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Can hospitals turn away patients?

Jeffrey Johnson

Managing Editor & Lawyer

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Privately-owned hospitals may turn away patients in a non-emergency, but public hospitals cannot refuse care. Public hospitals, funded by taxpayer dollars, are held to a different standard than privately owned for-profit hospitals. This means that a public hospital is the best option for those without health insurance or the means to pay for care.

The Emergency Medical and Treatment Labor Act (EMTLA)

Public and private hospitals alike are prohibited by law from denying a patient care in an emergency. The Emergency Medical and Treatment Labor Act (EMTLA) passed by Congress in 1986 explicitly forbids the denial of care to indigent or uninsured patients based on a lack of ability to pay. It also prohibits unnecessary transfers while care is being administered and prohibits the suspension of care once it is initiated, provisions that prevent dumping patients who cannot pay on other hospitals. The treatment of indigent and uninsured patients is a huge financial drain upon the health system, especially in areas where no public hospitals are available.

While EMTLA does not prohibit care providers from asking about a patient’s ability to pay, it does make it very clear that emergency treatment cannot be delayed while ability to pay is being checked. Essentially, the law establishes a “treat first, ask questions later” policy. This policy serves a dual purpose by protecting both private hospitals and patients. Private hospitals are protected because they can deny non-emergency care based upon ability to pay and patients are protected because refusal or delay of emergency care based on means to pay is illegal.

Patient Protection Under The EMTLA

What is to prevent a hospital from denying care and then lying about the severity of a patient’s condition? A schedule of stiff fines included in EMTLA is intended to discourage lying about a patient’s condition with extreme prejudice. Both hospitals and individual doctors can be held liable under EMTLA, doubling potential financial punishment. In a business that, for better or for worse, revolves around the bottom line, the threat of fines in excess of $50,000 is enough to give most hospitals and doctors pause before downplaying a patient’s condition.

Imagine a pregnant woman without health insurance living in an area that does not have a public hospital. If she goes into labor and the closest hospital is privately-run, the EMTLA requires that the hospital must admit the woman regardless of her ability to pay as childbirth is considered an emergency situation. The woman's labor and delivery care, regardless of length and complication, should be indistinguishable from that of a fully insured patient. This equal treatment will continue until the end of the emergency (i.e. after the child is born and there are no complications).

Hospital Bills

Hospitals are not shy about trying to collect from uninsured emergency patients. Their efforts can involve the hospital’s internal billing department, collection agencies, and even lawsuits. The collection process can be unpleasant: wages may be garnished and liens may be instituted on property. Hospitals, like any business, do not like getting stiffed on the tab, no matter what the law says.

Going back to the previous example of the uninsured mother, the privately-run hospital that delivered the baby can resume payment talks once it is clear that there are no further complications. At this point the hospital's billing department may take a harder line and discharge the woman within 24 hours. Once the emergency (childbirth) has been resolved, the hospital is under no obligation to provide treatment to the mother or her child. Elective procedures such as circumcision will likely not be an option and the hospital will continue to attempt to bill the woman for the services provided.

Public hospitals may not deny patient care based on ability to pay (or lack thereof). Private hospitals may, in non-emergency situations, deny or discontinue care. If you think you were unlawfully denied care or your treatment was not adequate because of lack of insurance or inability to pay, contact a local malpractice attorney to discuss your options.