EMTALA, two decades later: a descriptive review of fiscal year 2000 violations

Purpose To determine to what extent cases sanctioned under the Emergency Medical Treatment and Active Labor Act (EMTALA) reflect willful refusal of screening or stabilization. Basic Procedures The Centers for Medicare and Medicaid Services were petitioned for all confirmed EMTALA citations from year 2000. Each citation was classified into one of three categories: (1) willful refusal to perform a screening exam or to stabilize; (2) possible refusal to screen or stabilize; or (3) no evidence of refusal to screen or stabilize. Citations were reviewed to determine the presence of 10 other characteristics. Three investigators independently reviewed a subset of data to verify acceptable inter-rater reliability. Findings We received 157 (53%) of the 294 records requested. Of the 131 involving ED personnel, 44 (34%) demonstrated willful refusal of screening or stabilization. Thirty-two (24%) were possible refusals of service, and 55 (42%) contained no evidence of refusal. Principal Conclusion Emergency department willful refusal of screening and stabilization still occurs despite enforcement of EMTALA.