Medical service patients who were transferred were twice as likely to die as those treated at the transferring hospital, and 24% of the patients were considered to have been transferred in an unstable condition. Only 6% of the patients had given written informed consent for their transfer. The reason given for the transfer by the sending institution was lack of insurance in 87% of the cases. The majority of such transfers to Cook County Hospital involved patients who were minorities and unemployed. The authors defined dumping as “the denial of or limitation in the provision of medical services to a patient for economic reasons and the referral of that patient elsewhere” ( 1). In 19, 2 articles appeared in the literature by physicians from Cook County Hospital in Chicago detailing the extent of patient dumping to that facility ( 1, 2). The emphasis is on the impact of the statute-not just on the emergency care of patients but on the hospital and its medical staff. It includes discussions of on-call physician responsibilities under the statute, penalties, and enforcement procedures. This article summarizes the historical context of EMTALA and discusses the requirements of the statute both in the law's original language and in the subsequent interpretations by HCFA and the courts. Thus, all physicians on the hospital staff, not just emergency physicians, need to be familiar with its general requirements. Even though its initial language covered the care of emergency medical conditions, through interpretations by the Health Care Financing Administration (HCFA) (now known as the Centers for Medicare and Medicaid Services), the body that oversees EMTALA enforcement, as well as various court decisions, the statute now potentially applies to virtually all aspects of patient care in the hospital setting. Although only 4 pages in length and barely noticed at the time, EMTALA has created a storm of controversy over the ensuing 15 years, and it is now considered one of the most comprehensive laws guaranteeing nondiscriminatory access to emergency medical care and thus to the health care system. The law's initial intent was to ensure patient access to emergency medical care and to prevent the practice of patient dumping, in which uninsured patients were transferred, solely for financial reasons, from private to public hospitals without consideration of their medical condition or stability for the transfer. The Emergency Medical Treatment and Active Labor Act (EMTALA) was passed by the US Congress in 1986 as part of the Consolidated Omnibus Reconciliation Act (COBRA), much of which dealt with Medicare issues.
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