Editing Emergency medicine (section)

====EMTALA====

Doctors that work in the EDs of hospitals receiving Medicare funding are subject to the provisions of [[EMTALA]].<ref name=":2">{{Cite web|url=https://www.law.cornell.edu/uscode/text/42/1395dd|title=42 U.S. Code § 1395dd – Examination and treatment for emergency medical conditions and women in labor|website=LII / Legal Information Institute|access-date=2016-11-19}}</ref> The US Congress enacted EMTALA in 1986 to curtail "patient dumping", a practice whereby patients were refused medical care for economic or other non-medical reasons.<ref name=":3">{{cite journal |pmid=15002183 |year=2004 |last1=Lee |first1=T. M. |title=An EMTALA primer: The impact of changes in the emergency medicine landscape on EMTALA compliance and enforcement |journal=Annals of Health Law |volume=13 |issue=1 |pages=145–78, table of contents}}</ref> Since its enactment, ED visits have substantially increased, with one study showing a rise in visits of 26% (which is more than double the increase in population over the same period).<ref name=":4">{{Cite journal |last=Dollinger |first=Tristan |year=2015 |title=America's Unraveling Safety Net: EMTALA's Effect on Emergency Departments, Problems and Solutions |url=http://scholarship.law.marquette.edu/mulr/vol98/iss4/9 |journal=Marquette Law Review |volume=98 |pages=1759}}</ref> While more individuals are receiving care, a lack of funding and ED overcrowding may be affecting quality.<ref name=":4" /> To comply with the provisions of EMTALA, hospitals, through their ED physicians, must provide medical screening and stabilize the emergency medical conditions of anyone that presents themselves at a hospital ED with patient capacity.<ref name=":3" /> EMTALA holds both the hospital and the responsible ED physician liable for civil penalties of up to $50,000 if there is no help for those in need.<ref name=":2" /> While both the [[Office of Inspector General, U.S. Department of Health and Human Services]] (OIG) and private citizens can bring an action under EMTALA, courts have uniformly held that ED physicians can only be held liable if the case is prosecuted by OIG (whereas hospitals are subject to penalties regardless of who brings the suit).<ref>{{Cite news|url=http://law.justia.com/cases/federal/district-courts/FSupp/786/538/1380004/|title=Jones v. Wake County Hosp. System, Inc., 786 F. Supp. 538 (E.D.N.C. 1991)|newspaper=Justia Law|access-date=2016-11-19}}</ref><ref>{{Cite news|url=http://law.justia.com/cases/federal/district-courts/FSupp/756/1476/2291188/|title=Delaney v. Cade, 756 F. Supp. 1476 (D. Kan. 1991)|newspaper=Justia Law|access-date=2016-11-19}}</ref><ref>{{Cite journal|last=Circuit.|first=United States Court of Appeals, Fourth|date=1992-10-07|title=977 F2d 872 Baber v. Hospital Corporation of America Hca B|url=http://openjurist.org/977/f2d/872/baber-v-hospital-corporation-of-america-hca-b|volume=F2d|issue=977|page=872}}</ref> Additionally, the Centres for Medicare and Medicaid Services (CMS) can discontinue provider status under Medicare for physicians that do not comply with EMTALA.<ref name=":3" /> Liability also extends to on-call physicians that fail to respond to an ED request to come to the hospital to provide service.<ref name=":2" /><ref>{{Cite web|url=https://www.acep.org/clinical---practice-management/cms-question-and-answer-program-memorandum-on-emtala-on-call-responsibilities/|title=CMS Question and Answer Program Memorandum on EMTALA On-Call Responsibilities // ACEP|website=acep.org|access-date=2016-11-19|archive-url=https://web.archive.org/web/20161128195134/https://www.acep.org/clinical---practice-management/cms-question-and-answer-program-memorandum-on-emtala-on-call-responsibilities/|archive-date=28 November 2016|url-status=dead}}</ref> While the goals of EMTALA are laudable, commentators have noted that it appears to have created a substantial unfunded burden on the resources of hospitals and emergency physicians.<ref name=":4" /><ref>{{cite journal |pmid=10179281 |year=1998 |last1=Hyman |first1=D. A. |title=Patient dumping and EMTALA: Past imperfect/future shock |journal=Health Matrix |volume=8 |issue=1 |pages=29–56}}</ref> As a result of financial difficulty, between the period of 1991–2011, 12.6% of EDs in the US closed.<ref name=":4" />