Emergency Medical Treatment and Labor Act (EMTALA)

Doctors at Cook County Hospital in Chicago followed 467 medical and surgical patients who had been sent to them from the emergency departments of other hospitals and then admitted. Eighty-nine percent were Black or Hispanic and 81 percent were unemployed. The sending hospitals gave lack of adequate insurance as the reason in 87 percent of cases, and only 6 percent of the patients had given written consent. Twenty-four percent were unstable when they left. Among medical patients, 9.4 percent of those transferred died, against 3.8 percent of those who were not. R. L. Schiff, D. A. Ansell and colleagues published the study in the New England Journal of Medicine in February 1986.

The practice, known as patient dumping, was not confined to Chicago. Ansell and Schiff reported in 1987 that such transfers in Dallas had risen from 70 a month in 1982 to more than 200 a month in 1983.

Congress acted through a budget bill, the Consolidated Omnibus Budget Reconciliation Act of 1985, enacted on 7 April 1986. Its emergency section added section 1867 to the Social Security Act. A hospital that takes Medicare and offers emergency services must give a medical screening examination to anyone who requests care for an emergency condition, including labor, regardless of ability to pay. It must then stabilize the patient, or arrange an appropriate transfer if it cannot or if the patient asks. The law covers any individual who comes to the emergency department, whether or not eligible for Medicare.

The first penalty was a fine of up to $25,000 per knowing violation, for the hospital and for the responsible physician. Amendments in 1987 and 1990 raised the ceiling to $50,000 and made negligent violations punishable, and a 1989 amendment struck the word 'active' before 'labor'. In 1999 the Supreme Court held, in Roberts v. Galen, that a claim that a hospital failed to stabilize a patient does not require proof of an improper motive.