Some U.S. Emergency Rooms Can Legally Decline Patients Who Cannot Pay, Report Finds

A growing number of emergency care facilities in the United States are operating outside a decades-old federal law that requires hospital emergency rooms to evaluate and stabilize patients regardless of their ability to pay, according to a new report by STAT.

The law, known as the Emergency Medical Treatment and Labor Act (EMTALA), has protected patients since 1986 by requiring Medicare-participating hospitals to provide emergency medical screening and necessary stabilizing treatment without considering a patient's financial status.

However, the requirement only applies to hospitals that participate in Medicare. Some for-profit emergency hospital operators have chosen not to enroll in the federal program, allowing them to operate outside EMTALA's legal obligations.

One of the companies highlighted in the report is Houston-based Nutex Health, which operates 27 hospitals across 12 U.S. states. According to STAT, most of the company's facilities do not participate in Medicare, meaning they are not legally required to follow EMTALA regulations.

Although Nutex Health says it voluntarily screens every patient and never refuses treatment to anyone facing a life-threatening emergency, several patients interviewed by STAT described being asked to make payments before receiving medical evaluations.

One reported case involved Robert Behounek, a 34-year-old New Mexico resident who sought emergency treatment after experiencing chest pain, breathing difficulties, and swelling—symptoms commonly associated with heart conditions. Behounek alleged that he was informed his visit could require an upfront payment exceeding $1,600 before he could be examined.

He later sought care at another hospital, where physicians diagnosed him with systolic heart failure and a minor heart attack.

Another incident cited by STAT involved Julie Bliss, who brought her 11-year-old daughter to a Nutex-operated hospital near Oklahoma City after the child fainted and appeared to experience a seizure. Bliss stated that treatment was paused until an initial payment was made. Her daughter was later diagnosed with vasovagal syncope, a condition involving a sudden drop in blood pressure.