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Q: Within a dual staffing arrangement in the emergency department (ED), what do we need to be careful of to ensure compliance with the Emergency Medical Treatment and Labor Act (EMTALA)?

Compliance Monitor, April 27, 2007

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Q: Within a dual staffing arrangement in the emergency department (ED), what do we need to be careful of to ensure compliance with the Emergency Medical Treatment and Labor Act (EMTALA)?

A: Some managed care organizations (MCO) contract with hospitals to station their own physicians in the hospital's ED, separate from the hospital's emergency physician staff. The physicians screen and treat the MCO's patients who request emergency services. This is considered a "dual staffing" arrangement.

Regardless of any contractual arrangement a hospital enters to staff its emergency department, the hospital remains responsible under EMTALA to provide an appropriate medical screening examination and necessary stabilization services. Also, the hospital is bound by provisions that protect whistleblowers who report violations of EMTALA in dual staffing situations.

A dual staffing system based on method of payment or insurance status, and which creates delays in screening or stabilization, violates EMTALA. If a hospital constructs two equally good emergency service tracks, each adequately staffed and each with equally good access to all of the medical capabilities of the hospital, then a dual staffing arrangement would not appear to violate EMTALA.

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