Public Health Law Map - Beta 5 - Medical and Public Health Law Site

to treat and the patient’s right to choose his or her physician.
1. Emergency Medical Treatment and Active Labor Act
Hospitals with emergency facilities must provide medical screening and needed
treatment to all persons who request emergency medical care, including delivering
the infant of a woman in labor. The important consideration for physicians is that the
law is structured to trigger the physician–patient relationship: whenever a patient
presents with a request for emergency care, the patient must receive a medical
screening examination from either a physician or someone under the supervision of a
physician. Once the patient receives this examination, the physician will have
exercised independent medical judgment on behalf of the patient, the patient will
have relied on that judgment, and the physician will be required to provide all
necessary care until the patient can either be discharged from the hospital or
transferred to another physician.
This duty is not limited to the physicians on duty in the emergency room. Most
hospital bylaws require medical staff members to assist in the delivery of emergency
care if needed or to participate in a specialty call system. This contractually obligates
the physician to treat persons in the emergency room when called on by the hospital.
If a physician refuses to treat a patient when requested under this agreement, the
hospital has the contractual right to cancel the physician’s medical staff privileges.
Such a refusal also violates the physician’s duty under EMTALA and will subject the
physician to sanctions under the Act. Even if the hospital wants to avoid this by not
calling the physicians for indigent patients, EMTALA requires that the hospital
provide on-call physicians for specialty care.
Physicians can violate EMTALA in three ways: they can refuse to do screening
examination; they can refuse to provide needed care; and they can improperly
transfer the patient to another facility. A proper transfer can only be done when the
patient is stable, when there is a medical justification for the transfer, when the
receiving hospital agrees to accept the transfer, and when all of this has been
properly documented according to the standards of EMTALA. If the physician
violates EMTALA, the government can impose a fine of up to $50,000 and ban the
physician from participating in federal reimbursement programs. Other federal rules
prevent the physician from working with any medical care institution that
participates in federal reimbursement programs, making it impossible to work in
most medical care jobs.
EMTALA does not create a cause of action against the physician, although it does
create one against the hospital. The only basis for a patient lawsuit against the
physician is medical malpractice. Unfortunately, since the physician has a physician–
patient relationship with the patient, actions that violate EMTALA will probably also
be medical malpractice. In addition, the hospital can sue the physician for
indemnification for any losses it sustains because of the physician’s failure to comply
with EMTALA. This means that the physician could end up paying for a patient’s
lawsuit against the hospital for the EMTALA violation. Most troubling for
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