The Kentucky Supreme Court recently affirmed an award of punitive damages against a hospital for violating the Emergency Medical Treatment and Labor Act (EMTALA) that was 386 times the hospital’s share of compensatory damages. The jury originally awarded $1.5 million in punitive damages against the hospital, which was later reduced to $1.45 million.
The hospital was held liable even though the court acknowledged that the hospital “[u]ndoubtedly ... rendered helpful assistance to [the patient] during the final agonizing hours of his life,” according to the Supreme Court’s decision. (The decision from the court can be accessed at http://bit.ly/1UCJVvR.) The court explained that a hospital can violate EMTALA even if “it did some things right,” and it rejected each of the hospital’s challenges to the punitive award.
The case involved a claim that the defendant hospital violated EMTALA when it failed to stabilize “an uninsured and indigent paraplegic” homeless man who came to the hospital’s ED twice during an 18-hour period and complained of extreme pain. He was discharged after both visits. A few hours after a second discharge, the man died from a ruptured ulcer.
A trial court granted the hospital a directed verdict on the medical screening part of the plaintiff’s EMTALA claim but allowed the claim that the hospital failed to stabilize the decedent to go to the jury. The jury awarded the plaintiff $25,000 in compensatory damages and apportioned 15%, which was $3,750, to the hospital. The jury’s original $1.5 million in punitive damages against the hospital was later reduced to $1.45 million. The hospital appealed. It challenged the evidence and the amount of punitive damages.
The hospital cited an extensive list of the medical services provided to the man during the two emergency department visits preceding his death as evidence that it had provided the necessary care under EMTALA. The court was not impressed and said a party that allegedly committed a tort “is not absolved of liability simply because it did some things right.” The court stated, “From the totality of evidence, the jury could have reasonably believed, as it apparently did, that the Hospital engaged in illegal ‘patient dumping’ in its actions toward [the decedent].”
The hospital claimed it did not endorse the way the ED personnel handled the patient. The court concluded that “[t]he proactive nature of the concerted effort to keep [the decedent] away from the Hospital supports a reasonable inference the Hospital’s management personnel were aware of what was happening, and ... ratified it.”
The hospital also argued that it could not be held liable for punitive damages based on the conduct of its independent contractor physicians. The court said that it could and explained that a “hospital remains liable for compliance with EMTALA, and does not escape responsibility by affiliating independent contractor physicians and other nonemployees to provide EMTALA compliance.”
In an analysis posted recently, attorneys from the McGuireWoods law firm in Richmond, VA, explained that the court’s ruling could have far-reaching implications. (The analysis was written by Mitchell K. Morris, JD, and Nathan A. Kottkamp, JD, with Davis M. Walsh, JD. The analysis is available at http://bit.ly/25BUgxb.)
“Although somewhat couched in terms of vicarious liability for contractor conduct, the true thrust of the court’s holding appears to be that a hospital’s duties under EMTALA are non-delegable. In other words, even if the day-to-day operations of an emergency room are being carried out by contractors, the hospital itself will be liable — including, potentially, for punitive damages — if a patient is discharged in violation of EMTALA,” they wrote. “It should be expected, however, that plaintiffs will attempt to use [this decision] beyond the EMTALA context as a means to hold principals liable for punitive damages based on the conduct of independent contractors.”
