Designated Hospitals
Although community-based EMS protocols may determine the appropriate facility for a patient from the field, once a patient has arrived in the ED, he or she must be provided with an MSE and appropriate stabilizing care.
Hospitals are not relieved of their EMTALA obligation to screen or provide stabilizing treatment or an appropriate transfer because of prearranged community or state plans that have designated specific facilities to care for selected patients (eg, Medicaid patients, psychiatric patients, pregnant women, and trauma patients). Hospitals located in states with laws that require certain patients (eg, psychiatric) to be evaluated and treated at designated facilities may violate EMTALA if the hospital disregards the EMTALA requirements and does not conduct an MSE and provide stabilizing treatment or conduct an appropriate examination before referring or transferring the patient to the designated facility. If, after conducting the MSE and ruling out an EMC (or after stabilizing the EMC), the sending hospital needs to transfer a patient to another hospital for treatment, it may elect to transfer the individual to the hospital so designated by the state or local laws (these patients are not considered in unstable condition under EMTALA). The existence of a state law requiring transfer of certain patients to certain facilities does not preempt the requirement to meet federal EMTALA requirements.
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