Emergency Medical Treatment & Active Labor Act; EMTALA

Senior (College 4th year) ・Healthcare&Medicine ・MLA ・12 Sources

The Emergency Medical Treatment & Active Labor Act; EMTALA, was a bill that was passed by the US Congress in the year 1986 (Zibulewsky). This was part of the Consolidated Omnibus Reconciliation act which was concerned with issues to deal with Medicare.  EMTALA stipulates ""in the case of a healthcare facility that has a hospital emergency department if any individual comes to the emergency department and an appeal is made for checkup or for medication for a paricular condition, the hospital must provide an appropriate medical screening examination within the capacity of the hospital’s emergency department, including additional services regularly available to the emergency department to find out if an emergency medical condition exists.

This law discourages any participating hospital from delaying the emergency response to the patient by asking for insurance or method of payment status. EMTALA requirements encompass facilities that provide emergency services, for example, a boutique hospital that has no emergency facilities but does maternity services still fall under the body of facilities that EMTALA encompasses. EMTALA also requires that for example, if part of the hospital has another facility that operates with a different Medicare number, then the transfer of a patient from one facility to the other is an EMTALA movement and can only occur when a Medical Screening Examination has been done on the patient. Furthermore, the act requires that once a decision to transfer the patient is made, the patient also needs to give consent for the transfer. The reasons, risks, and benefits for the removal are then documented on a form. In cases where the patient refuses to have a transfer, the reasons are still recorded on the form.

In a case that seems to have violated EMTALA requirements, there was a lady that underwent a gastric bypass surgery and later was discharged (Brent). A few months later the girl developed complications of severe abdominal pain and was rushed to a nearby hospital which diagnosed her with intermittent bowel obstruction she was treated and discharged. A few months later she developed complications and was rushed to another hospital, since they had no history of the patient the practitioners did an x-ray of the girl and found stool in her abdomen and few air-fluid levels she was treated and discharged later the same day she came back she was administered a laxative and left the hospital with pain that was recorded as 8 on a scale of 1 to 10. The girl died later on, and the nurse that discharged the girl was found to be in contempt of EMTALA as the act requires the practitioner to stabilize the patient prior to discharge (Brent). In this case, the patient's right to Emergency Medical Treatment was violated, and that led to the unfortunate death of the patient. However, the situation also points out to the complexities that come about when a patient is given several treatments, and each case is treated differently without the patients’ history.

Right to healthcare finance (Medicare/ Medicaid)

The Act that oversees the right to health care finance is the Affordable Care Act which is famously known as “Obamacare.” This act aims to provide American citizens with better financial health security by putting up comprehensive health reforms that are set to expand medical coverage, create accountability in insurance companies, reduction of health care prices, offer choice and good quality care for all Americans (Medicaid Government). The Affordable Care Act contains two separate legislation; the Health Care and Education Reconciliation Act of 2010 (P.L. 111-152 and the Patient Protection and Affordable Care Act (P.L.111 – 148) (Medicaid Government).The Medicare policy aims to provide health coverage to poor Americans by providing opportunities to states to come up with Medicaid eligibility this is specifically for people who are under 65 years and whose incomes levels are up to 133 of the federal poverty level (Medicaid Government).

There is a case in court that challenges the right to healthcare finance in Canada. The owner of Vancouver's for-profit surgery proposes that there exists a privatized health insurance cover that could be sold for people who want to attend privatized profit-making centers (BC Health Coalition). This challenge on the constitution is a threat to the right to financial health care as the poor will continue to suffer in the public hospitals while those who are able to buy private insurance will be exposed to a system that relies heavily on private insurance, this gives room for providers to set high prices and exploit the poor citizens. This landmark ruling is much expected in Canada as it may deprive some of its citizens the right to financial health care (BC Health Coalition).

Right to informed Healthcare decisions

The right to informed healthcare decisions is provided for under the informed consent law (HG Legal Resources).  This law covers the right of an individual to be informed of and give consent to a procedure or treatment proposed to by the doctor or any other professional. This document is usually written and is very important as it can limit professional liability cases for the service providers (HG Legal Resources).

Before a patient signs a consent form, it is essential that the following legal requirements are met. First, ethics require that the doctor or any other medical practitioner performing a treatment procedure should have a discussion with the patient on his/her diagnosis, the purpose of the treatment, the risks involved in taking the medication, other available options and their consequences and the consequences and benefits of refusing any treatment (HG Legal Resources). The law also provides for the case where the patient is incapacitated and therefore unable to make an informed decision. In such a case a family member who is authorized by the law can make the decision on behalf of the patient (HG Legal Resources).

The first landmark cases that led to the formation of the informed cases law occurred mostly in the early 19th century (Wandler). One particular landmark ruling was the case of Mohr vs. Williams in 1905 (Wandler). Mrs. Mohr's gave consent to undergo an operation on her right ear in order to remove diseased parts in the ear. She gave the permission after having a discussion with their family doctor who was also present in her time of operation. Once Mrs. Mohr was given anesthesia the doctor discovered that the ear was not as diseased as he previously thought. Instead, her left ear was the one that needed urgent medical attention so in his own wisdom decided to do an operation on the left ear.  After the operation, the plaintiffs’ hearing was impaired, and she sued the surgeon; she claimed that the procedure was not consented by her and therefore was wrongful and unlawful. The Supreme Court ruled in favor of the plaintiff citing that the doctor should have consulted the patient and obtained consent to proceed with the operation (Wandler).

Right to personal privacy

The right of an individual to personal privacy is stipulated under the Health Insurance Portability and Accountability Act (HIPAA) (HG Legal Resources). This act consists of a number of statutes that are originally designed to ameliorate the efficiency and the effectiveness of the healthcare system. Most of it deals with issues related to the privacy of the health records and what medical practitioners and the insurance companies can share with others (HG Legal Resources).

The right to privacy requires that there are national standards that are set to ensure the confidentiality of the medical records of a patient (HG Legal Resources). The law, HIPAA gives the patients more control over what information should be released. HIPAA requires that patients are informed about how their information could be used and about the specific disclosures of the data have been made (HG Legal Resources).

In an instance where a patients privacy rights were violated, a nurse who was employed by Guthrie Clinic Steuben in New York City discovered that a patient had a Sexually Transmitted Disease, the nurse sent the patient's girlfriend text messages. The girlfriend was the nurses' sister-in-law (Guglielmo). The patient learned about the text messages and sued the hospital for releasing his health records. The plaintiff lost the case against the hospital. However, the nurse was held responsible for her own crime as she committed it for her own personal reasons (Guglielmo).

Right to freedom from wrongful discrimination

The right to freedom from wrongful discrimination is provided for in the Federal law (Thomson Reuters). This law protects individuals from various forms of discrimination in the course of healthcare provision. For instance, it prevents those who qualify for federal health insurance programs not to be segregated against on the basis of race, gender, and the nation of origin among many other factors. This law has an influence on the insurance companies and medical facilities (Thomson Reuters).

The federal law stipulates that it is illegal to deny services or other benefits that are usually provided for in a healthcare program, provide inconsistent services or benefits to what others are being offered and finally it is illegal to discriminate or segregate patients with respect to benefits, health insurance and other services (Thomson Reuters). The execution of the Age Discrimination Act (ADA) of 1975 made it illegal for health practices to single out people based on their age (Thomson Reuters).

In a study done by the Department of Justice in Washington D.C., the court records show that deaf and people who had hearing impairment did not have access to auxiliary aids and other services such as sign language interpreters (Sterman).  For instance, NAD sued a hospital in D.C., a lady who was a patient gave birth 10 weeks before her due date. The court filing found out that the patient had to painfully endure 16 hours of labor with no interpreter on site despite her requesting the staff to find her one (Sterman).  This is a violation on the patient as she was discriminated against and was unable to communicate with the medical staff effectively.

Works Cited

American College of Emergency Physicians. ""EMTALA."" 2016. ACEP Web site. 25 October 2017.

BC Health Coalition. ""The Legal Attack on Public Health Care."" 2017. BC health coalition website. 26 October 2017.

Brent, Nancy J. ""Court Case Highlights Nurses' Duty to Follow EMTALA."" 10 April 2017. Nurse Web site. 25 October 2017.

Guglielmo, Wayne J. Nurse Reveals STD Patient to Girlfriend, Man Sues; and More. 13 May 2013. 26 October 2017.

HG Legal Resources. ""Informed Consent Law."" n.d.

HG website. 26 October 2017. 

—. What is HIPAA and What Does it Mean to Me? n.d. 26 October 2017.

Medicaid Government. ""Affordable Care Act."" n.d. Medicaid Government Website. 26 October 2017.

Sterman, Joce. Local hospitals accused of discrimination, making patients feel 'completely powerless'. n.d. 26 October 2017.

Thomson Reuters. Health Care Discrimination. n.d. 26 October 2017.

Wandler, Mitchell. ""The History of the Informed Consent Requirement in United States Federal Policy."" 2001. Document. 26 October 2017.

Zibulewsky, Joseph. ""The Emergency Medical Treatment and Active Labor Act (EMTALA): what it is and what it means for physicians."" Baylor University Medical Center Proceedings 4 (2001): 449 -346. 25 October 2017.

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