The Emergency Medical Treatment and Labor Act (EMTALA) was passed in 1986 by Congress and signed into law by President Ronald Reagan. The act was intended to prevent hospitals from turning away uninsured patients who needed emergency care or women in labor, so-called “patient dumping.”

The statute requires that all hospitals that participate in the federal Medicare program provide emergency care and medical screenings in ERs to patients regardless of their insurance status or ability to pay. If the hospital does not have the capability to stabilize the patient, the act requires a transfer to another hospital with that ability be arranged.

Also, a hospital with such special capabilities is required by the law to accept a transferred patient if it has the capacity to do so. This element of EMTALA is intended to prevent so-called “reverse dumping” when a hospital does not accept a patient for transfer because of a lack of insurance or inability to pay.

Hospitals and doctors found to have violated EMTALA are subject to fines of up to $50,000 per violation and could be excluded from participation in the Medicare and Medicaid programs. In addition, the act subjects hospitals to civil lawsuits by patients for violations.

EMTALA violations are enforced by the Office of Inspector General of the U.S. Department of Health and Human Services. In 2009 seven hospitals settled allegations of patient dumping with the OIG, including the Robert Wood Johnson University Hospital-Hamilton in Mercer County New Jersey.

RWJ Hamilton agreed to pay $65,000 to settle OIG allegations that it “failed to provide a medical screening examination, stabilizing treatment or an appropriate transfer for a mother and her newborn child who came to RWJ Hamilton's emergency department for examination and treatment for a medical condition.”

Almost every hospital in the county must adhere to EMTALA rules because most participate in the Medicare program. Medicare covers more than 43 million senior citizens and disabled Americans.

Top five hospitals in Southeastern Pennsylvania by Medicare revenue
(fiscal year ending June 30, 2008)
                                               operating                          Medicare                    operating
Hospital                                   revenue                            revenue                       income
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Hosp.of the Univ. of Penn.        $1.72 billion                     $390 million                $187 million
Thomas Jefferson Univ. Hosp.   $1.15 billion                     $359 million                $48.5 million
Abington Memorial Hospital      $604.8 million                  $269 million                $18.2 million
Albert Einstein Medical Center  $573.5 million                  $231 million                 $9.6 million
Temple University Hospital        $685.0 million                  $226 million               -$12 million

Source: Pennsylvania Health Care Cost Containment Council