EMTALA violations are seen in nearly all states

More than 520 hospitals in 46 states, the District of Columbia, and Puerto Rico have violated the federal Emergency Medical Treatment and Active Labor Act (EMTALA) by denying patients access to quality emergency health care, according to a report by the Washington, DC-based consumer group Public Citizen.

The report says 500 hospitals violated the screening, stabilizing treatment or transfer provisions of EMTALA between 1997 and 1999. Violations of EMTALA, which guarantees patients access to emergency care regardless of their ability to pay, have racked up more than $1 million in fines, the report says. A few of the violations in the report were confirmed in 1996 and 2000.

Administrative trouble

Not all the hospitals violating the act actually "dumped" patients, which refers to the inappropriate transfer of a person whose condition is not stable. Some violations were administrative in nature, involving such actions as omitting documentation or failing to post signs spelling out patients’ rights.

The report lists the name of each hospital, the nature of the violation, and any fines assessed against the hospital. Of the 500 hospitals that had confirmed violations in 1997, 1998, and 1999 and were eligible to be fined, 85 (17%) had been fined as of April 2001.

States with no confirmed violations listed in the report are Delaware, Hawaii, New Mexico, and Wyoming. To find out which hospitals in a particular state violated the law, people can visit the web site www.citizen.org, go to "Questionable Hospitals," click on a map of the United States, and select the state. A copy of the report also is posted there.

Among the report’s key findings are:

• Nationwide, for-profit hospitals had a significantly higher rate of violation (1.7 times higher) than not-for-profit hospitals.

• Up to one-third of surveyed emergency department registration staff recently told the U.S. Department of Health and Human Services that patients might be asked for insurance information before a screening is provided or while it is taking place. Thirty-five percent said they contact health plans for authorization of screening exams at some point. These actions violate the law if they delay treatment.

• Hospitals are being fined more than in previous years. Civil money penalties increased from $130,000 in fiscal 1988 to more than $1 million in each of 1998, 1999, and 2000. However, most hospitals with confirmed violations are not fined, the report says.