A 39-year-old disheveled homeless woman walks into the emergency department complaining of abdominal pain. The woman smells strongly of alcohol and seems disoriented. She describes the abdominal pain as "real bad" but cannot specify when the pain first started, where it is localized, or what factors exacerbate or relieve the pain. She then adds that she does not have health insurance and has no money to pay for her care. What is the next best step in handling this situation?

Question

A 39-year-old disheveled homeless woman walks into the emergency department complaining of abdominal pain.  The woman smells strongly of alcohol and seems disoriented.  She describes the abdominal pain as "real bad" but cannot specify when the pain first started, where it is localized, or what factors exacerbate or relieve the pain.  She then adds that she does not have health insurance and has no money to pay for her care.  What is the next best step in handling this situation?

Quizplus · Accepted Answer

Congress enacted The Emergency Medical Treatment and Active Labor Act (EMTALA) in 1986. This law was designed to prevent hospitals from inappropriately transferring, discharging, or refusing to treat indigent patients, and allows for strict fines to be levied on any hospital found in violation of the Act. EMTALA imposes three primary requirements on hospitals that provide emergency services. First, the hospital must provide an appropriate screening medical exam to anyone who comes to the ED seeking medical care (Choice C). Second, if such an individual has an emergency medical condition, the hospital must treat and stabilize the emergency condition. Third, the hospital must not transfer an individual with an emergency medical condition that has not been stabilized unless several complex conditions are met. Refusing care without advance payment from the patient (Choice A) or from her family members (Choice B) is in violation of EMTALA and therefore incorrect. An appropriate medical screening exam and stabilization should be done before transferring the patient to any other facility (Choice D). Moreover, any such transfers must be arranged in compliance with EMTALA. Referring the patient to a free clinic (Choice E) is also in violation of EMTALA. It is possible that this patient is quite ill and in need of urgent medical care. To postpone evaluation until next week could endanger her life. Educational objective: The Emergency Medical Treatment and Active Labor Act (EMTALA) was enacted by Congress to prevent hospitals from inappropriately transferring, discharging, or refusing to treat indigent patients. All patients who present to the emergency department must receive an appropriate screening medical exam and stabilization of their condition, regardless of ability to pay.

A 39-Year-Old Disheveled Homeless Woman Walks into the Emergency Department