Some clear criteria are set under the Act to determine if a medical condition is an emergency or not. Although the process of arriving at a conclusion is a medical one based on scientific facts, the criteria under the statute provides a legal framework. For example, the statute explicates the criteria to determine an emergency condition thus:
“A medical condition manifesting itself by acute symptoms of sufficient severity (including severe pain) such that the absence of immediate medical attention could reasonably be expected to result in placing the health of the individual (or, with respect to a pregnant woman, the health of the woman or her unborn child) in serious jeopardy, serious impairment to bodily functions, or serious dysfunction of any bodily organ or part, etc… With respect to a pregnant woman who is having contractions – that there is inadequate time to effect a safe transfer to another hospital before delivery, or that the transfer may pose a threat to the health or safety of the woman or her unborn child.” (Bristol, 2006)
The criteria for “stability” are different for patients suffering from psychiatric illnesses when compared to those brought in for organic traumas. For psychiatric cases, a patient is declared “Stable for discharge” when he/she is not regarded as a threat to self and others. Similarly, the emergency physician can declare a patient “Stable for transfer”, when the patient is sufficiently protected from injuries during transfer. In other words,
“To “stabilize” means to provide such medical treatment of the condition as may be necessary to assure, within reasonable medical probability, that no material deterioration of the condition is likely to result from or occur during the transfer of the individual from a facility, or . . . with respect to a pregnant women who is having contractions, to deliver (including the placenta).” (Rosenbaum, 2003)
The key words in the provisions for women in active labor are “safe transfer”, “inadequate time” and “threat to health or safety”. With such clear framing of sentences, the statute leaves no room for ambiguity or misinterpretation. EMTALA is equally explicit about patient transfers. The following are the conditions stated by the statute for patient transfer:
1. (For emergency medical conditions) “that no material deterioration of the patient’s condition is likely to result from the transfer or is likely to occur during the transfer”,
2. (For patients in active labor) “the infant and the placenta have been delivered” (Hampers, 2002).
It is important to note that while EMTALA is applicable to the hospitals and the hospital administrators, physicians are also liable for incidents of noncompliance. Since all private hospitals are also business corporations, the laws applicable to the latter are also applicable to the former. Some of the clauses in the Act do specifically mention the conduct expected of physicians. For example, Section 1395dd (d)(1)(C) mentions that penalties could be imposed on the physician who has failed to respond to the emergency situation according to the statute. Physicians who transfer patients even if the situation does not warrant it can be made accountable for their actions (Hampers, 2002).
Physicians can also be held liable for negligence and incorrect diagnoses. Physicians are also covered under the State malpractice law for negligence and wrong diagnoses. Since the scope for the State law is broader than EMTALA, medical personnel who meet EMTALA requirements can still face punitive action under the State malpractice law. Summers v. Baptist Medical Center of Arkadelphia case is a classic example of punitive action against emergency healthcare personnel for an inadequate process of screening examination. In this case,
“…an examination of a patient who had fallen from a tree stand while hunting was allegedly incomplete because a chest x-ray had not been included when a set of spinal x-rays was ordered. The physician did not believe that the patient had any fractures, and discharged him home, with instructions. There was no transfer to another facility involved. The patient presented at another hospital two days later, and he was diagnosed with an acute comminuted vertebral fracture, a sternal fracture, and bilateral hemopneumothoraces secondary to untreated rib fractures.” (www.emtala.com, 2003)