SMI Digest: EMTALA
SMI Digest is a monthly publication from Treatment Advocacy Center (TAC) that summarizes recently published research on topics related to serious mental illness (SMI) with psychosis. This month’s digest honors the 40-year anniversary of The Emergency Medical Treatment and Labor Act (EMTALA).
What is The Emergency Medical Treatment and Labor Act? EMTALA is a federal law passed in 1986 that requires hospitals that receive Medicaid or Medicare funding to provide emergency screening and stabilization or a transfer to an appropriate facility for all patients who arrive at the hospital with an emergency medical condition, including psychiatric emergencies. EMTALA applies regardless of a patient’s ability to pay or level of care needed for stabilization.
While obligations to treat under EMTALA generally do not apply if a patient does not consent to be treated, the law includes emergency exceptions to informed consent, including when the patient lacks capacity, when capacity is uncertain due to an altered mental state, and when failing to stabilize would create a risk of deterioration, harm to health, or mortality. An examination to determine whether a person meets the state’s criteria for involuntary commitment may not meet the threshold for a medical screening examination under EMTALA.
When a hospital or physician fails to adequately screen, treat, or transfer under EMTALA, they may be liable for settlements, fines, or termination from participation in Medicare.
Failure to adequately respond to psychiatric emergencies represented almost one in five EMTALA fines from 2002 to 2023. Despite serious mental illness impacting less than 9% of American adults, psychiatric emergencies represented 23% of all 260 fines issued for EMTALA violations from 2002 to 2023. Fines related to psychiatric emergencies were more likely to be caused by a hospital failure to adequately stabilize the patient before discharging them than EMTALA fines related to other medical emergencies. This included cases in which patients experiencing psychiatric crises were sent to jail without being appropriately evaluated or stabilized. Settlements related to psychiatric emergencies also resulted in higher costs to hospitals. The average settlement amount for EMTALA violations during psychiatric emergencies was $271,952 from 2019 to 2023.
What can I do if I’ve experienced or witnessed an EMTALA violation? Only approximately 3.2% of EMTALA investigations result in fines, and not all EMTALA violations are reported or lead to an investigation. If you believe you experienced or witnessed an EMTALA violation, including a delayed emergency medical examination or a discharge without adequate stabilization from the emergency department, you can submit a complaint to your State Survey Agency. For support with contacting your state survey agency or to learn how to use your story to improve care for people experiencing SMI, send our team an email at help@tac.org.
