Your Right to Emergency Medical Care
You have important rights when you go to a hospital's emergency room, regardless of your insurance status. California law severely restricts and regulates the ability of all licensed health care facilities with emergency departments to transfer and discharge emergency patients.1 These laws expand upon the important protections in the federal Emergency Medical Treatment and Active Labor Act ("EMTALA,").2 The federal protections under EMTALA and its regulations apply to all hospitals that participate in the Medicare program and apply to all patients that go to those hospitals, not just Medicare patients.
WHAT IS CONSIDERED AN "EMERGENCY MEDICAL CONDITION" THAT REQUIRES EMERGENCY MEDICAL CARE?
Your condition is a medical emergency when your life, body parts or bodily functions are at risk of damage or loss unless immediate medical care is received.
The federal regulations that apply to Medicare hospitals expand upon this definition to expressly include psychiatric disturbances and symptoms of substance abuse to the extent that such conditions meet the definition of an emergency medical condition (i.e., where the absence of immediate medical attention could reasonably be expected to result in placing the patient's health in serious jeopardy, etc.).4
DOES A WOMAN IN LABOR HAVE AN EMERGENCY MEDICAL CONDITION?
Any pregnant woman who is having contractions has an emergency medical condition if there is inadequate time before delivery of the baby to have her safely transferred to another hospital, or if such a transfer may pose a threat to the health or safety of the woman or unborn child.5 Federal regulations at Medicare hospitals clarify that a pregnant woman experiencing contractions is not in "true labor" if, after a reasonable time of observation, the doctor certifies that the woman is in "false labor."6
WHAT ARE MY RIGHTS TO EMERGENCY CARE?
When you have an emergency medical condition, you have the right to emergency care at any licensed health facility operating an emergency department when the facility has the proper facilities and personnel to provide you the care.8
A hospital must inform you of your right to receive emergency services and care, prior to transferring or discharging you, and without regard to your ability to pay:
WHAT DOES IT MEAN TO HAVE MY MEDICAL CONDITION SCREENED?
When you go to a hospital's emergency department, you must be examined by a doctor, or other appropriate personnel under the doctor's supervision, in order to determine whether you have an "emergency medical condition," or are in "active labor," in a pregnant woman's case as discussed above.11 THIS REQUIRED SCREENING MUST BE PERFORMED BEFORE THE HOSPITALS ASKS YOU ABOUT YOUR ABILITY TO PAY.12
Your medical screening must be done by medical staff who are qualified under hospital bylaws or rules.13 Emergency services must also be supervised by qualified members of the medical staff, and there must be adequate medical and nursing staff who are qualified in emergency care to carry out written emergency procedures and meet the needs anticipated by the hospital.14
WHAT DOES IT MEAN TO HAVE MY CONDITION STABILIZED?
Your condition has been "stabilized" only when you have been provided the necessary medical treatment to assure, within reasonable medical probability (likelihood), that no material deterioration (worsening) of your condition is likely to result from, or occur during, your transfer from the facility.15 A pregnant woman in labor is considered stabilized once the child and the placenta have been delivered.16
WHEN CAN I BE TRANSFERRED TO ANOTHER HOSPITAL?
A hospital cannot transfer you to another hospital when you go to a hospital's emergency department with an emergency medical condition unless you are stabilized and all other requirements under the California law are met (as listed below) or if an exception applies (e.g., if you need services not available at that hospital).
Requirements for Transfer
You cannot be transferred to another hospital for any non-medical reasons (such as your inability to pay) unless all of the following conditions are met:
Federal law places the following additional requirements on the transferring and receiving hospitals that accept Medicare patients:
No. Whether you are stabilized or not, you have a constitutional right to control your body and medical treatment. If you are forcibly transferred to another facility over your objection you may have a claim of battery, false imprisonment or other claims against the hospital or doctor.
Can I Be Transferred at My Request Before I Have Been Stabilized And Against Medical Advice?
Yes. Hospitals can transfer or discharge you if you request a transfer or discharge against medical advice and provide informed consent to receive such a transfer or discharge.19
WHAT ARE MY LEGAL RIGHTS IF I AM HARMED WHILE RECEIVING EMERGENCY CARE?
California law permits you to sue a transferring or receiving hospital that harms you as a result of violation of these laws or regulations. You may recover damages (money to compensate you for your losses), reasonable attorneys' fees, and other appropriate relief. You may also seek an injunction against the hospital, or administrative or medical personnel. An injunction is a court order directing that a particular illegal action be stopped, such as a transfer to another hospital when the benefits would not outweigh the risks. If the injunction is granted, you must be granted attorneys' fees.
WHAT ARE MY HEALTH CARE PLAN'S OBLIGATIONS WITH REGARD TO PAYING FOR EMERGENCY SERVICES I RECEIVE?
Under California law, your health plan must reimburse any doctor who performs any emergency services that you receive to stabilize you.20 The only time that a plan is not required to pay for your emergency health care services is when it determines that you did not require emergency services, and you should have known that an emergency did not exist. Your plan must also provide 24-hour access for you and doctors to obtain authorization for care once your condition has been stabilized.
WHERE CAN I GO FOR HELP WITH QUESTIONS OR COMPLAINTS REGARDING A HOSPITAL'S EMERGENCEY SERVICES?
For complaints about California-licensed hospitals:
California Department of Health Services
714 P Street
Licensing & Certification/ Hospitals/Nursing Homes:
(916) 657-3064 (general info.)
(916) 657-0240 FAX
For complaints about emergency services received at your HMO's facilities:
California Department of Managed Health Care
Department of Managed Health Care
California HMO Help Center
980 Ninth Street, Suite 500
Sacramento, CA 95814-2725
(888) HMO-2219 or
(800) 400-0815 or
(877) 688-9891 (TDD)
(916) 229-0465 FAX
For complaints about hospitals that accept MediCare patients:
U.S. Department of Health and Human Services
200 Independence Avenue, S.W.
Washington, D.C. 20201
Toll Free: 1-877-696-6775