The Emergency Medical Treatment and Active Labor Act (EMTALA) was enacted by Congress in 1986 in response to widespread reports that hospitals were refusing to admit or provide emergency treatment to indigent persons. EMTALA establishes that if an individual "comes to" a hospital's emergency room and requests an examination or treatment for a medical condition, the hospital must provide an appropriate medical screening examination. If this initial screening shows the individual suffers from an emergency medical condition, the hospital must also provide the services necessary to stabilize the condition.
In recent years, more individuals have turned to hospital emergency rooms for medical services, with over sixteen million patients per year admitted to hospitals via this route, including many individuals who lack health care coverage and many individuals with a mental health disorder (roughly one million patients per year are admitted for mental health or substance abuse disorders). At the same, because this federal mandate has not been accompanied by specific funding to reimburse hospitals for these services, many hospitals have complained about the costs that they are obligated to incur in providing services to indigent patients.
Frequently, patients needing emergency treatment are brought to a hospital via ambulance. The paramedics in the ambulance often call ahead to an emergency room to inform staff that they are en route to enable staff to prepare for their arrival and to facilitate their timely response to the patient's needs when they do arrive. The question that has arisen is whether this call invokes the hospital's EMTALA obligations or whether the emergency room staff can inform the paramedics at this point that they must take the patient elsewhere.
In its first ruling on the question, the First Circuit joined the Ninth Circuit in holding that an individual can "come to" the emergency room of a hospital for EMTALA purposes without physically arriving on the hospital's grounds as long as the individual is en route to the hospital and the emergency department has been notified of the individual's imminent arrival. In the case before the court, paramedics in an ambulance had called ahead to the emergency department of the hospital where they were planning to deliver a patient (a choice based on the fact that this was the hospital where the patient's physician regularly practiced). The director of the hospital's emergency department inquired as to whether the patient had medical coverage. When he received no such assurance, he abruptly terminated the call, an action the paramedics interpreted as a refusal to treat the patient at the hospital's emergency department and that led them to take the patient to a different facility. …