EMTALA may apply to non-ED patients
By Thomas Schieffelin, JD
Adams, Hill, Reis, Adams, Hall & Schieffelin
Orlando, FL
In July 1988, this patient was admitted to a Virginia hospital, approximately 33 weeks pregnant. Four days later, she was taken to the hospital's labor and delivery facilities with contractions and abnormally colored vaginal discharge. A few hours later, the hospital called a physician who was not her regular attending physician, and who had never examined her, for orders on what to do. The physician ordered the patient transferred to a different hospital.
When the patient arrived at the second hospital, she was taken immediately to the delivery room where her child was delivered by cesarean. Both mother and child suffered substantial injuries and subsequently sued the original treating hospital, claiming a violation under EMTALA. The trial court held that EMTALA does not apply to "emergency conditions arising from medical negligence during a stay in the hospital." The plaintiff appealed.
The supreme court of Virginia reversed, holding that the EMTALA prohibition on patient dumping is neither related to, nor dependent upon, the patient arriving through the ED without being stabilized. The state supreme court held that EMTALA applies when an emergency medical condition, or active labor, begins after admission and initial stabilization of the patient's condition, whether or not the patient was admitted through the ED.1
A similar case in 1987 was decided by the U.S. District Court of Appeals, Sixth Circuit.2 A patient was taken to a hospital ED and admitted to the intensive care unit, where she was treated for 10 days. The patient was later transferred to regular inpatient care where she was treated for another 11 days, then discharged. The patient brought suit under EMTALA, alleging the hospital failed to stabilize her condition before discharging her. The district court of appeals agreed that EMTALA applied to this situation.
The court reasoned that EMTALA was intended to ensure that patients with medical emergencies receive emergency care, and this emergency care should not stop when a patient is wheeled from the ED into the main hospital. The court concluded that the holding is consistent with the legislative intent to prevent hospitals from dumping patients who lack insurance to pay their medical bills by either refusing treatment or transferring the patients to other hospitals.
These cases should prompt risk managers to make sure hospital staff are aware that the EMTALA provisions apply to all patients on hospital grounds who have an emergency medical condition or who are in active labor. This is regardless of whether the patient has been stabilized in the ED and then an emergency condition develops, or the patient has been admitted to the hospital through the ED or any other method and then develops an emergency condition. Health Care Financing Administration regulations define the phrase "comes to the emergency department" to mean the individual is somewhere on the hospital property (including ambulances owned and operated by the hospital, even if the ambulance is not on hospital grounds).3
Risk managers also need to ensure that all patients are in stable condition as required under EMTALA, before being discharged or transferred to another facility. By following the EMTALA requirements for all patients, no matter which hospital door the patient enters, your hospital will have less risk of liability under EMTALA.
References
1. Smith v. Richmond Memorial Hospital, 416 S.E. 2d 689 (Va. 1992).
2. Thornton v. Southwest Detroit Hospital, 895 F. 2d 1131 (5th Cir. 1990) .
3. HCFA Regulation, 42 C.F.R. § 489.24(b).
(Editor's note: The authors were assisted in research and development by Lori A. Wellbaum.) *
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