EMTALA and the ethical delivery of hospital emergency services.

This article examines the role and impact of EMTALA on the ethical delivery of hospital-based emergency services, primarily through close inspection of three of the core EMTALA mandates: the medical screening examination, the duty to accept patients in transfer from less capable facilities, and the requirement that the hospital provide on-call physician services to the emergency department to help stabilize patients with emergencies or help accept patients in transfer. Hospital and physician responses to these mandates, such as triaging/screening patients away from the emergency department, avoiding the application of EMTALA, refusing to accept inpatients with emergencies in transfer, and devising ways to avoid on-call duties, are analyzed in some detail.