Historically, American law did not require hospitals to admit patients, despite sporadic legislative attempts to change this practice. In 1986, however, President Reagan signed the Emergency Medical Treatment and Labor Act (EMTALA) into law. Before the enactment of EMTALA, most hospitals enjoyed the commonlaw "no duty" rule, which allowed them to refuse treatment to anyone. Hospitals believed indigent patients should receive care through charitable organizations or through uncompensated care provided by hospitals. After EMTALA, Medicare-participating hospitals must provide a medical screening exam to any individual who comes to the emergency department and requests examination or treatment for a medical condition. If a hospital determines that an individual has a medical emergency, it must then stabilize the condition or provide for an appropriate transfer. The hospital is obligated to provide these services regardless of the individual’s ability to pay and without delay to inquire about the individual’s method of payment or insurance status. This book examines the enforcement of EMTALA which was passed by Congress to address the problem of "patient dumping." Patient dumping refers to certain situations where hospitals fail to screen, treat, or appropriately transfer patients and is a possible violation of federal law, including civil rights laws. Specifically, the book focuses on disabled patients, and an even narrower subset of that population-those with a psychiatric disability. This book examines the enforcement of EMTALA and the policies in place to ensure that hospitals, localities, or states are not "dumping" indigent, mentally ill patients in need of emergency care on other hospitals, localities, or states. This book also considers what policies may be adopted to better protect the rights of the mentally ill.
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