Legal Eagle Eye Newsletter for the Nursing Profession (6)4 Apr 98

Quick Summary: The EMTALA says if a hospital has an emergency department and any person comes to the emergency department and a request is made for examination or for treatment of a medical condition, the hospital must provide an appropriate medical screening examination within the capability of the hospital’s emergency department, including ancillary services routinely available in the emergency department, to determine whether or not an emergency medical condition exists.

   If the hospital determines the person has an emergency medical condition, the hospital must provide further evaluation and treatment within its staff and facilities at the hospital as required to stabilize the medical condition, or transfer the person to a medical facility that has the appropriate staff and facilities available.

   An emergency medical condition is one where the absence of immediate medical attention can be expected to place the person or a pregnant woman’s unborn child in serious jeopardy of harm. UNITED STATES COURT OF APPEALS, FIFTH CIRCUIT (LOUISIANA), 1998.

CASE ONE: The U.S. Court of Appeals for the Fifth Circuit (Louisiana) recently had a case where a hospital was sued for sending a teenage patient home with what seemed like only an upper respiratory infection. In fact the young woman had had a cerebrovascular accident consistent with a left middle cerebral artery infarction, her diagnosis at a different hospital where her mother took her the next day.

   The EMTALA applies to nursing assessment in the E.R. as well as the E.R. physician’s examination and diagnostic testing, when the EMTALA refers to an appropriate medical screening examination. In this case the young woman’s parents sued only the hospital itself, not the nurses or physicians.

   All patients, the court said, regardless of financial status, are entitled to an appropriate medical screening examination in the E.R. As this court put it, Congress enacted the EMTALA to outlaw "patient dumping," hospitals refusing to treat patients who are uninsured, on public assistance or otherwise unable to pay. As interpreted by nearly all Federal and state courts, however, the EMTALA does not burden a patient filing a civil lawsuit with having to prove after-the-fact the hospital had an improper financial motive.

   The court said if a patient sues over a substandard E.R. medical screening examination, the court looks only at whether the patient was given the same screening examination as other patients presenting with similar signs and symptoms.

   In throwing out this case, the court expressly discounted the testimony of a nurse who had overheard a heated discussion between the E.R. physician and a second E.R. nurse. The second nurse was vehemently arguing with the physician that this patient should be admitted or transferred to another hospital, not sent home.

   The problem for the court was the first nurse could not say this patient was treated differently than other patients coming in with the same signs and complaints. Marshall v. East Carroll Parish Hospital Service District, 134 F. 3d 319 (5th Cir., 1998).



CASE TWO: A registered nurse was among the defendants sued in a recent case in the U.S. District Court for the District of Colorado. The court ruled the civil negligence lawsuit could go forward against the nurse and one of the defendant physicians, while the case against the patient’s health plan and its staff physician should go before an arbitrator.

   The patient came to the emergency room with elevated vital signs and flank and buttocks lesions the nurse and physicians thought were uninfected bedsores. The patient was sent home. He actually had necrotizing fasciitis/myositis, according to the court, for which he should have been treated immediately.

   The legal gist of this case was that the emergency room physicians and nurse violated the EMTALA by not seeing that the patient got necessary stabilizing treatment before being discharged from the E.R.

   The court took out the literal language of the EMTALA and quoted it verbatim in the court’s opinion. To stabilize an emergency medical condition means to provide medical treatment, within the staff and facilities available at the hospital, needed to assure, within reasonable medical probability, that no material deterioration of the patient’s condition is likely to result, either while the patient is being transferred, if the patient is transferred to another facility, or after the patient is discharged, if the patient is not transferred, but is discharged instead.

   This court took the same position as most U.S. courts that a patient with insurance or with the means to pay privately has the same right to sue for violation of the EMTALA as an indigent person denied an appropriate screening examination or necessary stabilizing treatment.

   Congress said "... any individual ..." over and over in the EMTALA. The court ruled Congress must have wanted the law to apply to anyone who comes to a hospital emergency department seeking care. Morrison v. Colorado Permanente Medical Group, 983 F. Supp. 937 (D. Colo., 1997).