38 U.S.C. § 1784A — Examination and treatment for emergency medical conditions and women in labor
submitted 10 years ago by Pub. L. 114-315 to r/title-38-VETERANS-BENEFITS · 1,289 words · no verdicts yet
This section requires Department hospitals with emergency departments to screen people who request examination or treatment. It requires stabilizing emergency conditions and labor or making an appropriate transfer, and defines related terms.
(a) In General. If a person comes to a Department* hospital with an emergency department, or its campus, and someone asks for examination or treatment of a medical condition, the hospital must provide an appropriate screening examination within the emergency department’s capabilities, including routinely available additional services, to determine whether an “emergency medical condition” exists. This section does not define “appropriate” or “ancillary services.”
(b) Necessary Stabilizing Treatment for Emergency Medical Conditions and Labor. (1) If the hospital determines that the person has an emergency medical condition, it must either (A) provide, with its available staff and facilities, the examination and treatment needed to stabilize it, or (B) transfer the person under (c). (2) It meets (1)(A) if it offers the examination and treatment, explains their risks and benefits, and the person or representative refuses consent; it must reasonably seek written informed consent to refuse. (3) It meets (1)(B) if it offers a transfer under (c), explains its risks and benefits, and the person or representative refuses; it must reasonably seek written informed consent to refuse.
(c) Restricting Transfers Until Individual Stabilized. (1) An unstabilized person may be transferred only if (A) the person or legally responsible representative, after being told the hospital’s duties and transfer risk, requests it in writing; or a Department physician certifies that expected medical benefits at the other facility outweigh increased risks to the person and, in labor, the unborn child*; or, if no Department physician is physically present, a qualified medical person (defined by the Secretary* for this section) makes that certification after the physician makes the determination in consultation and later countersigns; and (B) the transfer is appropriate. (2) The certification must summarize its risks and benefits. (3) An appropriate transfer requires treatment within the transferring hospital’s capacity that minimizes risks; a receiving facility with space and qualified personnel that agrees to accept and treat the person; all available relevant records, including symptoms, preliminary diagnosis, treatment, test results, and the request or certification; qualified personnel and equipment with necessary medically appropriate life support; and any other health-and-safety requirements the Secretary considers necessary.
(d) Payment to the Department. The Secretary must charge under other billing and reimbursement authorities.
(e) Definitions. (1) “Campus” means the area next to the main buildings, areas and structures no more than 250 yards away even if not contiguous, and other areas the Secretary determines are part of the campus. (2) “Emergency medical condition” means a sufficiently severe acute-symptom condition, including severe pain, where lack of immediate care could reasonably seriously endanger health, seriously impair bodily functions, or seriously disrupt an organ or body part; for pregnancy this includes the woman or unborn child. It also means a pregnancy stage of labor that leaves inadequate time for safe transfer before delivery or makes transfer a threat to the woman or unborn child. (3) “To stabilize” means treatment making material deterioration during transfer unlikely within reasonable medical probability, or, for labor, delivery including the placenta. “Stabilized” means that no such deterioration is likely, or that the woman has delivered including the placenta. (4) “Transfer” means movement, including discharge, outside Department hospital facilities at the direction of a hospital employee or affiliated person. It excludes a person declared dead or one leaving without permission.
In the case of a hospital of the Department* that has an emergency department, if any individual comes to the hospital or the campus of the hospital and a request is made on behalf of the individual for examination or treatment for a medical condition, the hospital must provide for an appropriate medical screening examination within the capability of the emergency department, including ancillary services routinely available to the emergency department, to determine whether or not an emergency medical condition exists.
If any individual comes to a hospital of the Department that has an emergency department or the campus of such a hospital and the hospital determines that the individual has an emergency medical condition, the hospital must provide either—
within the staff and facilities available at the hospital, for such further medical examination and such treatment as may be required to stabilize the medical condition; or
for transfer of the individual to another medical facility in accordance with subsection (c).
A hospital is deemed to meet the requirement of paragraph (1)(A) with respect to an individual if the hospital offers the individual the further medical examination and treatment described in that paragraph and informs the individual (or a person acting on behalf of the individual) of the risks and benefits to the individual of such examination and treatment, but the individual (or a person acting on behalf of the individual) refuses to consent to the examination and treatment. The hospital shall take all reasonable steps to secure the written informed consent of the individual (or person) to refuse such examination and treatment.
A hospital is deemed to meet the requirement of paragraph (1)(B) with respect to an individual if the hospital offers to transfer the individual to another medical facility in accordance with subsection (c) and informs the individual (or a person acting on behalf of the individual) of the risks and benefits to the individual of such transfer, but the individual (or a person acting on behalf of the individual) refuses to consent to the transfer. The hospital shall take all reasonable steps to secure the written informed consent of the individual (or person) to refuse such transfer.
If an individual at a hospital of the Department has an emergency medical condition that has not been stabilized, the hospital may not transfer the individual unless—
the individual (or a legally responsible person acting on behalf of the individual), after being informed of the obligations of the hospital under this section and of the risk of transfer, requests, in writing, transfer to another medical facility;
a physician of the Department has signed a certification that, based upon the information available at the time of transfer, the medical benefits reasonably expected from the provision of appropriate medical treatment at another medical facility outweigh the increased risks to the individual and, in the case of labor, to the unborn child* from effecting the transfer; or
if a physician of the Department is not physically present in the emergency department at the time an individual is transferred, a qualified medical person (as defined by the Secretary* for purposes of this section) has signed a certification described in clause (ii) after a physician of the Department, in consultation with the person, has made the determination described in such clause, and subsequently countersigns the certification; and
the transfer is an appropriate transfer to that facility.
A certification described in clause (ii) or (iii) of paragraph (1)(A) shall include a summary of the risks and benefits upon which the certification is based.
For purposes of paragraph (1)(B), an appropriate transfer to a medical facility is a transfer—
in which the transferring hospital provides the medical treatment within its capacity that minimizes the risks to the health of the individual and, in the case of a woman in labor, the health of the unborn child;
in which the receiving facility—
has available space and qualified personnel for the treatment of the individual; and
has agreed to accept transfer of the individual and to provide appropriate medical treatment;
in which the transferring hospital sends to the receiving facility all medical records (or copies thereof) available at the time of the transfer relating to the emergency medical condition for which the individual has presented, including—
observations of signs or symptoms;
preliminary diagnosis;
treatment provided;
the results of any tests; and
the informed written request or certification (or copy thereof) provided under paragraph (1)(A);
in which the transfer is effected through qualified personnel and transportation equipment, including the use of necessary and medically appropriate life support measures during the transfer; and
that meets such other requirements as the Secretary considers necessary in the interest of the health and safety of the individual or individuals transferred.
The Secretary shall charge for any care or services provided under this section in accordance with billing and reimbursement authorities available to the Secretary under other provisions of law.
In this section:
The term “campus” means, with respect to a hospital of the Department—
the physical area immediately adjacent to the main buildings of the hospital;
other areas and structures that are not strictly contiguous to the main buildings but are located not more than 250 yards from the main buildings; and
any other areas determined by the Secretary to be part of the campus of the hospital.
The term “emergency medical condition” means—
a medical condition manifesting itself by acute symptoms of sufficient severity (including severe pain) such that the absence of immediate medical attention could reasonably be expected to result in—
placing the health of the individual (or, with respect to a pregnant woman, the health of the woman or her unborn child) in serious jeopardy;
serious impairment to bodily functions; or
serious dysfunction of any bodily organ or part; or
in the case of a pregnant woman, a stage of labor that a medical provider determines indicates—
that there is inadequate time to effect a safe transfer to another hospital before delivery; or
that transfer may pose a threat to the health or safety of the woman or the unborn child.
The term “to stabilize” means—
with respect to an emergency medical condition described in paragraph (2)(A), to provide such medical treatment of the condition as may be necessary to assure, within reasonable medical probability, that no material deterioration of the condition is likely to result from or occur during the transfer of the individual from a facility; or
with respect to an emergency medical condition described in paragraph (2)(B), to deliver (including the placenta).
The term “stabilized” means—
with respect to an emergency medical condition described in paragraph (2)(A), that no material deterioration of the condition is likely, within reasonable medical probability, to result from or occur during the transfer of the individual from a facility; or
with respect to an emergency medical condition described in paragraph (2)(B), that the woman has delivered (including the placenta).
The term “transfer” means the movement (including the discharge) of an individual outside the facilities of a hospital of the Department at the direction of any person employed by (or affiliated or associated, directly or indirectly, with) the hospital, but does not include such a movement of an individual who—
has been declared dead; or
leaves the facility without the permission of any such person.
Source credit: (Added Pub. L. 114–315, title VI, § 606(a), Dec. 16, 2016, 130 Stat. 1572.)
- 2016Enacted · Pub. L. 114-315 · 130 Stat. 1572
A history note hasn’t been published yet. The record shows enactment by Pub. L. 114-315 on 2016-12-16.
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