The Emergency Medical Treatment and Labor Act (EMTALA) was enacted by Congress in 1986 to allow people without health insurance or the ability to pay for medical care access to emergency medical treatment (Emergency Medical Treatment & Labor Act (EMTALA), 2022). Three elements must be met by hospitals with dedicated emergency departments participating in Medicare. The elements will be used to analyze if liability is present in the scenario of a visitor on hospital property suffering cardiac arrest.

          1. A medical screening examination must be made when the patient presents for evaluation or treatment of an emergent medical condition including active labor.


          In the scenario, the visitor collapses in cardiac arrest 100 yards from the ED entrance. When the security guard found the visitor unresponsive, his determination as a layperson was that the visitor needed to be evaluated for an emergent medical condition. An emergent medical condition is defined as a medical condition that if immediate medical attention is not rendered, serious bodily harm could be reasonably expected to occur (“Interpretation of EMTALA in Medical Malpractice Litigation,” 2018). Because the patient was within 250 yards of the emergency department and had a suspected emergent medical condition, a medical screening examination must be completed under EMTALA (Lulla & Svancarek, 2023).

          A medical screening exam must be completed to determine if an emergent medical condition is present, and is completed by a physician or other qualified medical person (Lulla & Svancarek, 2023). In this scenario, a security guard with no medical training is not qualified to determine the presence of an emergent medical condition as defined by EMTALA. While he did radio the emergency department for help, no medically trained person evaluated the visitor. 

          2. If an emergent medical condition is present, the hospital must stabilize the patient.

          Stabilizing care is the appropriate treatment of an emergent medical condition so that it would be unlikely that the patient’s condition would worsen during transfer (“Interpretation of EMTALA in Medical Malpractice Litigation,” 2018). While the security guard did his best to care for the visitor with no training in CPR, the care he provided did not meet the standard of providing stabilizing care.

          3. Appropriate transfer of the patient should be completed if the hospital cannot stabilize the patient with the resources available to them.

          In the scenario, the patient was transported by EMS to a hospital 4 miles away at the request of the emergency department charge nurse. This was done before a medical screening exam was completed. It therefore could not be determined if the patient’s condition exceeded the capabilities of the emergency department.

          After applying the elements of EMTALA, it appears that a violation has occurred. Because the event occurred on hospital property, the first entity liable is the hospital. Next, because the charge nurse turned away the visitor from being taken to the emergency department for medical screening, she is also liable. Finally, EMS transported the visitor from one hospital to another 4 miles away before stabilizing treatment could be completed. They also committed an EMTALA violation by transporting an unstable patient. Hospital security had no formal medical training and therefore not considered qualified medical persons. Their actions were the result of speaking with a qualified medical person, making them not liable for doing what they thought was best for the visitor. 


Emergency Medical Treatment & Labor Act (EMTALA). (2022, December 5). CMS.Gov.

Interpretation of EMTALA in Medical Malpractice Litigation. (2018). Annals of Emergency Medicine, 72(4), e53.

Lulla, A., & Svancarek, B. (2023). EMS USA Emergency Medical Treatment and Active Labor Act. In StatPearls. StatPearls Publishing.

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