Question of the Week

Question: Our state government has directed that when a Medicaid mental health patient arrives at our Emergency Department, we are to immediately send that individual to a hospital with which the state has contracted for screening and care of this patient population.  Now I understand that following that state direction could get us in trouble under the Emergency Medical Treatment and Active Labor Act.  Is that true?  And if there’s a conflict between state law and the federal EMTALA law, which wins?

Answer:  Unfortunately, the answer is yes.  As described in CMS’s EMTALA Interpretive Guidelines:

Hospitals are not relieved of their EMTALA obligation to screen, provide stabilizing treatment and/or an appropriate transfer to individuals because of prearranged community or State plans that have designated specific hospitals to care for selected individuals (e.g., Medicaid patients, psychiatric patients, pregnant women).  Hospitals located in those States which have State/local laws that require particular individuals, such as psychiatric or indigent individuals, to be evaluated and treated at designated facilities/hospitals may violate EMTALA if the hospital disregards the EMTALA requirements and does not conduct an MSE and provide stabilizing treatment or conduct an appropriate transfer prior to referring the individual to the State/local facility. If, after conducting the MSE and ruling out an EMC (or after stabilizing the EMC) the sending hospital needs to transfer an individual to another hospital for treatment, it may elect to transfer the individual to the hospital so designated by these State or local laws.  Hospitals are also prohibited from discharging individuals who have not been screened or who have an emergency medical condition to non-hospital facilities for imposes of compliance with State law.  The existence of a State law requiring transfer of certain individuals to certain facilities is not a defense to an EMTALA violation for failure to provide an MSE or failure to stabilize an EMC therefore hospitals must meet the federal EMTALA requirements or risk violating EMTALA.

This means that the hospital has to fulfill its own EMTALA obligations, even if the state has designated another facility to screen and treat the patient.  And as you likely suspect, EMTALA wins in a fight with state law.  Federal law – EMTALA – trumps state law and state contracts.