Question

You have graduated from an university and manage the emergency services department of Winterfell Castle. You are fully aware of the regulations under EMTALA (42 C.F.R. § 413.65). Recently many persons in the surrounding countryside have suffered burns, or knife or sword wounds. They have been found just outside the doors of the ED or about 100 yards of the main doors. Clinical staff of the ED have not noticed those patients who are found about 100 yards of the doors and as a result many have suffered and died due to their injuries. Fortunately, those that stagger near the doors are brought into the ED and treated.  

Based on your knowledge of EMTALA and the Health and Human Services regulations, as the manager of the Winterfell ED, what would your policies and practices be regarding treating patients who are injured and found outside of the ED? Write out the rule language of the rule that governs your response.

Answer 1

Every injured person found about 100 yards of the main doors should be brought to and treated by the emergency services of Winterfell Castle. Assuming that they were on their way to the emergency care and couldn’t reach because of their injuries and lack of support, clinical staff should take turns to do an hourly check for the injured people about 100 yards of the hospital also. This can be written in rule language as “Every injured patient coming to the Winterfell Castle Emergency Services or found injured at or within 100 yards, the covered area, should be stabilized and treated, regardless of their insurance status or ability to pay in accordance with EMTALA and rules and regulations of Health and Human Services. Hereafter it will be the responsibility of the clinical staff to spot and assist the injured within the covered area for which they are required to take turns to do an hourly check and failure to do so will invite penalties, which include but are not limited to deducted salary. Since any lapse in treatment could lead to the death of the patient, the concerned employee should be ready to face litigation and any action taken by the Department of Health and Human Services."

The Emergency Medical Treatment and Labor Act (EMTALA) is a federal law that requires every patient coming to an emergency department to be stabilized and treated, regardless of their insurance status or ability to pay, but since its enactment in 1986 has remained an unfunded mandate. EMTALA was passed in 1986 to tackle patient dumping, the practice of hospitals rejecting patients with medical emergencies because of their inability to pay or inappropriate insurance. EMTALA is enforced by the Centers for Medicare and Medicaid Services, a division of the Department of Health and Human Services. As per EMTALA provisions even if the patient owes a hospital past dues, the hospital cannot turn him/her away from its emergency room.