dapted from Sara Rosenbaum, et al., "Case Studies at Denver Health: 'Patient Dumping' in the Emergency Department Despite EMTALA, the Law that Banned It,Health Affairs 31, no. 8 (2012): 1749-56.

Alicia Cortes, a 36-year-old uninsured woman, arrived at Westlea Hospital's emergency department complaining of severe abdominal pain, nausea, and vomiting. A physical examination by an emergency department physician detected a tender abdomen, but laboratory results were unremarkable. An abdominal ultrasound ordered by the physician revealed evidence the physician concluded was indicative of cholecystitis (gallbladder inflammation), gallstones, and distension of the gallbladder. The patient was diagnosed with cholelithiasis (gallstones). Following a seven-hour course of treatment in the emergency department to relieve her severe pain and nausea, the patient was discharged. She was wheeled out of the hospital to a waiting ride-share service driver (arranged by hospital staff) after being directed to follow up with her regular doctor to determine whether she should have surgery to remove her gallbladder. She did not have a regular doctor and told the emergency room nurse who counseled her prior to discharge that she did not have any other source of medical care other than going to the emergency room when she's in pain.

The next day, she went to County General Medical Center's emergency department. She was admitted to County General with acute cholecystitis, had a laparoscopic cholecystectomy surgery to remove her gallbladder, and was discharged the day after that. Her hospital charges were $15,014.

The general counsel and chief compliance officer of Westlea Hospital have called a meeting with their associates to discuss measures that should be taken to address this incident and to prevent similar incidents from occurring in the future.

Part a: You are an investigator with the state health department. What factual and legal questions will you need to answer as part of your investigation to determine whether Westlea Hospital violated EMTALA. Please explain the significance of each of these questions to your investigation.

Part b: You are a compliance officer at Westlea Hospital. What steps would you recommend that Westlea take to enhance EMTALA compliance following the incident described above?