need to demonstrate that a breach occurred that directly led to injuries; and also prove they are compensable such as additional or ongoing medical bills and pain and suffering as a result of this breach.
In order to establish medical malpractice, a patient or their family must establish that their treating doctor breached an established standard of care by deviating from it when treating them. They could hire expert testimony as support of their case that the physician breached this standard by refusing treatment altogether.
Hannon Legal Group can help if a doctor refuses to treat you because you lack insurance, with decades of experience representing both injured patients and their families in medical malpractice claims. Call or complete our contact form for a free consultation – we look forward to hearing from you. Our New York City-based office serves clients from throughout New York state; no fees will be assessed until either we win or settle your case! To learn more about us please visit our About Us page where our attorneys are members of the New York Bar Association as well as certified by National Board of Trial Advocacy.
Patient Dumping
Patient dumping occurs when hospitals prematurely discharge patients without making adequate arrangements for their continued care, usually to bus stops, homeless shelters, or other hospitals. It often happens when hospitals are understaffed and overwhelmed. Not only is patient dumping unethical and illegal but it may lead to further injury or even death for those dumped; additionally it damages facilities’ reputations as healthcare providers as well as strain other facilities within the healthcare system.
Patient dumping cases have quickly become local and national causes celebres that shed light on the darker aspects of healthcare industry operations. While we might assume that this issue stems from healthcare providers operating on razor thin margins to make ends meet, patients without coverage who cannot afford medical bills may actually be victims of deeper systemic flaws than just poor financial planning.
In the late 1800s, “patient dumping” was first made popular by New York Times articles which described how private hospitals would send sickly patients via horse drawn ambulance to Bellevue Public Hospital in order to reduce mortality rates and costs. Patients would arrive there unprotected and often without adequate medical treatment; sometimes even dying during transport.
EMTALA and other state regulations prevent hospitals from discriminating based solely on patients’ ability to pay, yet their enforcement can sometimes be insufficient. Some courts have even found a failure by hospitals to adequately treat all patients regardless of ability-to-pay to be in violation of EMTALA.
As part of an effective solution, facilities should ensure all patients who come through are provided with proper screening examination and stabilization regardless of socioeconomic status. It’s also vital that any physicians employed by your facility adhere to AMA code guidelines regarding turfing or patient dumping as part of their employment contract and policies governing patient treatment; otherwise they could potentially breach those guidelines and engage in turfing/patient dumping behaviors themselves.
State Regulations
Never would a patient want to face being denied medical care when in dire need, yet most hospital employees are aware of federal laws prohibiting this behavior, known as “patient dumping.” Unfortunately, though, this law doesn’t cover every situation; for example a hospital may legally refuse treatment to an uninsured patient due to lack of resources or inability to handle their condition.
However, hospital rules can be more complex than this. For example, they may deny treatment to an individual who displays dangerous behavior that endangers other patients’ safety or staff lives; on religious or conscientious grounds; or when there’s evidence suggesting mental health problems are making treatment impossible.
However, hospitals must still provide emergency services to all patients irrespective of insurance or ability to pay; EMTALA policies dictate this practice. If someone needs urgent medical treatment despite not having insurance or the means to cover care, they cannot be denied care unless serious or life-threatening injuries exist that necessitate hospital intervention according to EMTALA policy.
If you have been denied treatment at a hospital, and feel it has violated your rights, contact our team of legal experts immediately for advice on the possible options that exist to pursue legal action against it. We can assist in filing a medical malpractice claim against them.
US hospitals are required by law to treat all patients who present themselves at emergency rooms regardless of their ability to pay or insurance status, so as to guarantee every citizen access to emergency healthcare should they require it.
Hospitals will still charge you for the services they provide; rather, they may try to collect via their internal billing system or third-party collectors.
Hospitals may still charge you for emergency services they provided even if your income falls below the federal poverty level; some hospitals even offer discounts to low-income patients without health insurance policies.