 Researchers also interviewed doctors who reported that EMTALA citation fines were a disincentive to violate EMTALA protocols.In 1988 the COBRA Act was meant to be a series of revised regulations which required hospital emergency rooms to treat every patient that walked through the door and doubled the fine for violations.News Editor for the American Journal of Nursing, Brider (1987) reported that public hospital staff in Illinois were under a lot of pressure due to the influx of patients that were being sent to them from other hospitals, and that the incidence of patient transfers or patient dumping increased through a loophole in COBRA.