Emergency Medical Treatment and Active Labor Act (EMTALA) laws are applicable to every patient arriving at the ED. To remain EMTALA-compliant, it should be understood that:
A tertiary hospital cannot refuse a patient in transfer.
ED-to-ED transfers are EMTALA violations.
It is not a violation to transfer an unstable patient.
EMTALA fines are covered by malpractice insurance.
Referrals from the ED to a specialist's office are potential EMTALA violations.
A tertiary care center must accept patients for whom it is has the specialty resources to care for, but is not required to accept patients for whom it can provide no additional benefit. ED-to-ED transfers are permissible, when the patient is going to a higher level of care and appropriate measures have been taken to stabilize the patient. While some patients must be transferred in an unstable state, it is a violation if all measures that could be taken to stabilize have not been performed. EMTALA fines are not covered by professional liability policies. Under strict interpretation of EMTALA, it is required that the specialist come to the ED to see the patient.