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The Emergency Medical Treatment and Labor Act (EMTALA) was enacted by the US congress in 1986 to ensure that the general public had access to emergency medical care without regard to their financial or legal status. The act compelled hospitals that offered emergency services to accord treatment for all emergency circumstances that include a patient's medical screening examination (MSE) whenever the examination is requested and also cases of active labor without consideration of one's ability to pay (State of Operations Manual, 2009). The hospitals are also required to ensure that patients with emergency medical conditions are stabilized. In cases where a hospital lacked necessary resources that led to its inability to stabilize a patient or they requested their transfer, the hospital should make an appropriate transfer in accordance to EMTALA guidelines. EMTALA was enacted to counter the increasing cases of 'patient dumping'. Hospitals were turning away, discharging or improperly transferring patients who needed emergency medical care due to their inability to pay. Whenever patients do not exhibit emergency medical situations or they have already been stabilized, then it means that the hospital is no longer tied to EMTALA obligations.

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According to Furrow et al (1997), if a patient launched a complaint against a hospital, a thorough investigation of the hospital's processes and policies is carried out. In case the investigation reveals that EMTALA policies have been violated, the hospital is subject to monetary fines or they could have their medical provider contracts terminated. Hospitals face monetary fines not exceeding $50,000 for each violation and if a hospital has less than 100 beds, its maximum fine is up to $25,000 for each violation. A physician who is responsible for the offence is also liable a penalty.

Hospitals are prohibited from transfer of emergency cases unless they lack the capacity to handle them or the patient requests to be transferred. All transfers should be in accordance to EMTALA guidelines. The hospital should make sure it obtains a written approval of the patient in question or their legal guardian. This shows that both parties have reached an agreement of transfer and the patient was not transferred against his will or his inability to meet treatment costs (Furrow, 2009). Secondly, before the transfer is done, the medical benefits that the patient will receive from the new hospital where they are being transferred must be evaluated and found to outweigh any risks that would occur if they were to remain in the initial hospital or risks during the transfer process, a qualified medical doctor should offer certification of the above.


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The receiving hospital should also make an assurance that it is fully capable of handling the emergency case. A patient should not be transferred top a hospital that is without the necessary resources to treat them. Emergency department managers should make sure that all medical records for the patient who is to be transferred are availed to the receiving hospital. This measure serves to prepare the receiving hospital in advance and also saves them time taken to diagnose the patient. Finally all transfers should be carried out with qualified medical staff using appropriate transportation equipment. Fully equipped ambulances with properly trained staff should be used to transfer all emergency cases from one hospital to another (Furrow et al, 1997).

As an emergency department manager I would ensure the following steps are taken for the operations of my department correspond to EMTALA guidelines. I would first aim to adopt and enforce all the policy guidelines and procedures as stipulated by EMTALA. As a sign of my department's dedication to deal with emergency cases without discrimination, I would post signs in the department outlining the rights of patients with emergency medical conditions and also state if my department is a participant in the Medicaid program. I would ensure that all patients transferred to and from my hospital over a period of five years of their transfers have their medical records properly maintained for future reference (State of Operations Manual, 2009).

My department would maintain a list of qualified physicians who would be on- call to offer treatment and evaluation needed to stabilize patients with emergency medical conditions. I would also ensure that patients with emergency medical conditions are accorded proper screening examinations and medical stabilization within the department's capacity. In the event that my department genuinely lacks the capacity to handle an emergency case or a patient requests to be transferred to another medical facility, I would ensure that the patient is transferred in accordance to EMTALA transfer guidelines to a facility that is properly equipped to handle their case (Furrow, 2009). 

My department will, at all times receive those with emergency medical situations transferred from other hospitals if we have the capacity to treat them and if their transfer was in accordance to EMTALA guidelines. It will be the duty of my department to ensure that patients with emergency medical conditions are attended to immediately and ensure that time is not wasted enquiring the patients' abilities to pay for the services accorded to them. (State of Operations Manual, 2010) Physicians in my department will be encouraged to report any EMTALA violations or reject transfers of patients whose cases they can handle without fear of them being penalized.

The enactment of EMTALA has ensured that patients with emergency medical situations who lack the ability to pay for medical services are given the best medical attention in the US. It has also considerably reduced the cases of 'patient dumping' as medical facilities are aware of the heavy penalties they would face in case it is discovered that they have violated EMTALA guidelines.

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