My healthcare administration colleagues in south California and south Texas, especially, tell me about the huge amounts of money they are losing in providing labor and delivery services that go unpaid. Apparently, many pregnant women near term make an effort to cross the border and deliver on American soil, thus granting American citizenship to the child born here. Again, under EMTALA, if a woman presents to your hospital in active labor, you must admit them and do the delivery. You can only transfer the patient to another hospital for clinical reasons, such as it is a high-risk delivery, and your facility has no neonatologist or neonatal ICU. EMTALA applies to all patients, American citizens or not.