# 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?

> source: MyMerci (mymerci.kr)  
> url: https://mymerci.kr/pages/nclex_q.php?qn_id=374913&lang=en  
> language: en  
> subject: NCLEX-RN  
> category: MOC

## Question

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?

## Option

1. Inform the patient that the hospital cannot evaluate them without insurance and direct them to a county hospital.
2. Provide 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**
3. Collect a $200 deposit before allowing the patient into the treatment area.
4. Have the patient sign a waiver of all hospital liability before any care is provided.

**Correct answer: 2**

## 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.

## In-depth explanation

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.

## Clinical scenario

Adult uninsured patient walks into the ED with **chest pain**. The triage nurse must determine the EMTALA-compliant first action.

## Key concepts

- **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.

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