It’s the facts that count in EMTALA cases
Avoid knee-jerk’ response, expert says
A decision earlier this year in an Emergency Medical Treatment and Active Labor Act (EMTALA) lawsuit is important because it shows that every case ultimately depends on whether the facts hold up, says Stephen A. Frew, a Rockford, IL, health care lawyer who advises hospitals on the 1986 law. The decision should serve as a reminder to health care providers that they should not make the "knee-jerk assumption" that just because the law applies in a particular case, liability will attach, Frew says.
In the case, Roberts vs. Galen of Virginia Inc., a federal jury decided that a hospital did not violate EMTALA when it sent a patient to a nursing home and her condition subsequently deteriorated. The hospital transferred the patient to a nursing home after an emergency admission and a six-week stay.
In one of the first tests of the law in a trial by jury, the U.S. District Court for the Western District of Kentucky ruled in favor of the defendant, a hospital operating under the name of Galen of Virginia Inc., and against the plaintiff, who was the guardian of the patient.
There have been few EMTALA cases that have reached verdict, Frew notes, and most of the rulings until now have been on legal interpretations of the law. In January 1999, for example, the Supreme Court held in Roberts vs. Galen (119 S. Ct. 685 1999) that patients who claim to have been dumped in violation of EMTALA — the anti-dumping statute — need not prove that the hospital acted with an improper motive. That holding left physicians, hospitals, and attorneys wondering about its implications for federal malpractice cases arising under EMTALA.
The U.S. Supreme Court remanded the case back to the District Court after appeal through the U.S. Court of Appeals for the 6th Circuit.
In the recent decision, Frew points out, the jury found that the plaintiff failed to establish that the patient was inadequately stabilized before movement. "This goes back to the ultimate issue, that every case is ultimately decided on individual merits," he says. "Just because the court rules that EMTALA applies, the sky is not falling. Yes, the [plaintiffs] alleged enough to justify [trying the case]. They just couldn’t prove it."
How to view a violation
Some rulings produce a "hysterical reaction on the part of hospitals and medical providers who up until now hadn’t been paying attention," he says. It’s important to consider the rulings, but not until a case is decided completely, he emphasizes. "Interim decisions are not necessarily going to define the law."
On the other hand, Frew notes, hospitals should be aware that just because a jury finds there is no EMTALA violation, that doesn’t mean the Health Care Financing Administration (HCFA) won’t enforce a violation in an administrative context. "There is a lot of confusion between what the courts do and what HCFA does," he adds, pointing out that HCFA regulations "mirror the general provisions of EMTALA and provide more extensive and more quality-oriented standards.
"My personal view," Frew says, "is that hospitals have insurance for lawsuits, but they don’t have insurance for administrative citations. So while [EMTALA cases] are certainly an issue, let the insurance companies worry about the courts and the health care providers concentrate on complying with HCFA."
(More information on EMTALA issues is available on Frew’s web site at www.medlaw.com.)
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