There exists a common misconception that both the Centers for Medicare and Medicaid Services (CMS) and the Joint Commission consider “severe pain” to be an emergency medical condition under the Emergency Medical Treatment and Labor Act (EMTALA), and that the law mandates the emergency physician to prescribe medication to treat a patient’s pain. The short answer to the title question is, “No.” Severe pain is NOT in and of itself an emergency medical condition under EMTALA. The long answer is, as your clinical instinct would suggest, “It depends.”

First, any individual presenting to the emergency department of a Medicare participating hospital with pain of any kind or degree, including “severe pain,” must be provided an appropriate medical screening examination (MSE) to determine if there is an emergency medical condition (EMC).¹

Many physicians, hospital administrators, and even hospital attorneys erroneously believe that if a person does not have an emergency condition,

EMTALA’s requirements are never triggered. That is not legally accurate. The medical screening requirement is triggered anytime an individual requests “examination or treatment for a medical condition.” The statute doesn’t say, “for an emergency medical condition.”^1-2 Pain is certainly a medical condition. Therefore, anyone, including known chronic pain patients, presenting to the emergency department with any pain must be medically screened to determine if that pain is or is not a manifestation of an emergency medical condition.¹

That’s the whole purpose of EMTALA’s mandated MSE – to determine if the patient’s presenting complaint is an emergency medical condition.³

Second, and always crucial when interpreting EMTALA, one must examine the definitions contained in the federal statute and CMS’s implementing regulations to determine what constitutes an EMC under the law. The government defines the term “emergency medical condition” to mean a medical condition manifesting itself by acute symptoms of sufficient severity (including severe pain) such that the absence of immediate medical attention could reasonably be expected to result in:

1. placing the health of the individual (or, with respect to a pregnant woman, the health of the woman or her unborn child) in serious jeopardy,
2. serious impairment to bodily functions, or
3. serious dysfunction of any organ or part.⁴

“Severe pain” alone is not sufficient to establish the presence of an emergency medical condition; it must be “severe pain such that the absence of immediate medical attention” could reasonably be expected to result in very bad things happening to the patient.⁵ For example, the chronic back pain patient with “severe pain” that’s a “12” out of a possible 10 does not have an emergency condition if he does not need immediate medical attention for an aortic aneurysm that’s ruptured, an epidural abscess, a herniated disc that’s producing serious neurological loss, or some other true emergency condition. Thus, the patient with just “severe back pain” that is not a manifestation of serious disease does not have an emergency medical condition as defined by EMTALA.