Settlements resulting from Emergency Medical Treatment and Labor Act (EMTALA) violations declined 87% between 2002 and 2015, according to a recent analysis.1 Some key findings:

  • Failure to stabilize patients in need of emergency care and failure to screen were the top violations in these settlements;
  • Settlements occurred most often in urban area hospitals (74%) and hospitals in the South (48%);
  • Violating hospitals incurred annual settlements of close to $32,000, on average, for a total of nearly $5.3 million over the study period.

EMTALA’s status as an unfunded mandate and efforts to repeal the Affordable Care Act threaten the financial viability of safety-net hospitals, researchers warn, which could lead to more EMTALA violations.

When EMTALA first became law in 1986, “we all had a very healthy understanding and respect for the law. I have found over the years that this has diminished,” says Heather L. Brown, DMSc, PA-C. Brown, CEO of HL Brown and Associates in Roswell, GA, recently co-authored a paper on the history that led to the enactment of EMTALA.2

“There is misinformation and lack of education on EMTALA,” Brown says. Steep civil monetary penalties can result from violations. “Anyone working in patient care in the emergency medicine arena should be familiar with the law’s do’s and don’ts in order to stay on the correct side of this federal statute,” says Brown, who asks ED providers to keep the following in mind:

  • The provision of a mandatory screening medical exam and stabilization before discharge or transfer are the basic requirements for healthcare providers seeing patients in an emergency situation;
  • It is the patient, or a reasonable layperson, who would deem a situation to be an emergency, not the trained medical professional;
  • “Presenting” to the ED does not mean only patients who come in the department and register. Even those simply in proximity to the facility are deemed to be seeking care, too;
  • When and where the law does not apply.

A common misconception: EMTALA applies to off-campus urgent care centers or physician offices. Sometimes, staff from the urgent care center wrongly believe that it is a violation to send a patient to the ED for evaluation without calling first to give a report or without getting acceptance for the patient to come. Likewise, staff from clinics sometimes think that informing a patient that their insurance is not accepted is an automatic EMTALA violation. This is not true.

If the patient has presented for care at the ED, he or she needs to be given the screening exam and treatment to stabilization, not encouragement to seek care elsewhere. “If a patient comes to the ED — by the definition, they get screened and stabilized, or the ED could be in violation,” Brown says.

Well-meaning ED staff might encourage a patient to see their primary care physician because the wait is too long or the bill will be less for an outpatient location. “The look of impropriety or coercion would not be favorable for a facility and/or provider who is investigated for a complaint,” Brown warns. n


  1. McKenna RM, Purtle, J, Nelson KL, et al. Examining EMTALA in the era of the patient protection and Affordable Care Act. AIMS Public Health 2018;5:366-377.
  2. Brown HL, Brown TB. EMTALA: The evolution of emergency care in the United States. J Emerg Nurs 2019; Mar 20. pii: S0099-1767(18)30723-2. doi: 10.1016/j.jen.2019.02.002. [Epub ahead of print].