Feature Article: Emtala: Impact on hospital dentistry emergency services

The Emergency Medical Treatment and Active Labor Act (EMTALA) requires hospital-based dental residency programs and hospital dentists to meet Federal standards when patients come to a hospital emergency department and need emergency dental services. EMTALA (42 U.S.C. 1395dd) has three key provisions which must be understood because of Its impact on hospital emergency dental services:
Medical Screening Requirements,
Necessary Stabilizing Treatment for Emergency Medical Conditions, and
Restricting Transfers Until the Individual is Stabilized.
This article reviews the relevant Federal statutes, codes of Federal regulation, and published court cases to help practitioners understand the Issues. An understanding of the informed consent process, including the informed refusal doctrine, as well as the dentist's obligation when patients refuse recommended diagnostic tests, treatment, or transfer, is Important. Immunity for failure to obtain informed consent is sometimes appropriate under state law. Under EMTALA, the term physician applies to dentists. Recent changes clarify distinctions between the terms on campus and off campus related to hospital property emanating from the Ravenswood tragedy. Hospital dentists must be familiar with these requirements when caring for patients seeking emergency services     

Special Care Dentistry: a professional challenge

As a profession we have a responsibility to ensure that the oral health needs of individuals and groups who have a physical, sensory, intellectual, medical, emotional or social impairment or disability are met. In the UK, over 200,000 adults have profound learning disabilities and/or complex medical conditions. Adults with a disability often have poorer oral health, poorer health outcomes and poorer access to services than the rest of the population. This paper examines the need for Special Care Dentistry based on a review of published literature, surveys and health policy, and suggests how services might be delivered in the future. Existing models of good practice reveal that established clinicians working in this field have a patient base of between 850 and 1,500 patients per year and work across primary care and hospital settings, liaising with colleagues in health, social services and the voluntary sector to ensure integrated health care planning. On this basis, a conservative estimate of 133 specialists is suggested for the future, working in networks with Dentists with Special Interests (DwSIs) and primary dental care practitioners. A skilled workforce that can address the wider needs of people requiring Special Care Dentistry should be formally recognised and developed within the UK to ensure that the needs of the most vulnerable sections of the community are addressed in future.