EMTALA was enacted to prevent hospitals from turning away—or “dumping”—ER patients because they can’t pay. EMTALA requires a hospital to (1) provide a screening exam to determine if an emergency medical condition (EMC) exists and if it does, either (2) stabilize the condition or transfer the patient to another facility.

So if a hospital screened a patient, determined that an EMC existed, and then kept the patient, there would be no violation of EMTALA, right? Wrong, according to a June 23 Settlement Agreement that cost South Carolina’s AnMed Health $1.3 million.

How did keeping a patient become dumping the patient? The explanation is that the patients—actually 36 of them—had psychiatric EMCs, and AnMed kept them in its ER rather than moving them to its behavioral unit, where they could be treated by psychiatrists instead of ER doctors. According to HHS, AnMed did this when patients lacked financial resources, keeping them in the ER involuntarily for days or even weeks, awaiting beds at the local mental health center.

Dealing with behavioral care patients is a serious and growing concern for American hospitals, both because the number of such patients involuntarily brought to the ER by law enforcement or others is increasing and because state funding for behavioral care is declining along with overall behavioral care facility capacity.