- The Emergency Medical Treatment and Labor Act (EMTALA) mandates a screening examination for all patients presenting to an ED—this essentially obviates the need for consent in a minor unaccompanied by a parent or guardian.
- The Health Insurance Portability and Accountability Act (HIPAA) mandates that all possible care be taken to ensure the confidentiality of a patient's medical records.
- Many states have “emancipated minor” statutes that permit adolescents to make their own health care decisions.
- When refusal of care becomes an issue, the “best interest” of the minor is the priority.
- Good forensic documentation is an important part of patient advocacy.
- Disclosure of medical errors is becoming increasing common and in the near future may become the law in many states.
The emergency medicine physician must work within the context of a society's laws as they apply to the emergency department (ED). He or she must also work within the framework of ethical paradigms as they apply to each patient; ethics is the branch of philosophy that deals with what is right and what is wrong. For the most part, laws will agree with what is considered to be ethical. However, in a multicultural and multireligious democracy, there will be occasions when a law is nonexistent, vague, or at odds with what may be considered ethical in a particular situation, and the physician must make a decision based on what is best for the patient. The chapter on “Ethical Considerations in the Emergency Department” explores the role of the emergency physician's ethical responsibility as an advocate for pediatric patients in situations where a law and ethics may collide. This chapter will discuss some basic legal issues as they pertain to the ED.
Laws in the United States can be divided into three categories: statutory, common, and administrative. Statutory law is codified by legislative bodies; an example is the requirement to report child abuse to authorities. Common law is based on case law; it has evolved over centuries, and is interpreted by judges as it applies to litigated cases. Common law applies to medical malpractice. Administrative laws are enabled by legislation and are issued by agencies in the form of regulations; an example is the Drug Enforcement Agencies regulations regarding the prescription of narcotics. U.S. law is also divided into state and federal law. Most laws applicable to emergency medicine are state laws. The federal statues that apply most directly to an ED are the Emergency Medical Treatment and Labor Act (EMTALA) and the Health Insurance Portability and Accountability Act (HIPAA).1
EMTALA was enacted by congress in 1986 as part of the Consolidated Omnibus Reconciliation Act of 1985 (COBRA) as a response to the refusal of some EDs to provide care to uninsured patients. One of the key provisions of EMALA is that when a patient requests care at an ED, “the hospital must provide an appropriate medical screening examination within the capability of the hospital's emergency department, including ...