No law enacted before or since EMTALA has had a bigger impact on the way you and your hospital must examine and treat emergency department patients. This ACEP “gold standard” is an authoritative EMTALA reference, and it is still your best resource on the “antidumping” law.
Written by Robert A. Bitterman, MD, JD, FACEP, a practicing emergency physician, attorney, and EMTALA expert. It’s the “inside scoop” you can count on.
Supplement Published 2004
Final EMTALA regulations went into effect November 10, 2003. To keep this ACEP best-seller current, Dr. Bitterman wrote a supplement. It explains the regulatory changes and how they affect the content in the book. Because it addresses only the changes in the final regulations, the supplement must be read in conjunction with the original 2001 publication to ensure a complete understanding of the law and the regulations and how they are enforced. Purchasers of the original 2001 publication can download one copy of the supplement at no extra cost.
PDF content cannot be altered or printed.
Editor’s Note to
Providing Emergency Care Under Federal Law: EMTALA
The print edition of this best-selling ACEP book by Robert A. Bitterman, MD, JD, FACEP, was published in January 2001. In the 11 years since then, thousands of emergency physicians and hospital administrators have relied on it as the definitive work on the history of the law and regulations as well as a practical guide to ensure compliance. When the regulations changed in November 2003, Dr. Bitterman wrote a 26-page supplement to explain how the information in the book was affected. That supplement is included here.
In a conversation with Dr. Bitterman on March 9, 2012, I learned that, even though the book is more than a decade old and out of print, much of the information in it is still of value. We talked about what emergency physicians need now and how best to meet that need; a smartphone app seems to be the way to go, so the College will investigate that possibility. But since Dr. Bitterman believes that most of the information in the book is still valid, the College will continue to make it available for purchase. Some court opinions, CMS regulations or guidelines, and ACEP policies have changed and are thus outdated. But the in-depth information on the law is correct, and the practical guidance for evaluating individuals who come to the emergency department for care is still useful.
All copyright and disclaimer information published in the front matter of the original print edition still applies. Distribution of this electronic version without the permission of the College is strictly prohibited.
— Marta Foster
Robert A. Bitterman, MD, JD, FACEP
Chapter 1: Why EMTALA, and Why This Book? Robert A. Bitterman, MD, JD, FACEP
Chapter 2: The History of EMTALA, Larry A. Bedard, MD, FACEP, Charlotte S. Yeh, MD, FACEP, and Robert A. Bitterman, MD, JD, FACEP
Chapter 3: Hospital and Physician Responsibilities Mandated by EMTALA, Robert A. Bitterman, MD, JD, FACEP
Chapter 4: The Medical Screening Examination Requirement, Robert A. Bitterman, MD, JD, FACEP
Chapter 5: Stabilization of Patients With Emergency Medical Conditions, Robert A. Bitterman, MD, JD, FACEP
Chapter 6: Medical Staff and On-Call Physician Obligations, Todd B. Taylor, MD, FACEP, and Robert A. Bitterman, MD, JD, FACEP
Chapter 7: Transferring and Accepting Patients Under EMTALA, Robert A. Bitterman, MD, JD, FACEP
Chapter 8: Special Situations: Obstetric and Psychiatric Patients, Robert A. Bitterman, MD, JD, FACEP
Chapter 9: EMTALA Enforcement, Robert A. Bitterman, MD, JD, FACEP
Chapter 10: Living Through a HCFA Investigation, Stephen A. Frew, JD
Chapter 11: Enforcement of EMTALA by the Office of Inspector General, Robert A. Bitterman, MD, JD, FACEP
Chapter 12: Civil Enforcement by Individuals and Hospitals, Paul Craig, RN, JD, and Daniel J. Sullivan, MD, JD, FACEP
The Federal Statute - 42 USC 1395dd, Examination and Treatment for Emergency Medical Conditions and Women in Labor
HCFA Regulations, Interpretive Guidelines, and State Operations Manual Governing the HCFA Interpretation and Enforcement of EMTALA
Transfer Materials: Instructions, Checklist, Order Form, Medically Indicated Transfer Form, Patient-Requested Transfer Form, EMTALA Transfer Acceptance or Denial Form, Informed Consent to Refuse Examination, Treatment, or Transfer Form
Signs Required to be Posted in Hospitals Informing Patients of Their Rights Under EMTALA, English and Spanish
Hospital EMTALA Compliance Checklist
OIG/HCFA Special Advisory Bulletin on the Patient Antidumping Statute Related to Managed Care Plans
Larry A. Bedard, MD, FACEP, is a past president of the American College of Emergency Physicians and has been practicing clinical emergency medicine for more than 20 years, primarily at Marin General Hospital, Greenbrae, California. He is a senior partner in California Emergency Physicians and served on its board of directors for 15 years, including 3 years as chair. Dr. Bedard has been instrumental in the passage and enforcement of patient transfer laws on both the state and national levels. During his term as president of CalACEP, he led the effort for the successful passage of SB 12, the California patient transfer law that made on-call physicians “responsible physicians” and provided “whistleblower protection” for emergency physicians. From 1996 to 1998, Dr. Bedard was one of three ACEP representatives to the HCFA work group that addressed EMTALA enforcement and recommended revisions to the enforcement guidelines. He then served on the ACEP EMTALA Task Force in 1999. As a delegate to the American Medical Association House of Delegates, Dr. Bedard co-authored and successfully advocated for a resolution to study and find solutions for the on-call issue. And in 1999, ACEP honored Dr. Bedard with its prestigious John G. Wiegenstein Leadership Award.
Paul Craig, RN, JD, is senior director of care management services for Saint Francis Memorial Hospital in San Francisco, California, and formerly a senior risk management consultant with the MMI Companies, Deerfield, Illinois. From 1991 to 1996, he worked as an attorney specializing in health care issues. Before practicing law, Mr. Craig worked as an emergency department and intensive care nurse for 10 years, including 3 years as an emergency department assistant manager in an urban trauma center. He lectures frequently and has authored numerous journal articles and textbook chapters on legal liability, risk in emergency medicine, and ethical issues in patient care.
Stephen A. Frew, JD, is a health care attorney based in Rockford, Illinois, and a nationally known consultant, speaker, author, and resource on EMTALA issues. He is the author of the ACEP publication Patient Transfers: How to Comply With the Law. He works extensively with hospitals under investigation for alleged EMTALA violations throughout the country and maintains a leading online resource for EMTALA information at www.medlaw.com.
Daniel J. Sullivan, MD, JD, FACEP, is an associate professor of emergency medicine at Cook County Hospital, Chicago, and an attending physician at Ingalls Hospital. He is president of MEA-AEA, Ltd, and president of The Sullivan Group (www.TheSullivanGroup.com). He is co-editor of the ACEP publication Emergency Medicine Risk Management: A Comprehensive Review, 2nd ed., and a past chair of the ACEP Medical-Legal committee.
Todd B. Taylor, MD, FACEP, is an attending emergency physician at Good Samaritan Regional Medical Center and Phoenix Children's Hospital, Phoenix, Arizona, and an affiliate assistant professor in the Division of Clinical Education, Arizona College of Osteopathic Medicine. Dr. Taylor also is vice president for public affairs for the Arizona College of Emergency Physicians and an EMTALA compliance consultant.
Charlotte S. Yeh, MD, FACEP, is the medical director for National Heritage Insurance Company, the northern New England carrier for Medicare, Part B. Dr. Yeh has been a practicing emergency physician for more than 20 years. From 1990 to 1998, she served as physician-in-chief of the emergency department at New England Medical Center, and prior to that she was a staff physician and chief of the Department of Emergency Medicine at Newton-Wellesley Hospital. She is the immediate past chair of the ACEP Federal Government Affairs committee and a former member of the ACEP Board of Directors. She also has served on the board of trustees for the Massachusetts Hospital Association and on numerous Massachusetts Medical Society committees. Along with Dr. Bitterman and Dr. Bedard, Dr. Yeh was a leader and emergency medicine advocate in the HCFA work group established to address EMTALA enforcement. In 1999, ACEP recognized Dr. Yeh’s leadership in the specialty with its James D. Mills Outstanding Contribution to Emergency Medicine Award.IPAD Use:
- Download file via iTunes or to Dropbox
- Use Dropbox to download the file to your iPad, for free
- Load the file to Dropbox from your computer
- Open the Dropbox application on your iPad
- Choose which program you wish to read the PDF in
Directions to load the EMTALA PDF via iTunes to be read as an iBook:
- GoodReader can pull files directly from Dropbox and also allows bookmarks to show in the PDF.
- Download the book to your computer.
- Open iTunes, and click on the File Menu, click on “Add File to Library”. It will appear under Books in your library.
- Connect your iPad to your computer.
- Drag the EMTALA file onto your iPad. (Keep in mind, you may have to have your iPad and computer re-sync to get the file onto the iPad).
- Go to your iBooks app, the EMTALA file will be there.
- iBooks does not show bookmarks
- With your Kindle connected to your computer via the USB cable, you can drag and drop supported files into the appropriate folder on your Kindle.
- When finished, use the safe removal method recommended by your computer's operating system.
- If you need more assistance - www.amazon.com/USBtransfer
Robert A. Bitterman, MD, JD, FACEP
Dr. Bitterman earned his medical degree from Wayne State University and completed an emergency medicine residency at the University of Cincinnati. He spent the next 15 years in private practice as an owner of Emergency Physicians Medical Group, Inc., Ann Arbor, Michigan. He directed programs in quality assurance, EMS, ACLS/ATLS, and medical student education and for 5 years was director of the emergency department at Mercy Hospital in Detroit. While in Detroit, his interest in access to health care issues led to a law degree from the University of Detroit Law School. He served as associate editor of the University of Detroit Law Review and received the American Jurisprudence Award for Legal Writing and Research and the Rakow Award from the Federal Bar Association of Michigan.
Dr. Bitterman lectures nationally for the American College of Emergency Physicians, Temple University, Mutual Assurance Corporation, The Reciprocal Group, and other medical and legal organizations. He has written numerous articles and chapters in both the medical and the legal literature, primarily on gastrointestinal emergencies such as food poisoning and on the Emergency Medical Treatment and Active Labor Act, or EMTALA, and state laws and risk management issues concerning emergency medicine. He wrote one of the first influential law review articles identifying the potential ramifications of EMTALA for hospitals, physicians, and access to health care and produced nationally distributed audiovisual programs on EMTALA and emergency medicine risk management.
Dr. Bitterman is on the editorial boards of Emergency Department Legal Letter and Managed Care Emergency Department and serves as a consultant to ACEP, other health care organizations, hospitals, and law firms throughout the country on EMTALA. He chaired the ACEP EMTALA Task Force/Education committee and is a member of the ACEP Medical-Legal committee. He represented ACEP on the HCFA advisory work group on EMTALA during the drafting of the new interpretive guidelines, leading the Enforcement Issues subgroup.
Presently, Dr. Bitterman is director of risk management and managed care in the Department of Emergency Medicine at the Carolinas Medical Center, clinical assistant professor of emergency medicine at the University of North Carolina, and a full-time faculty member of the Carolinas Medical Center emergency medicine residency program. He also is a partner in Medical Practice Risk Assessment, Inc., a medical-legal education and consulting firm based in Ann Arbor. Dr. Bitterman is board certified in emergency medicine, a Fellow of the American College of Emergency Physicians and the American College of Legal Medicine, and a member of the State Bar of North Carolina.
Dr. Bitterman lives in Charlotte, North Carolina, with his wife, Liz, and their children, Michelle and Matthew.Chapter 7