Using EMTALA to Recover for Clients Denied Emergency Medical Attention

Summary

Under the Emergency Medical Treatment and Active Labor Act (EMTALA), hospitals with emergency rooms cannot turn away patients suffering from an “emergency medical condition.” 42 U.S.C. 1395dd. In the current climate of public hostility to health insurance red tape and increasing emphasis on “patient’s rights,” EMTALA has the potential to be an area in which a determined trial lawyer can make a difference for his or her clients.

Using EMTALA to Recover for Clients Denied Emergency Medical Attention: The Supreme Court Lowers the Gate

At a time of historic economic strength locally and nationally, emergency rooms remain primary care facilities for large numbers of people who have no health insurance and therefore no other access to health care.

For those patients who are covered, private health insurers and health maintenance organizations establish arbitrary rates of compensation for needed medical services, if they deem the services worthy of coverage at all.

Under these circumstances, it is no surprise that hospitals that maintain emergency rooms are feeling financially squeezed. If, however, the hospital reacts to this pressure by restricting access to its emergency room facilities, it may be violating federal law and exposing itself to civil liability to the patients it shuts out.

The Consolidated Omnibus Budget Reconciliation Act of 1985 is the source of today’s federal law requiring hospital emergency rooms to treat all comers regardless of their ability to pay.

Under the Emergency Medical Treatment and Active Labor Act (EMTALA), hospitals with emergency rooms cannot turn away patients suffering from an “emergency medical condition.” 42 U.S.C. 1395dd. In the current climate of public hostility to health insurance red tape and increasing emphasis on “patient’s rights,” EMTALA has the potential to be an area in which a determined trial lawyer can make a difference for his or her clients.

To bring an EMTALA claim, the plaintiff must satisfy certain conditions

First, EMTALA covers only hospitals that maintain an emergency department. 42 U.S.C. 1395dd(a) (“[i]n the case of a hospital that has a hospital emergency department…).

The plaintiff must have come to the emergency department and requested that he be examined or treated for a medical condition. Id. The hospital is required to provide for “an appropriate medical screening examination within the capability of the emergency department.” Id. This includes “ancillary services routinely available to the emergency department.” Id. The purpose of the screening examination is to determine whether or not an emergency medical condition exists. Id. Once the determination is made that a patient suffers from an emergency medical condition, the hospital must either treat the patient directly so as to stabilize the patient’s emergency condition, or must transfer the patient to a facility possessing facilities to address the patient’s particular medical condition. Id.

Damages available to the successful EMTALA plaintiff are “those damages available for personal injury under the law of the State in which the hospital is located, and such equitable relief as is appropriate.” Id. at 1395dd(d)(A).

Although EMTALA was drafted broadly to impose strict obligations upon hospitals with emergency rooms, EMTALA litigation has been largely constrained by restrictive judicial interpretation. In interpreting EMTALA courts have considered that a hospital meets its obligations under the Act if it provides consistent screening for patients who present with similar complaints and symptoms. So long as a hospital could prove that it applied the same standard medical screening for a particular presenting complaint, hospitals are held not to have violated EMTALA standards. E.g., Brooks v. Maryland General Hospital, 996 F.22d 708, 710-11 (4th Cir. 1993).

In other words, a hospital can defend an EMTALA case on the basis that the screening and disposition given to a particular emergency room patient was no different than that provided to every other similar case at that hospital, regardless of ability to pay.

The defense for the plaintiff

The corollary of this defense, then, is that the plaintiff may prevail if he demonstrates that the screening and disposition afforded him at the emergency room differed from that afforded other patients presenting with similar complaints. But does the plaintiff also have to prove why he was afforded different treatment?

Until recently, the answer was unclear. The United States Court of Appeals for the Sixth Circuit had decided that proof of intent or improper motive was a prerequisite to a successful EMTALA claim.

In Roberts v. Galen of Virginia, 111 F.3d 405 (6th Cir. 1997), following precedent within the Circuit, the Court of Appeals held that for a patient to recover for an alleged violation of the Act, he or she must allege and prove an improper motive.

This holding differed from those in the 1st, 8th and 10th Circuits. Correa v. Hospital of San Francisco, 69 F.3d 1184 (1st Cir. 1995); Summers v. Baptist Medical Center Arkadelphia, 91 F.3d 1132 (8th Cir. 1996); Repp v. Anadarko Municipal Hospital, 43 F.3d 519 (10th Cir. 1994).

In January 1999, the United States Supreme Court overturned the Sixth Circuit restriction imposing a standard requiring proof of an “improper motive” in EMTALA cases The Supreme Court stated that nothing in the Act can reasonably be read to require proof of an improper motive. This is a disaster averted for potential EMTALA plaintiffs. Proving that a particular hospital’s actions were motivated by an “improper motive” would have been a burden few plaintiffs could meet and whose cases would therefore likely fail at the summary judgment stage. And, from a statutory perspective, Congress’ purpose in enacting EMTALA would have been largely thwarted by an unreachable standard of proof.

So the good news for potential EMTALA plaintiff lawyers is that the inquiry into liability can focus on the examination and treatment rendered rather than on the hospitals motivations for its actions – or inaction. Proving EMTALA cases will require plaintiff’s counsel to focus on careful and thorough discovery of the hospital’s screening and disposition history for similar patient complaints and symptoms.

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