Being Denied Emergency Medical Care in California
I was denied emergency medical care — here's what California law says and what to do next.
Statute: Cal. Health & Safety Code § 1371.9 et seq.; Cal. Ins. Code § 10112.8 (AB 72 — specified state law)
Deadline: 120 days
Penalty: California has a specified state law under the NSA. State-regulated plans use California's independent dispute resolution process instead of federal IDR. Violations may result in federal penalties of up to $10,000 per violation and state enforcement action by the DMHC or CDI
What is being denied emergency medical care?
The Emergency Medical Treatment and Labor Act passed in 1986 in direct response to a national pattern of "patient dumping" — uninsured emergency patients turned away at the door, or shipped off to other hospitals before they were stabilized. The most notorious case involved a woman in active labor in Chicago who was refused care at one hospital and delivered her baby in the back of a transferring ambulance. The baby didn't survive.
EMTALA requires every Medicare-participating hospital with an emergency department to provide a medical screening examination for anyone who walks in — regardless of ability to pay, insurance, immigration status, or anything else. If they have an emergency medical condition, the hospital must stabilize them before discharge or transfer. Penalties scale up to $133,420 per violation for hospitals with 100+ beds (inflation-adjusted from the original $50,000), and physicians can be personally fined and excluded from Medicare. EMTALA also has a private right of action — patients can sue.
What to Do If a Hospital Refuses to Treat You in an Emergency
Step 1: Go to the ER if you believe you have an emergency. No insurance, no ID, no money — none of it matters under EMTALA. Tell triage your symptoms clearly and concisely.
Step 2: If asked about payment first, invoke EMTALA out loud. "I need a medical screening examination. I have a right to be screened under EMTALA." The hospital must screen before discussing payment.
Step 3: Question any transfer. If they try to transfer you before stabilizing, ask why and whether it's medically necessary. You can refuse the transfer. If you consent, the hospital must confirm the receiving facility has agreed to accept you and can treat your condition.
Step 4: Complain to CMS. Federally, file at cms.gov or call 1-800-633-4227 (1-800-MEDICARE). You can also file with your state health department, which often investigates faster.
Step 5: Sue under the private right of action. 42 U.S.C. § 1395dd(d)(2) lets EMTALA-violation victims sue the hospital for damages. The limitations period is typically 2 years from the violation. Medical malpractice or patients' rights attorneys take these on contingency.
How California differs from federal law
California goes beyond the federal EMTALA requirements with additional state-level emergency care protections:
- California Health & Safety Code § 1317: Requires all licensed hospitals with emergency departments to provide emergency care to anyone who needs it, regardless of ability to pay. This state law mirrors EMTALA but is independently enforceable under California law.
- Cal. Health & Safety Code § 1317.1 (anti-dumping): Prohibits hospitals from transferring patients for financial reasons. Transfers must be medically appropriate and the receiving hospital must agree to accept the patient. Violations can result in license revocation.
- Knox-Keene Act emergency protections: California managed care plans must cover emergency services at any hospital, in- or out-of-network, without prior authorization. The "prudent layperson" standard applies — if a reasonable person would believe it was an emergency, the plan must cover it.
- Medi-Cal emergency services: Emergency Medi-Cal covers emergency medical conditions for people who would qualify for full Medi-Cal except for immigration status. This provides critical emergency coverage for undocumented residents.
Additional steps in California
File a complaint with the California Department of Public Health at cdph.ca.gov or call (800) 236-9747. For managed care plan emergency disputes, contact the Department of Managed Health Care at dmhc.ca.gov or call (888) 466-2219. Contact Health Consumer Alliance at (888) 804-3536 for free assistance.
What you should NOT do
Don't leave the ER before being screened. If you walked in with an emergency complaint, do not leave against medical advice without being screened. If the wait is long, tell staff your symptoms are getting worse.
Don't let billing questions delay your care. The hospital can ask about insurance for record-keeping, but they cannot delay your screening or treatment because of billing. If you feel pressured, remind staff of your EMTALA rights.
Don't agree to a transfer you're uncomfortable with. If the hospital wants to transfer you before your condition is stable, you can refuse. If you do agree, make sure the receiving hospital has accepted you and can treat your condition.
Don't assume EMTALA covers follow-up care. EMTALA requires screening and stabilization of emergency conditions. Once you are stabilized and discharged, the hospital is not required to provide ongoing treatment under EMTALA. However, ask about financial assistance, charity care, and follow-up resources before you leave.
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Generate your surprise billing →This page is general legal information for California, not legal advice for your specific situation. Laws change, and how a statute applies depends on facts we don't know. For advice on your matter, consult a licensed attorney in California.