In 2010, the federal government provided public notice that it was considering the application of the Emergency Medical Treatment and Labor Act (EMTALA) to inpatients. Specifically, the Department of Health and Human Services (DHHS) considered the application of EMTALA to patients who were admitted as inpatients, but who had not been stabilized as defined under this statute. On February 2, 2012, DHHS published its determination in the federal register, in which DHHS declined to apply EMTALA to patients admitted in good faith, whether or not they are stabilized.
This issue first arose in 2003, following a United States Supreme Court case. At that time, DHHS proposed a rule that would apply EMTALA to inpatients who presented to a dedicated emergency department, but who remained unstable after admission. In its Final Rule, DHHS reversed course and determined that a hospital's obligation under EMTALA ended when an individual was admitted in good faith for stabilizing treatment.
Following a 2007 request for further consideration by the EMTALA Technical Advisory Group, DHHS considered the obligation of a hospital with specialized capabilities to accept transfer of an unstable inpatient under EMTALA. Again, DHHS proposed a rule requiring a hospital to accept an unstable inpatient in certain circumstances. However, its 2009 Final Rule rejected this interpretation and provided that a receiving hospital had no EMTALA obligation to accept any inpatient, stable or unstable.
Currently, federal circuit courts are divided on EMTALA's application to inpatients. For example, Sixth Circuit1 decisions hold that an inpatient must be stabilized for a hospital to satisfy its EMTALA duties. Most circuit courts, including the Fourth Circuit2, have recognized that a hospital satisfies its EMTALA duties when a patient is admitted in good faith. Thus, in 2010, the Solicitor General represented to the Supreme Court that DHHS had committed to reconsider this issue.
In its 2012 notice, while acknowledging the split of authority, DHHS declined to extent EMTALA obligations to inpatients. DHHS recognized that expansion of these obligations to unstable inpatients poses potential pitfalls for hospitals and patients, especially for patients who have periods of medical stability and instability. DHHS also affirmed that EMTALA does not require a hospital with specialized capabilities to accept an inpatient, even if the patient originally presented to the emergency department and remains unstable. This guidance applies solely to EMTALA and does not restrict or change any other legal obligation. Thus, previous guidance remains in effect and a hospital satisfies its EMTALA responsibilities through the good faith admission of a patient for continuing treatment (except perhaps in the Sixth Circuit). DHHS has invited further comments from the public, which may result in additional guidance on this topic.
1 The Sixth Circuit reviews cases from U.S. District Courts in Kentucky, Michigan, Ohio, and Tennessee.
2 The Fourth Circuit reviews cases from North and South Carolina, Maryland, Virginia, and West Virginia.