Intent to dump’ not needed for EMTALA violation
Question: The doctors and staff in our emergency department have a clear understanding that they cannot "dump" patients they do not want to admit, but they do not seem to understand that they can violate the Emergency Medical Treatment and Active Labor Act (EMTALA) without intending to dump the patient. I’ve had doctors insist that "technical" violations of EMTALA will have no consequences as long as there was no intention to dump the patient.
Am I correct when I explain to them that federal officials don’t care what we intended, only what we did?
Answer: The intent of the emergency department staff and physicians has little or no bearing on whether you violated EMTALA, according to John West, JD, MA, DFASHRM, a risk management consultant in Cincinnati and former assistant legal counsel with the American Hospital Association in Chicago. West addressed this topic at the recent meeting of the American Society for Healthcare Risk Management in Chicago.
West says the Supreme Court has not specifically addressed whether the provider’s motive can determine an EMTALA violation, but one recent case touched on the issue closely enough to suggest that motive is not a factor. In a 1992 case, a woman alleged that her transfer from a hospital violated EMTALA because her condition was unstable.1
The trial court granted summary judgment for the hospital on the grounds that the plaintiff failed to show the hospital acted with an improp er motive, The Sixth Circuit Court of Appeals affirmed the trial court’s decision, and then the case was appealed to the Supreme Court.
The Supreme Court ruled unanimously that EMTALA does not require the plaintiff to show that the defendant hospital acted with an improp er motive in transferring a patient, at least with regard to the required stabilization of the patient’s condition. But in reference to screening the patient, another requirement of EMTALA, the court held that the issue of motive was not before it, and so it refused to address the question.
West says the court’s ruling is based on the wording of the EMTALA statute, which requires the hospital to provide "such further medical examination and treatment as may be required to stabilize the medical condition.
"There is no mention in the statute that the stabilization must be appropriate, nor is there any mention that the failure to provide it must be made with an improper motive," he says. "Thus, any consideration of motive in the context of stabilization is irrelevant."
Reference
1. Roberts v. Galen of Virginia, U.S. Sixth Circuit Court of Appeals, No. 97-53, Jan. 13, 1999.
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