An article appearing in Clinical Practice Cases Emergency Medicine in September 2025 entitled “Medical Malpractice in the Waiting Room: Who Is at Risk?” provides a helpful general analysis of the requirements of the Emergency Medical Treatment and Labor Act (“EMTALA”):
Since its enactment in 1986, the Emergency Medical Treatment and Labor Act (“EMTALA”) requires all hospitals that accept Medicare payments to provide a screening exam to patients seeking emergency care and stabilize any emergency medical conditions identified prior to patient discharge or transfer.
EMTALA requires that all patients who present to the Emergency Department (“ED”) receive a timely medical screening exam (“MSE”) that is consistently administered for all patients with similar symptoms and conditions. The MSE must be designed to identify an emergency medical condition. The Centers for Medicare & Medicaid Services (“CMS”) does not delineate precise requirements for an MSE, but it requires that it be commensurate with the clinical conditions of the patient and be provided equally to all patients with that condition at that facility.
EMTALA does not specify the components of an MSE but instead gauges the exam’s appropriateness based on 1) a determination that it was designed to identify an emergency medical condition and 2) a finding that it is uniformly applied to all patients who present to the ED with similar symptoms or conditions.
Both common law and EMTALA’s medical screening exam requirements impose significant obligations on physicians and hospitals to proactively manage patients in the waiting room. Prolonged emergency department wait times pose problems for both patients and ED staff. Poor patient outcomes can result in litigation that could have been prevented by faster access to care.
The article states that emergency department staff should routinely document these screenings while a patient is in the waiting room as part of the ongoing MSE process. Since appropriate MSEs are determined by each hospital’s written policies, ED staff—including clinicians, nursing, and administration—must be aware of their hospital’s relevant clinical practice guidelines. When such guidelines are unavailable, ED staff must be aware of the applicable professional standard of care. Emergency clinicians should understand that they may be held responsible for the care provided, or not provided, to patients in the waiting room, even with very little involvement with those patients and no face-to-face time: “Often the MSEs come from the hospital’s internal policies and clinical practice guidelines; these can be a double-edged sword by helping emergency clinicians make quick decisions regarding patient assessments and plans of care, while also creating legal risks when the guidelines are not applied uniformly. Therefore, it is imperative that ED personnel are well informed on the policies and guidelines that the hospital in which they practice has adopted. In situations where a hospital does not have established policies, the applicable professional standard of care takes its place.”
If you or a loved one may have an EMTALA violation claim, you should promptly find a medical malpractice lawyer in your state who handles EMTALA claims and may investigate your EMTALA claim for you and represent you or your loved one in an EMTALA case, if appropriate.
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