While EMTALA is essentially concerned with the hospital receiving the patient first, some obligations are imposed on the hospital that receives the patient through referral. Usually, patients brought to the emergency ward are transferred only if a more specialized trauma unit is available in a nearby medical facility. Again, the patient requirements are placed ahead of the hospital’s profitability or its staff’s convenience. The receiving hospital (after being referred) will inevitably have to provide trauma-care to the patient, except under one condition. Where the primary referring hospital is equally capable of providing treatment to the patient, the referred hospital can refuse to attend to the patient. If this happens, any deterioration of patient’s health as a result of this futile transfer will be the responsibility of the hospital receiving the patient first. Exceptions are made for hospitals running at full capacity and not in a position to take any more patients. Also,
“If an individual presents to any contiguous or on-campus facility of a hospital that has one or more hospital-owned non-contiguous or off-campus facilities, the emergency medical screening examination must be performed within the contiguous or on-campus facilities of the hospital. In this situation, it would not be appropriate for the hospital to move the patient to an off-campus facility for a medical screening examination. Assuming that coming to the off-campus hospital-based facility is the same as coming to the parent hospital, under the EMTALA requirements, the hospital-based facility must comply with the transfer guidelines.” (www.emtala.com, 2004)
The regulations do no require hospitals to transfer a patient identified to be in an emergency medical condition without the latter’s consent. The physician needs to certify that there are more benefits attached with the transfer when compared to the potential risks and the hospital receiving the patient is sufficiently equipped and agreed to treat the patient. The patient’s medical history is made available to the receiving facility and the transfer is carried out only by qualified medical personnel (www.emtala.com, 2003)
Another key provision of EMTALA puts forth the circumstances in which medical personnel, especially physicians in specialty wards, should serve on the hospital’s medical staff on-call lists. The new regulations inform that hospitals will have a right to draw-up their on-call lists by taking into consideration the interests of their communities. The hospitals are no longer required to have doctors on-call at all times. They can even exempt certain senior medical personnel from on-call duty. Doctors will now be permitted to be on-call in two or more hospitals simultaneously.
For hospitals and healthcare personnel who breach the obligations under EMTALA, the penalties could be quite severe. For smaller hospitals, with a total capacity of less than one hundred beds, the pecuniary damages could reach as much as $25000. For larger hospitals with a bigger intake capacity, the penalty could be twice as much. EMTALA makes very little distinction between regular and on-call medical personnel. Even on-call personnel are required to be aware of all their obligations under EMTALA and can attract the same punitive charges as applicable to regular doctors. If anything, on-call physicians are more prone to violating their obligations. For example, an on-call physician might fail to respond to his call and arrive at the hospital within the expected time. He/she is then liable for penalties (Westfall, 2003).
In the final analysis, hospitals with off-campus treatment units should make sure that the emergency department and off-campus medical personnel form effective lines of communication regarding EMTALA related compliance. The hospital should perform in-house training programs to make sure that the medical staff at all its facilities (on or off site) is aware of their obligations as proscribed by EMTALA. Hospitals are also advised to train some of their personnel in emergency lifesaving techniques. The hospital should also adopt policies and procedures for off-campus, provider-based clinics, urgent care facilities and “fast track” in such a way that the EMTALA requirements are also taken care of.