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EMTALA (Emergency Medical Treatment and Labor Act)

The federal law that requires a hospital emergency department to screen and stabilise anyone who comes through the door, regardless of insurance or ability to pay, before it may transfer or discharge them.

Informational only - this is not legal advice. These definitions explain general legal vocabulary in plain English. They are not advice about your situation, reading them creates no attorney-client relationship, and the law differs from state to state and changes over time. For advice you can rely on, speak to a lawyer licensed in your state.

What it means

EMTALA is the reason an emergency department cannot turn a patient away for lack of insurance. Any hospital that participates in Medicare - which is nearly every hospital - must give anyone who comes to its emergency department asking for examination or treatment an appropriate medical screening examination to determine whether an emergency medical condition exists. If one does, or if a woman is in labour, the hospital must provide treatment to stabilise the condition within its capability, or transfer the patient to a facility that can, under conditions the statute sets: the patient must be stabilised to the extent possible, the receiving hospital must have agreed to accept them, and the transfer must be medically appropriate. A hospital may not delay the screening or stabilising treatment to ask about payment.

The duty is limited in ways that matter. It attaches at the emergency department and, once a patient is admitted as an inpatient in good faith, it generally ends and ordinary malpractice law takes over. It requires a screening comparable to what the hospital gives other patients with similar symptoms, not a correct diagnosis - a hospital that screens everyone equally badly may have committed malpractice without violating EMTALA. And it requires stabilisation, not cure: a patient who is stable may be discharged or transferred even if they are still unwell. Specialised hospitals with the capability to treat are required to accept appropriate transfers.

A patient harmed by a violation has a private right of action against the hospital (not against the individual physician) for the damages available under the state's personal-injury law, and the federal government may impose civil penalties on hospitals and physicians and exclude a hospital from Medicare. The statute also protects hospital staff who report a violation and prohibits a hospital from penalising a physician for refusing to transfer an unstable patient.

Where this comes from

EMTALA is 42 U.S.C. § 1395dd, enacted as part of the Consolidated Omnibus Budget Reconciliation Act of 1986; the implementing regulations are at 42 C.F.R. § 489.24, with the enforcement provisions at 42 C.F.R. § 1003.500 and following. The private right of action is § 1395dd(d)(2) and borrows the damages law of the state where the hospital is located. Roberts v. Galen of Virginia, Inc., 525 U.S. 249 (1999), held that a stabilisation claim does not require proof of an improper motive.

When people hire a lawyer for this

The signs of a violation are a screening that never happened, a transfer or discharge while the patient was visibly unstable, or a question about payment before treatment. A lawyer will look first at whether EMTALA applies at all - it is an emergency-department statute, not a general right to care - and then at whether the claim is better framed as malpractice, because the two have different defendants, different elements and different deadlines. A complaint to the state survey agency or the federal regional office is separate from any lawsuit and can be made by anyone.

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Part of the LawyerLand plain-English legal glossary. Definitions are written from primary sources - statutes and court rules - and each entry states the authority it rests on, or says plainly when the doctrine is state law with no national rule.

If you cannot afford a lawyer, civil legal aid programmes provide free help with many of these problems: civil legal aid programmes by state.

Related free reference tools: statute of limitations for a personal-injury claim, by state, quoted from each state's official text - part of LawyerLand's legal reference tools.