Although providers are gener- ally aware of their obligations under the Federal Emergency
Medical Treatment and Labor Act
(EMTALA), they often struggle with how
to satisfy their EMTALA obligations
when examining, stabilizing, treating,
and/or transferring behavioral health
patients. Complicating factors include
a lack of inpatient and community ser-
vices, insufficient insurance coverage,
and a shortage of qualified providers to
treat behavioral health patients. In 2016,
the per capita number of state psychi-
atric beds was 11. 7 per 100,000 people,
the same level as in the 1850s. The esti-
mated need is approximately four to
five times that amount — 40 to 60 beds
per 100,000. In sheer numbers, there are
now approximately 38,000 state-funded
psychiatric beds for 8.1 million people
with serious mental illness compared
to 560,000 beds serving 3. 3 million
people with the same conditions
in 1955.1, 2
Given the lack of available beds,
it is not surprising that many patients
with behavioral health problems
are seeking treatment in hospital
emergency rooms (ERs). Nor is it
surprising that ER physicians are
struggling with how best to examine,
stabilize, treat, and/or transfer these
patients, given the patient volume
and the limited resources available to
support ER physicians trying to care
for this patient population. This bed
shortage and the resulting need to
treat behavioral health patients within
the confines of an ER is also complicating providers’ ability to comply with
their EMTALA obligations.
by Catherine Greaves and Kristin Roshelli
EMTALA and the challenges
of treating behavioral health
patients in crisis
» Hospitals need carefully developed policies and procedures that address their EMTALA obligations.
» Emergency department staff need EMTALA training.
» Detailed and complete documentation of EMTALA obligations is essential.
» Multiple modes of transport are available when transporting behavioral health patients but each mode carries
associated risks and benefits.
» Hospitals should be familiar with CMS’s interpretations of its EMTALA regulations, The Joint Commission standards
addressing patients boarded in the Emergency department, and prior EMTALA enforcement actions.
Catherine Greaves ( firstname.lastname@example.org) is a Counsel in the Austin, TX
office of King & Spalding LLP. Kristin Roshelli ( email@example.com) is a
Senior Associate at the law firm King & Spalding LLP in Houston.