Your Rights in an Emergency Room
When you walk into an emergency room (ER), you have certain legal protections to ensure you receive care, regardless of your insurance status or ability to pay. The Emergency Medical Treatment and Labor Act (EMTALA) guarantees that hospitals receiving Medicare funds cannot refuse to treat you if you have an emergency medical condition.
Under EMTALA, hospitals must:
- Provide an appropriate medical screening exam
- Treat you until your condition is stabilized
- Offer an appropriate transfer to another facility if they cannot provide the necessary care
These protections are in place to ensure that every patient in an emergency medical situation gets the help they need.
Can an ER Refuse to Treat You?
In most cases, an ER cannot refuse treatment if you have a medical emergency. However, they can ask about your insurance, as long as this does not delay your medical screening or treatment. If your condition is not considered an emergency, the hospital may direct you elsewhere for care, such as an urgent care clinic.
If an ER violates EMTALA by refusing treatment, a complaint can be filed with the Centers for Medicare & Medicaid Services (CMS) or the U.S. Department of Health and Human Services Office of Inspector General (HHS-OIG). Hospitals that negligently deny care may face civil penalties.
What Hospitals Must Do
1. Provide a Medical Screening Exam
A qualified medical professional must assess whether you have an emergency medical condition. This applies to anyone who walks into an emergency department, regardless of financial status.
2. Stabilize Your Condition
If the screening determines that you have a medical emergency, the hospital must provide treatment to prevent your condition from worsening. This includes stabilizing patients experiencing active labor.
3. Transfer You If Necessary
If a hospital cannot stabilize your condition due to lack of staff or facilities, they must arrange for a transfer to another hospital that can provide the required care. Before transferring you, the hospital must inform you of any benefits and risks.
What Happens in a Mental Health Crisis?
Mental health crises are treated differently from physical emergencies in some ways, but you still have rights. Many people experiencing a mental health crisis are taken to the ER by family members, law enforcement, or emergency medical personnel. The ER staff must determine whether the patient poses a danger to themselves or others.
Involuntary Commitment and Your Rights
In cases where a patient is deemed a risk, involuntary commitment (IVC) may be initiated. This means the person can be held against their will for psychiatric evaluation and treatment. The process typically includes:
- A First Mental Health Exam: Conducted by a qualified provider, including social workers or physician assistants in some states.
- Legal Determination of Danger: If the patient has threatened or attempted suicide, self-harm, or harm to others, they may meet the criteria for involuntary commitment.
- Transport to a Psychiatric Facility: If inpatient care is necessary, the patient is usually transported by law enforcement, though some states allow family members or health professionals to transport them instead.
Rights of Patients in Psychiatric Emergencies
If you or a loved one is undergoing involuntary commitment, it is important to understand the legal rights involved:
- You have the right to a second mental health exam within 24 hours of arrival at a psychiatric facility.
- You have the right to a court hearing within 10 days of commitment.
- A state-appointed attorney will represent you during the hearing.
- If the judge finds you to be a danger to yourself or others, you may be held for up to 90 days for treatment.
Parents and guardians of minors undergoing involuntary commitment have limited decision-making rights, as the court order supersedes their authority. However, they retain the right to consent to or refuse specific treatments, such as electroshock therapy.
What If You Have to Wait for Psychiatric Care?
Emergency rooms often face long wait times for psychiatric beds, leading some patients to remain in the ER for days or even weeks. In some cases, a patient’s condition may improve during this time, and they may be discharged before transfer. If you believe inpatient treatment is unnecessary, working with ER staff to develop an outpatient care plan may help avoid involuntary commitment.
Alternative Options to the ER for Mental Health Crises
If you or a loved one is experiencing a mental health crisis but is not in immediate physical danger, there are alternatives to visiting the ER:
- Call or text 988, the national suicide and crisis lifeline, for support and resources.
- Mobile crisis units can come to your location to assess and de-escalate the situation.
- Behavioral health urgent care centers offer immediate mental health evaluations without the long waits of an ER.
- Peer-run respite centers provide voluntary stays with mental health support from trained peers.
Filing a Complaint for EMTALA Violations
If you believe your rights under EMTALA were violated, you can:
- File a complaint with CMS or HHS-OIG.
- Contact the hospital’s patient advocate or patient relations department.
- Report the incident to state health agencies or elected officials.
Planning for the Future
To avoid the need for emergency mental health intervention, consider:
- Creating a psychiatric advance directive, which outlines preferred treatment options in case of future crises.
- Designating a health care power of attorney, allowing a trusted person to make medical decisions if you are unable to.
- Filling out a HIPAA authorization form, to ensure that your family can access your medical information during a crisis.
Understanding your rights in an emergency room, whether for a medical emergency or a mental health crisis, can help ensure you receive the necessary care. If you ever feel that your rights have been violated, know that there are steps you can take to hold hospitals accountable and advocate for better treatment for yourself or your loved ones.
