EMTALA: Patient Was Stable, OK To Send To Public Hospital For Surgery
Legal Eagle Eye Newsletter for the Nursing Profession
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September 1998
Quick Summary: While it would be laudable for private hospitals never to transfer patients to public hospitals for inability to pay, EMTALA does not impose such a duty on private hospitals that participate in the Medicare program. This patient was stable when sent to a public hospital for her appendectomy, where her ureter was cut.
If a private hospital transfers a medically-stable patient to a public hospital where the patient encounters faulty medical care, that is not the private hospital’s fault.
EMTALA imposes a duty to stabilize an emergency patient, but it does not impose a duty to fully cure an emergency condition before transferring or discharging a patient.
If no significant deterioration of the patient’s emergency medical condition is likely to result, within reasonable medical probability, as a result of the transfer or discharge, then the patient is considered stabilized, and no EMTALA violation occurs.
UNITED STATES DISTRICT COURT, PUERTO RICO, 1998.The patient came to the emergency room with abdominal pain, vomiting and nausea. The emergency room staff made sure the physician on duty saw the patient at once.
The physician ordered lab tests, x-rays, physically examined the patient and ordered medications to relieve her pain and to control her vomiting. When the test results were in, the physician made a diagnosis of acute appendicitis and cholecystitis.
Because the patient did not have medical insurance and could not pay privately, the physician made the necessary arrangements to transfer her to a public hospital for an appendectomy. She arrived at the public hospital three and one-half hours after she first presented in the first hospital’s emergency room.
According to the U.S. District Court for the District of Puerto Rico, there was no deterioration in her condition during or as a result of the transfer. However, at the public hospital her right ureter was cut during her appendectomy, which caused major complications.
The court ruled the first hospital fulfilled the legal requirements of the Emergency Medical Treatment and Active Labor Act. The patient was given an appropriate medical screening for her emergency medical treatment, even though she was uninsured and unable to pay privately for her emergency care. She was medically stable when she was transferred to another facility for her surgery.
The court ruled the private hospital did not have to do her appendectomy on a charity basis, since she was stable and could be transferred to a public hospital without the act of transfer or the time taken for the transfer compromising her condition. Medical malpractice committed at the public hospital was not an EMTALA violation by the transferring private hospital.
Torres Nieves v. Hospital, 998 F. Supp. 127 (D. Puerto Rico, 1998).