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


Quick Summary: The nurse did the entire rape crisis screening openly in the emergency room, rather than taking the 15 year-old victim to a private room.  The nurse later admitted she did not follow any of the hospital’s detailed procedures for sexual assault.

   The Emergency Medical Treatment and Active Labor Act (EMTALA) is a Federal law that requires a hospital to conduct an appropriate medical screening of any person who visits the emergency room for an emergency medical condition, within the capabilities of the hospital’s emergency department.

   An appropriate medical screening is a medical screening similar to one the hospital would provide to another patient.

   A hospital fulfills its appropriate medical screening requirement when the hospital conforms to its standard screening procedures.

   Any major departure from the hospital’s standard screening procedures amounts to an inappropriate screening, and is a violation of the EMTALA’s screening requirement.

   This hospital’s procedure manual had precepts for dealing with suspected sexual assault. It was taken by the court as the hospital’s standard screening procedure for victims of rape or sexual assault.      COURT OF APPEALS OF TEXAS, 1997.


   The nurse was told the young woman had been raped by a twenty-seven-year-old man and that she was in severe pain. The nurse did not take the patient’s vital signs, nor did she ask for any medical history, nor was any physical examination done. The nurse did ask questions concerning how the rape had actually transpired. She also asked the patient if she had since bathed.

   Learning that she had bathed, the nurse stated there was nothing further the hospital could do for her, and she told the minor patient and her mother to go and see their family doctor. No other instructions were given by the nurse.

   The Court of Appeals of Texas pointed out that the mother repeatedly asked the nurse for an examination of her daughter to see if she was all right, but the nurse repeatedly insisted there was nothing the hospital could do for her.

   One of the ten to fifteen persons present in the waiting room at the time was a youngster who knew the victim and quickly spread the news among the victim’s friends from school. Because of the emotional devastation the victim experienced, the mother and her daughter moved to another town so the daughter did not have to continue living in the same neighborhood and going to the same school, the court stated.

   The mother also testified her daughter would seem to get ill when discussions arose about going to the doctor, was afraid of any sort of medical activity, would not talk to her mother about anything, and would not trust anyone with private information about herself.

   The court ruled under these circumstances the mother and daughter had the right to sue the hospital, the emergency room physician and the nurse for violation of the Emergency Medical Treatment and Active Labor Act.

   The Act states that any individual who suffers personal harm as a direct result of a hospital’s violation of the requirements of the Act has the right to file a civil lawsuit for the same damages for personal injury the individual would be entitled to seek under the laws of the state where the violation occurred.

   According to the court, the daughter and the mother both could sue for pain and suffering for the humiliation the daughter experienced when the nurse conveyed her implied belief the daughter had not been raped. In addition, because the interview was conducted in the waiting room rather than in a private room, the interview was overheard by others, which led to the neighbors and friends finding out about the incident. The humiliation from this forced the family to move.

   The court also accepted testimony from a sexual assault counselor at a women’s center where the patient went for counseling, that the nurse’s statements and actions in the emergency room caused the patient to have additional compounded emotional issues requiring counseling and prolonging the healing process.

   The hospital’s procedure manual mandated that emergency personnel were to provide for the medical detection and emotional support of a person who has been the victim of a sexual assault. The manual stated this was to include immediate provision of safety, evidence collection, comfort and privacy, as well as preventative and emergency medical treatment and referral services. The court ruled this was the definition of an "appropriate medical screening" under the particular circumstances.

   The court pointed out the nurse admitted she followed none of the hospital’s own rape crisis procedures.

   By contrast, the court pointed out the family doctor’s office nurse did a preliminary examination and provided the mother with rape crisis information, then sent them to the emergency department at another hospital. There appropriate procedures were followed, including a full physical examination and a rape kit, even though by then it was the next day. "C.M." v. Tomball Regional Hospital, 961 S.W. 2d 236 (Tex. App., 1997).