A patient without insurance arrives at the ED with chest pain. The triage nurse confirms the patient is uninsured. Which action reflects compliance with EMTALA?
1Have the patient sign a document waiving the hospital's liability for any adverse outcomes prior to starting the medical screening examination, as a routine procedure for uninsured patients.
2Provide a medical screening examination (MSE) to determine whether an emergency medical condition exists, regardless of ability to pay; stabilize any emergency condition before any transfer is considered.✓ Correct answer
3Request a $200 deposit from the patient prior to the medical screening examination, explaining that the hospital's policy is to collect payment before services are rendered for uninsured patients.
4Ask the patient about insurance coverage and, upon confirming they are uninsured, instruct them to go to the nearest county hospital for evaluation without providing a medical screening examination or stabilization.
Explanation
EMTALA (Emergency Medical Treatment and Active Labor Act) requires Medicare-participating hospitals with EDs to provide a medical screening examination to ANYONE who comes to the ED, regardless of ability to pay or insurance status, and to stabilize any emergency medical condition before any transfer. Choices 1, 3, 4 are explicitly EMTALA violations carrying federal penalties.
The two EMTALA pillars are MSE for everyone and stabilization before transfer. Demanding payment first or denying screening based on insurance is the most-tested EMTALA violation. Hospitals can collect insurance information AFTER stabilization, never before MSE.
Adult uninsured patient walks into the ED with chest pain. The triage nurse must determine the EMTALA-compliant first action.
EMTALA — Federal law requiring Medicare hospitals to provide medical screening exam and stabilization to all who come to the ED regardless of insurance.
Medical screening exam (MSE) — Examination by qualified medical personnel to determine if an emergency medical condition exists; required for everyone before any payment discussion.
Stabilization requirement — Hospital must stabilize emergency conditions before any transfer; transfer to higher level of care allowed only after stabilization or for medically necessary reasons.