Civil Monetary Penalties from Violations of the Emergency Medical Treatment and Labor Act for Patients Arriving or Leaving with Law Enforcement.

introductionThe Emergency Medical Treatment and Labor Act (EMTALA), a federal law enacted in 1986, is intended to prevent inadequate, delayed, or denied treatment of emergency medical or emergency psychiatric conditions by Medicare-participating hospitals when individuals present to dedicated emergency departments (EDs). EMTALA requires all patients seeking evaluation for an emergency medical condition (EMC) at a dedicated ED to have an appropriate medical screening exam (MSE), stabilization of identified EMCs, and an appropriate transfer if specialized services are needed for stabilization.

methodsWe obtained summaries of all EMTALA-related civil monetary penalties (CMPs) between 2002-2023 from the Office of the Inspector General (OIG) and reviewed them for instances where patients arrived or departed with law enforcement officers (LEOs). In this article, we describe the characteristics of these CMPs.

resultsOf 260 EMTALA-related CMPs, 15 (5.8%) were identified as having involved patients arriving to or departing from an ED with LEOs. Among these, nine (60%) involved patients arriving to the ED with LEOs, of whom five (55.6%) were transported to alternate facilities by LEOs at the direction of ED staff without receipt of an appropriate MSE. Overall, eight (88.9%) of nine patients arriving with LEOs involved psychiatric concerns. Four cases were identified as having involved patients discharged from but not arriving to the ED with LEOs. Of these, two involved patients brought to the ED for evaluation of psychiatric conditions and discharged to jail without appropriate MSE after becoming disruptive. Two involved patients with psychiatric issues sent to jail without appropriate MSE/stabilization, some due to hospital policies pertaining to alcohol intoxication. Two involved patients without noted psychiatric concerns escorted from the ED with the assistance of LEOs after reported to be "resistant" or "aggressive." One returned to the ED in cardiac arrest, and another was subsequently diagnosed with bacterial meningitis.

conclusionOverall, 5.8% of EMTALA-related CMPs involved patients arriving to or departing from the ED with LEOs; most of these involved patients with psychiatric emergencies. In many cases, LEOs were advised to either transport patients to an alternate medical facility without an appropriate MSE, or disruptive or intoxicated patients with noted psychiatric concerns were discharged to jail without adequate MSE or stabilization. Findings indicate a need for education surrounding EMTALA requirements to provide MSEs and, if needed, stabilizing treatment prior to discharge or transfer for all patients presenting to the ED, regardless of LEO involvement.