Individual EPs are rarely penalized by the Office of Inspector General (OIG) for EMTALA violations, according to a recent study.1

“For emergency physicians, a civil monetary penalty is an often-feared consequence of EMTALA enforcement,” says Sophie Terp, MD, the study’s lead author. Terp is assistant professor of clinical emergency medicine at Keck School of Medicine at University of Southern California, Los Angeles.

A physician can be held individually liable for a fine of up to $50,000, which is not covered by malpractice insurance. Recent studies have reported that only a small proportion of EMTALA violations result in civil monetary penalties against hospitals.2

However, according to Terp, “Little was known about characteristics of civil monetary penalties levied against individual physicians related to violations of EMTALA.” Terp and colleagues reported these findings:

  • Of 196 OIG civil monetary penalty settlements related to EMTALA between 2002 and 2015, 96% were against facilities.
  • Only eight were levied against individual physicians. Of those, seven were imposed on on-call specialists, surgeons, and OB/GYNs. Six of the specialists failed to respond to evaluate and treat a patient in the ED. One failed to accept appropriate transfer of a patient with an emergency medical condition requiring a higher level of care.
  • Only one EP was fined during the 2002-2015 period. That case involved a very clear violation of the EMTALA statute. The EP repeatedly failed to provide a medical screening exam to a pregnant teen repeatedly, based on the incorrect belief that a minor could not be evaluated or treated without parental consent.

Malpractice Suit More Likely

Continued active enforcement of EMTALA suggests that EPs are not always adhering to the statute, Terp notes. Hospitals, rather than individual EPs, typically are held responsible for EMTALA violations. The risk to an individual EP of an EMTALA fine is extremely low. “Comparatively, 7.6% of emergency physicians face a malpractice claim, and 1.4% have a claim resulting in payment to a plaintiff on an annual basis,” Terp notes.3

Although EMTALA investigations and citations were common at the hospital level, they were rare at the ED-visit level, according to another study conducted by Terp and colleagues.4

Between 2005 and 2014, investigations were conducted at 43% of hospitals with Centers for Medicare & Medicaid Services provider agreements, according to the researchers, and citations were issued at 27%. “On average, during the study period, 9% of hospitals were investigated, and 4.3% were cited for EMTALA violations annually,” Terp reports.

EPs should familiarize themselves with the requirements of EMTALA, Terp advises. These include, but are not limited to:

  • All patients presenting to an ED should receive timely medical screening evaluations and stabilizing care regardless of their ability to pay;
  • If specialty services required to stabilize an identified emergent condition are unavailable, transfer to an alternate hospital for a higher level of care must be arranged;
  • Receiving hospitals are obligated to accept transfer of patients requiring available specialized services, such as neurosurgery or burn care, if the facility has capacity to treat the patient.

“Emergency physicians should be diligent to ensure appropriate patient care, and that both they and their facilities are compliant with the EMTALA statute,” Terp concludes.

REFERENCES

  1. Terp S, Wang B, Raffetto B, et al. Individual physician penalties resulting from violation of Emergency Medical Treatment and Labor Act: A review of Office of the Inspector General patient dumping settlements, 2002-2015. Acad Emerg Med 2017;24:442-446.
  2. Zuabi N, Weiss LD, Langdorf MI. Emergency Medical Treatment and Labor Act (EMTALA) 2002-15: Review of Office of Inspector General patient dumping settlements. West J Emerg Med 2016;17:245-251.
  3. Jena AB, Seabury S, Lakdawalla D, Chandra A. Malpractice risk according to physician specialty. N Engl J Med 2011;365:629-636.
  4. Terp S, Seabury SA, Arora S, et al. Enforcement of the Emergency Medical Treatment and Labor Act, 2005 to 2014. Ann Emerg Med 2016;69:155-162.

SOURCE

  • Sophie Terp, MD, Department of Emergency Medicine, Keck School of Medicine, University of Southern California, Los Angeles. Email: terp@usc.edu.