Emergency Medical Treatment and Active Labor Act

The federal Emergency Medical Treatment and Active Labor Act (EMTALA) (42 U.S.C. §§ 1395dd) was enacted in 1986 to prevent patient dumping—the practice of refusing to provide emergency medical treatment to patients who are unable to pay for their care or transferring them to another facility before stabilizing their condition. Essentially, the statute requires that emergency departments provide emergency medical screening. If the screening reveals a need for further medical treatment, the emergency department must provide that treatment until the patient is stable and then may transfer him or her to another hospital. (If the screening reveals no need for treatment, the emergency department is not obligated to provide any.)

On the surface, EMTALA guidelines may seem irrelevant for SARTs. However, "despite the fact that the purpose of the statute is to prevent ‘patient dumping,' several courts have held that there is no requirement that the patient in fact be unable to pay his bills or that there be an economic motivation behind the decision to transfer the patient [see Cooper v. Gulf Breeze Hospital, 839 F. Supp. 1538 (1993)]." For SARTs, this could be interpreted to mean that hospitals should not transfer victims because they are unwilling to perform medical forensic exams at their facilities. In addition, states that receive funding under the Violence Against Women Act's STOP Formula Grant Program must certify that victims will not be held responsible for paying for medical forensic exams.

According to a national discussion on the SART Listserv hosted by the National Sexual Violence Resource Center, some hospitals that do not have sexual assault medical forensic exam programs medically screen patients according to EMTALA guidelines before transferring patients to facilities with forensic exam programs. Hospitals in other jurisdictions do not consider sexual assault victims to fall under EMTALA guidelines for emergency care and transfer patients without medical screenings.

A National Protocol for Sexual Assault Medical Forensic Examinations recommends that jurisdictions minimize the transfer of sexual assault victims. At a minimum, your SART could provide a list of designated exam sites to all local hospitals, law enforcement agencies, emergency medical services, sexual assault victim advocacy programs, and protective service agencies.²⁰

One jurisdiction developed SART guidelines for transferring victims because, until the protocol was developed, victims were transferred by ambulance and were charged more than $800 per transfer. The charges were not covered because transporting by ambulance was not considered a medical necessity or a part of the criminal investigation. After the protocol was created, hospitals changed their policies from transferring patients (which required being transported by ambulance) to discharging them and referring them to SANE-staffed hospitals or designated medical forensic exam facilities.