Before 1986, hospitals could legally turn away emergency patients who couldn't pay. Women in active labor were transferred to other facilities mid-delivery. Patients with gunshot wounds were refused treatment and told to find somewhere else to go. People died in ambulances being shuffled between hospitals while their conditions deteriorated.
Congress ended this practice with the Emergency Medical Treatment and Labor Act, known as EMTALA. The law requires hospitals with emergency departments to screen and stabilize all patients regardless of ability to pay. When hospitals violate EMTALA, injured patients can sue—and the violations still happen more often than you might think.
What EMTALA Requires
The law imposes two fundamental obligations on hospitals that accept Medicare (which is virtually all hospitals with emergency departments). First, any patient who comes to the emergency department requesting examination or treatment must receive a medical screening examination to determine whether an emergency medical condition exists. This screening must be performed by qualified personnel and must be adequate to identify emergency conditions.
Second, if an emergency medical condition is identified, the hospital must either stabilize the patient before discharge or transfer, or transfer the patient appropriately to another facility if stabilization isn't possible at the original hospital. Appropriate transfer requires that the receiving facility agree to accept the patient, that the transfer is medically appropriate, and that the transferring hospital sends all relevant medical records with the patient.
The law also prohibits hospitals from delaying screening or stabilization to inquire about insurance status or ability to pay. The emergency department must provide care first and sort out payment later.
Common EMTALA Violations
Patient dumping—transferring unstable patients to avoid providing uncompensated care—was the original target of EMTALA, and it still occurs. Patients without insurance or with Medicaid (which reimburses poorly) may find themselves transferred to county or public hospitals despite being unstable. If the transfer is motivated by financial considerations rather than medical necessity, it violates the law.
Inadequate screening violates EMTALA when hospitals perform cursory evaluations insufficient to identify emergency conditions. Having a triage nurse take vital signs is not a medical screening examination. If the hospital's screening process is less thorough for uninsured patients than for insured ones, or if it's inadequate to identify conditions that a proper screening would reveal, the hospital has violated its obligations.
Failure to stabilize occurs when hospitals discharge or transfer patients whose emergency conditions haven't been addressed. Sending home a patient with an unstable cardiac condition, or transferring a patient in active labor to another facility, violates the stabilization requirement unless specific exceptions apply.
Refusing to accept transfers violates EMTALA when a hospital with specialized capabilities refuses to accept a patient who needs those capabilities. A hospital with neurosurgery capacity can't refuse to accept a patient with a brain bleed simply because the patient lacks insurance.
EMTALA vs. Medical Malpractice
EMTALA violations and medical malpractice are related but distinct. Malpractice requires proving that care fell below professional standards; EMTALA violations are established by showing the hospital failed to meet its statutory obligations regardless of whether the care provided was otherwise competent.
A hospital could provide high-quality care but still violate EMTALA by delaying it to verify insurance. Conversely, a hospital could comply with EMTALA while still committing malpractice through negligent treatment. Many situations involve both—the failure to screen or stabilize leads to missed diagnoses or delayed treatment that also constitutes malpractice.
EMTALA claims can be easier to prove in some respects because they don't require expert testimony about medical standards—the question is whether statutory requirements were met, not whether care was medically competent. However, EMTALA damages are limited: the statute provides for actual damages but doesn't allow punitive damages, and doesn't provide independent recovery for things like pain and suffering beyond actual harm caused.
Who Can Sue
Patients who suffer personal harm as a direct result of EMTALA violations can bring civil suits against hospitals. If inadequate screening missed an emergency condition, if failure to stabilize led to deterioration, or if improper transfer caused harm, the injured patient can sue for damages resulting from that violation.
The federal government can also enforce EMTALA through administrative penalties, including fines and termination of Medicare participation. These enforcement actions don't directly compensate injured patients but can pressure hospitals to improve compliance.
Proving an EMTALA Case
Successful EMTALA claims require showing that you came to a hospital emergency department, that the hospital failed to provide adequate screening or stabilization, and that this failure caused you harm. Evidence includes emergency department records showing what evaluation was performed (or not performed), documentation of your condition at arrival and departure, transfer records if you were moved to another facility, and evidence of outcome—what happened after the alleged violation.
Timing matters. EMTALA has a two-year statute of limitations running from the date of the violation. Unlike some malpractice claims, there's no discovery rule extending this deadline—you have two years from when the violation occurred, regardless of when you learned about it.
Why This Matters
EMTALA exists because emergency care shouldn't depend on ability to pay. When hospitals violate this principle—when they screen inadequately, discharge prematurely, or transfer inappropriately because of financial considerations—they betray the trust patients place in emergency departments as safety nets. The law provides a remedy for those harmed by such violations, and using that remedy helps ensure hospitals take their obligations seriously.