A Descriptive Analysis of Emergency Medical Treatment and Labor Act Cases Involving Disruptive Patient Behavior, 2023

Introduction The Emergency Medical Treatment and Labor Act (EMTALA) requires emergency departments (EDs) to provide a medical screening exam (MSE) and stabilizing care regardless of ability to pay. While EMTALA protects access to care, its application can be challenging when patients are disruptive or violent. This study estimates the proportion of EMTALA citations for MSE deficiencies involving disruptive behavior and describes case characteristics. Methods We conducted a retrospective, descriptive analysis of Centers for Medicare & Medicaid Services (CMS) EMTALA citations for MSE deficiencies from 2023. We screened narrative inspection texts using predefined keywords, then manually reviewed them to identify disruptive behavior and assess whether it appeared willful. Case characteristics were recorded and described. Results Among 227 EMTALA citations involving MSE deficiencies with narrative inspection reports available for review, 49 (21%) were determined to involve disruptive behavior. Common behaviors included verbal abuse, refusal of care, threats, and violence, most often directed at nurses. Ten cases (20%) were considered likely willful; the remainder stemmed from acute psychiatric conditions, intoxication, or medical illness. Conclusion Disruptive behaviors appear in a notable proportion of EMTALA citations for MSE deficiencies, highlighting the challenge of balancing regulatory compliance with staff safety and ED operations.