EMTALA, two decades later: a descriptive review of fiscal year 2000 violations.
OBJECTIVE
To determine to what extent cases sanctioned under the Emergency Medical Treatment and Active Labor Act (EMTALA) reflect willful refusal of screening or stabilization.


METHODS
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.


RESULTS
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.


CONCLUSIONS
Emergency department willful refusal of screening and stabilization still occurs despite enforcement of EMTALA.
Department of Emergency Medicine, Kaiser Permanente San Rafael, CA 94903, USA. dballard30@yahoo.com
Dustin W
DW
Ballard
Robert W
RW
Derlet
Ben A
BA
Rich
Robert A
RA
Lowe
D014487:Centers for Medicare and Medicaid Services, U.S.; D004636:Emergency Service, Hospital / Q000331:legislation & jurisprudence*; D004638:Emergency Treatment / Q000706:statistics & numerical data*; D019538:Health Care Surveys; D006297:Health Services Accessibility / Q000331:legislation & jurisprudence*; D006801:Humans; D035846:Law Enforcement; D010360:Patient Transfer / Q000331:legislation & jurisprudence* / Q000706:statistics & numerical data*; D016079:Refusal to Treat / Q000331:legislation & jurisprudence* / Q000706:statistics & numerical data*; D014481:United States