ED managers: Know your EMTALA guidelines

The screening/counseling initiative employed by HCA facilities in Houston and Ocala, FL, appears to be in compliance with the Emergency Medical Treatment and Labor Act (EMTALA), says one expert. However, he notes that there are many aspects of the act that apply to these processes, and it’s crucial that ED managers understand what they are and how they can affect the design of such initiatives.

According to EMTALA, you can have the medical screening exam (MSE) done by a physician or by a qualified medical practitioner (QMP), notes Alan Steinberg, Esq., a partner with the Pittsburgh-based law firm of Horty, Springer & Mattern. (Editor’s note: According to EMTALA, QMPs are individuals who are "properly credentialed and have appropriate education and experience to perform [MSEs].")

"The rules require that the board of the hospital has approved that category, such as PAs [physician assistants]," Steinberg says. "It also depends on what the state says PAs can and can’t do, which is covered in the licensing rules." In the case of Ocala Regional Hospital, for example, the MSEs will be done by a physician, a PA, or a nurse practitioner.

There is no problem with dividing triage into five levels, he continues. "The only consideration is that you not have patients who are Level 5 unfairly sitting around," he adds. "At one point, CMS [the Centers for Medicare & Medicaid Services] had gotten concerned that folks who weren’t urgent were being made to wait around for too long in the waiting room, and you could get cited for that."

Once the screener has determined there is not an emergency situation, EMTALA is done, Steinberg observes. "Then regular rules for appropriate care and treatment apply," he concludes.


For more information about EMTALA, contact:

  • Alan Steinberg, Esq., Partner, Horty, Springer & Mattern, 4614 Fifth Ave., Pittsburgh, PA 15213. Phone: (412) 687-7677. E-mail: asteinberg@hortyspringer.com.