Emergency Medical Treatment and Labor Act (EMTALA)

Definitions

Capacity - encompasses such things as numbers and availability of qualified staff, beds and equipment, as well as the hospital’s past practices of accommodating patients in excess of its occupancy limits.

Capability - defined as the staff, equipment and specialty or specialist services available to care for a patient with an emergency medical condition.

Comes to the Emergency Department - for purposes of this policy, an individual is deemed to have “come to the emergency department” if the individual:

1. Presents at a dedicated emergency department, and requests examination or treatment for a medical condition, or has such a request made on his or her behalf. In the absence of such a request by or on behalf of the individual, a request on behalf of the individual will be considered to exist if a prudent layperson observer would believe, based on the individual’s appearance or behavior, that the individual needs examination or treatment for a medical condition; or
2. Presents on hospital property, other than a dedicated emergency department, and requests examination or treatment for what may be an emergency medical condition or has such a request made on his or her behalf. In the absence of such a request by or on behalf of the individual, a request on behalf of the individual will be considered to exist if a prudent layperson observer would believe, based on the individual’s appearance or behavior, that the individual needs emergency examination or treatment; or
3. Is in a ground or air non-hospital-owned ambulance on hospital property for presentation or examination for a medical condition at the hospital’s dedicated emergency department; or
4. Is in a ground or air ambulance owned and operated by the hospital for purposes of examination and treatment for a medical condition at a dedicated emergency department, even if the ambulance is not on hospital property. However, an individual in an ambulance owned and operated by the hospital is not considered to have come to the emergency department if: (1) The hospital-owned ambulance is operated under community-wide Emergency Medical Services (EMS) protocols that direct it to transport the individual to a hospital other than the owner hospital; or (2) The hospital-owned ambulance is operated at the direction of a physician who is not employed or otherwise affiliated with the hospital.

Dedicated Emergency Department - is defined as any department or facility of the hospital, regardless of whether it is located on or off the main hospital campus that meets at least one of the following requirements:

1. It is licensed by the state in which it is located under applicable state law as an emergency room or emergency department;
2. It is held out to the public (by name, posted signs, advertising, or other means) as a place that provides care for emergency medical conditions on an urgent basis without requiring a previously schedule appointment; or
3. During the calendar year immediately preceding the calendar year in which a determination under this section is being made, based on a representative sample of patient visits that occurred during that calendar year, it provides at least one-third of all its outpatient visits for the treatment of emergency medical conditions on an urgent basis without requiring a previously scheduled appointment.

Examples of “Dedicated Emergency Departments” may include licensed EDs, labor and delivery units, psychiatric departments, provider based urgent care centers.

Diversion – A notification to Emergency Medical Services (EMS) that the facility emergency department (ED) is beyond capacity. Diversion is just a notification about the ED capacity and EMS and/or the patient can still decide to be transported to the ED that is on diversionary status. Patients that are on the property of the facility cannot be diverted. Diversion status only applies to patients being transported by EMS.

Emergency Medical Condition means:

1. A medical condition manifesting itself by acute symptoms of sufficient severity (including severe pain, psychiatric disturbances and/or symptoms of substance abuse) such that the absence of immediate medical attention could reasonably be expected to result in either:
   
   • Placing the health of the individual (or, with respect to a pregnant woman, the health of the woman or her unborn child) in serious jeopardy, or
   • Serious impairment to bodily functions, or
   • Serious dysfunction of any bodily organ or part.
2. With respect to a pregnant woman who is having contractions:
   
   • That there is inadequate time to affect a safe transfer to another Hospital before delivery, or
   • That the transfer may pose a threat to the health or safety of the woman or her unborn child.

Hospital Property - means the entire main hospital campus, including the physical area immediately adjacent to the hospital’s main buildings (e.g., parking lots, sidewalks, and driveways), and other areas and structures that are not attached to the hospital’s main buildings but are located within 250 yards of the hospital’s main buildings. Hospital property excludes areas or structures of the hospital’s main building that are not part of the hospital, such as physician offices, rural health centers, skilled nursing facilities, or other entities that participate separately under Medicare, or restaurants, shops, or other non-medical facilities.

Labor - means the process of childbirth beginning with the latent or early phase and continuing through the delivery of the placenta. A woman is in true labor unless a physician or other qualified medical person certifies, after a reasonable period of observation that she is in false labor. Certification of false labor by a non-physician (i.e., physician assistant, nurse practitioner, or qualified registered nurse) requires physician certification.

Medical Screening Examination (MSE) - Is the process required to reach, with reasonable clinical confidence, the point at which it can be determined whether the individual has an Emergency Medical Condition or not. A Medical Screening Examination is not an isolated event. It is an ongoing process that begins, with the initial assessment by a Qualified Medical Person and ends when enough information has been gathered to determine the patient does not have an Emergency Medical Condition.

Qualified Medical Person or Qualified Medical Personnel (QMP) - means an individual or individuals in one of the following professional categories who has demonstrated current competence to perform a Medical Screening Examination.

1. Emergency Department: Emergency Medicine Physician, Emergency Department Physician’s Assistant, Emergency Department Certified Nurse Practitioner.
2. Labor and Delivery: Physician, Labor and Delivery Registered Nurse, Certified Nurse Midwife.
3. Psychiatry: Physician, Licensed Clinical Social Worker, Licensed Professional Counselor, Psychologist

To Stabilize or “Stabilize” or “Stabilized” means:

1. With respect to an emergency medical condition, that no material deterioration of the condition is likely, within reasonable medical probability, to result from or occur during the transfer or discharge of the individual from the hospital; or
2. With respect to a pregnant woman who is having contractions and who cannot be transferred or discharged before delivery without a threat to the health or safety of the woman or the unborn child, that the woman has delivered the child and the placenta.