Outpatient Versus Inpatient Transfers
EMTALA defines an inpatient as a patient who has been admitted to the hospital with the reasonable expectation that he or she will occupy a bed at least overnight. It does not matter if the patient is directly admitted to the ward, stops in the ED to get a room assignment, or is boarded in the ED pending bed placement.
Patients placed in temporary observation status or admitted for stabilizing care with the expectation of transfer without staying at the first hospital overnight are not “inpatients” under EMTALA. Patients admitted with the intent of avoiding EMTALA are not legally considered inpatients. The fact that a patient was admitted with the expectation he or she would occupy a bed overnight but whose condition deteriorated, requiring transfer, does not invalidate inpatient status.In the past, there was disagreement among several courts over whether EMTALA applies to inpatients. In Thornton v Southwest Detroit Hospital (895 F.2d 1131 [6th Cir. 1990]), a Federal Appellate Court found that “once a patient is found to suffer from an [EMC] in the emergency room, she cannot be discharged until the condition is stabilized.” Other courts have found that EMTALA obligations end when an individual is admitted as an inpatient. The CMS seemed to resolve the issue through a rule issued on August 19, 2008, stating that once an individual with an EMC is admitted as an inpatient, the EMTALA obligation ends. The CMS applies the Medicare Conditions of Participation (42 CFR §482) to monitor the hospital’s continued responsibility to meet the inpatient emergency needs. At the time of writing of this chapter, however, the CMS is considering revisions to the current rules.