In 1986 Congress passed the Emergency Medical Treatment and Labor Act (EMTALA), part of the 1985 Consolidated Omnibus Reconciliation Act (COBRA). Most people know COBRA as the law that mandates that a company has to let an employee who leaves pay into the health insurance plan and remain covered temporarily. This mandate protects employees from suddenly losing their health insurance after, for example, being laid off. EMTALA focuses on another issue: the practice of patient “dumping.” Dumping occurs when a hospital fails to treat, screen, or transfer patients. Not surprisingly, a patient’s ability to pay plays heavily into this treatment. Before EMTALA was passed, hospitals could transfer indigent patients instead of treating them.

Under EMTALA, no patient who arrives in a hospital with an emergency condition will be turned away or transferred unnecessarily. Anyone who shows up in a hospital emergency room will be screened to determine the severity of his or her condition. If the condition is deemed an emergency, the hospital is obligated to stabilize the patient. The hospital can transfer patients only when it lacks the ability to stabilize the patient beyond a certain limit; a transfer to a charity hospital merely to avoid treating the patient is a violation.

A woman who is in labor is deemed to be in an emergency medical situation and cannot be denied care or unnecessarily transferred.

The hospital does have the right to inquire whether the patient can pay. It is a violation, however, if examination or treatment is delayed while the hospital asks the question. The hospital is not permitted to base its decision to treat a patient on whether there is an expectation of payment.

The hospital has no obligation to the patient if an emergency condition does not exist. Nor does the hospital have an obligation to a patient who refuses examination, treatment, or transfer. The hospital is required to keep a record of this and also must try to get the patient’s refusal in writing. The patient should also be told about the risks incurred in leaving the hospital.

EMTALA imposes harsh penalties for hospitals that violate the law. The hospital may face fines of up to $50,000 per incident; attending physicians can also be fined if they are found to have hidden the true nature of a patient’s condition.

While laws like EMTALA are helpful, they ignore the issue of how uninsured people can pay for nonemergency care. Uninsured people have to pay full price for their prescription medication, for any routine doctor’s visit, and for elective procedures. Some uninsured individuals try to get around the law by showing up at a hospital’s emergency room for non-emergency care, in the hope that the emergency staff will provide some degree of assistance. Trying to use the emergency room for more routine health prob-lems still provides inadequate care to these people, and it also ties up staff and resources needed for true emergencies