More than 90 psychiatric hospitals have violated EMTALA in the past 15 years, and most have not faced any consequences, ProPublica found.
The Emergency Medical Treatment and Labor Act was enacted in 1986 and is the only law that requires universal care for emergency medical conditions regardless of insurance status. Since its enactment, thousands of EMTALA violations by hospitals across the country have been documented. At hospitals, an EMTALA violation results in penalties and, if serious enough, an immediate jeopardy warning.
However, a ProPublica investigation published Sept. 22 found that psychiatric hospitals have widely been able to avoid consequences after violations.
Here are five things to know:
1. Since 2010, CMS has found more than 300 EMTALA violations at psychiatric hospitals. These include sending gravely disabled and actively suicidal patients away, screening out uninsured patients and rejecting “frequent flyers” who have had interactions with staff in the past. In some cases, these patients met criteria for imminent risk of harm to themselves or others.
2. Since 2019, the HHS inspector general has only issued three penalties — totaling $427,000 — involving violations by psychiatric hospitals. In only a few cases, CMS pulled Medicare certification and funding, or threatened to do so. The inspector general declined ProPublica’s request for comment on why so few enforcement actions were taken.
3. New CMS guidance in July 2019 made it explicit that the law applies to psychiatric hospitals even if they do not have emergency departments. Since circulating the clarification, CMS has cited 37 psychiatric hospitals for EMTALA violations.
4. The widespread violations by psychiatric hospitals and lack of enforcement have come as the nation’s mental health crisis worsens. In March, the Trump administration’s Department of Government Efficiency announced plans to close half of HHS’ 10 regional offices and purge 25% of the agency’s staff. Democratic lawmakers have raised concerns that this could limit EMTALA oversight and compliance enforcement.
“CMS will continue to enforce EMTALA,” an agency spokesperson told ProPublica.
5. Grand Junction, Colo.-based West Springs Hospital was one such psychiatric hospital repeatedly cited for violating EMTALA in 2022 and 2023. In each instance, CMS put the hospital in immediate jeopardy, asked to create a plan for corrections and had the state increase its oversight of the hospital. The hospital closed in March due to low patient volumes, it said.
