EMTALA: impact on hospital dentistry emergency services

The Emergency Medical Treatment and Active Labor Act (EMTALA) requires hospital-based dental residency programs and hospital dentists to meet Federal standards when patients come to a hospital emergency department and need emergency dental services. EMTALA (42 U.S.C. 1395dd) has three key provisions which must be understood because of its impact on hospital emergency dental services: Medical Screening Requirements, Necessary Stabilizing Treatment for Emergency Medical Conditions, and Restricting Transfers Until the Individual is Stabilized. This article reviews the relevant Federal statutes, codes of Federal regulation, and published court cases to help practitioners understand the issues. An understanding of the informed consent process, including the "informed refusal" doctrine, as well as the dentist's obligation when patients refuse recommended diagnostic tests, treatment, or transfer, is important. Immunity for failure to obtain informed consent is sometimes appropriate under state law. Under EMTALA, the term "physician" applies to dentists. Recent changes clarify distinctions between the terms "on campus" and "off campus" related to hospital property emanating from the "Ravenswood" tragedy. Hospital dentists must be familiar with these requirements when caring for patients seeking emergency services.