In yesterday’s blog, we discussed the Emergency Medical Treatment and Active Labor Act (“EMTALA”) enacted in 1986 by the U.S. Congress that was intended to prevent hospitals from “dumping” patients in need of emergency care (“patient dumping” is defined as hospital emergency rooms denying uninsured patients the same treatment provided to paying patients, either by refusing care outright or by transferring uninsured patients to other facilities).
The EMTALA applies to all hospitals accepting Medicare. Section 489.24 of the EMTALA requires, with regard to hospitals with emergency departments, that if an individual (whether or not eligible for Medicare benefits and regardless of ability to pay) “comes to the emergency department”, the hospital must provide an appropriate medical screening examination within the capability of the hospital’s emergency department and if an emergency medical condition is determined to exist, provide any necessary stabilizing treatment.
In response to a widely-publicized incident in Chicago in 1998 in which a 15-year-old boy who had been shot on a playground was brought to an alley just off of the grounds of a nearby hospital but was not treated by the hospital emergency personnel because of a hospital policy not allowing them to leave the hospital grounds while on duty (which apparently was not a violation of the provisions of the EMTALA at that time), amendments to the rules regarding the EMTALA were enacted in 2000 (and revised in 2003) that further refined what is meant by the term “comes to the emergency department” and expanded the responsibility of hospital emergency rooms to respond to any presentation on the hospital “campus,” which was defined by the so-called “250-yard rule.”
What Is The “250-Yard Rule”?
As a result of the amendments and revisions, the EMTALA requirements benefit not only potential emergency department patients who appear within the physical confines of the emergency department itself, but also within 250 yards of the hospital’s buildings.
To understand the “250-yard rule”, one must look to the definitions of certain terms as they are used in the EMTALA:
Comes to the emergency department means, with respect to an individual who is not a patient (as defined in this section), the individual—
(1) Has presented at a hospital’s dedicated emergency department, as defined in this section, and requests examination or treatment for a medical condition, or has such a request made on his or her behalf…
(2) Has presented on hospital property, as defined in this section, other than the dedicated emergency department, and requests examination or treatment for what may be an emergency medical condition, or has such a request made on his or her behalf. In the absence of such a request by or on behalf of the individual, a request on behalf of the individual will be considered to exist if a prudent layperson observer would believe, based on the individual’s appearance or behavior, that the individual needs emergency examination or treatment.
Hospital property means the entire main hospital campus as defined in §413.65(b) of this chapter, including the parking lot, sidewalk, and driveway, but excluding other areas or structures of the hospital’s main building that are not part of the hospital, such as physician offices, rural health centers, skilled nursing facilities, or other entities that participate separately under Medicare, or restaurants, shops, or other nonmedical facilities.
Campus means the physical area immediately adjacent to the provider’s main buildings, other areas and structures that are not strictly contiguous to the main buildings but are located within 250 yards of the main buildings, and any other areas determined on an individual case basis, by the CMS regional office, to be part of the provider’s campus. (42 CFR 413.65).
Therefore, if you believe that you or a family member have been the victim of patient dumping by a hospital emergency room, you should consult with a medical malpractice attorney to investigate your potential claim.
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