The U.S. District Court for the Eastern District of Pennsylvania properly ruled in favor of several hospitals and doctors who allegedly violated the Emergency Medical Treatment and Active Labor Act (EMTALA), 42 U.S.C. § 1395dd, by failing to stabilize and inappropriately transferring a patient, when the patient in question did not present herself in an emergent state and was not in an emergent state until she began to undergo monitoring at the primary hospital.
One of the plaintiffs was a woman whose pregnancy was considered high risk due to her diabetes. On the morning of her child's birth, she went to a routine outpatient fetal monitoring appointment at a perinatal facility. When she arrived, she complained of discomfort, yet was not alarmed about her condition and did not feel she was in an emergent state. She was subsequently administered a non-stress test, during which she began to experience increased pain and contractions. Based on the preliminary test results and her diabetic condition, her doctor terminated the non-stress test and sent her to her primary hospital for extended perinatal monitoring.
At her primary hospital, she waited approximately 15 to 20 minutes for a room and was examined. Upon review of the woman's preliminary results, the woman was rushed into surgery and gave birth to a severely brain damaged child.
The child's parents filed suit, asserting, among other things, that the hospitals and doctors violated EMTALA by failing to stabilize the mother's emergency condition and inappropriately transferring her from the perinatal facility to her primary hospital.
EMTALA. EMTALA requires hospitals to give certain types of medical care to individuals presented for emergency treatment: (1) appropriate medical screening, (2) stabilization of known emergency medical conditions and labor, and (3) restrictions on transfer of unstabilized individuals to outside hospital facilities. Congress enacted EMTALA based on concerns that hospitals were either refusing to treat certain emergency room patients or transferring them to other institutions. The practice is known as “patient-dumping.”
Excluded patients. EMTALA's requirements are triggered when an “individual comes to the emergency department,” 42 C.F.R. § 489.24(a)(1). Such an “individual” can only “come” to the emergency department if that person is not already a patient of the hospital. Under 42 C.F.R. § 489.24(b), a patient is defined as “an individual who has begun to receive outpatient services as part of an encounter . . . other than an encounter that the hospital is obligated by this section to provide.” EMTALA does not apply to outpatients, even if during an outpatient encounter, they are later found to have an emergency medical condition and are transported to the hospital's emergency department.
The Third Circuit Court of Appeals held that, contrary to the parents' assertion, the mother did not come to the hospital with an emergency medical condition. The mother was not in an emergent state until after she began the monitoring at the primary hospital and her condition quickly changed. Neither her previous complaints of discomfort nor her high-risk pregnancy amounted to an emergency under EMTALA. The circumstances failed to trigger EMTALA, and therefore precluded the parents' EMTALA claim.
Actual knowledge requirement. The parents were moreover required to prove that: (1) the mother had an emergency medical condition, (2) the hospital actually knew of the condition, and (3) the patient was not stabilized before being transferred. Under EMTALA, hospitals are not held accountable for failing to stabilize conditions of which they are unaware, or even conditions of which they should have been aware. The parents' EMTALA claim failed because they did not satisfy the requirement of actual knowledge. For example, there was no evidence that any of the hospital staff at the perinatal facility actually knew that the mother's condition was an emergency before directing her to her primary hospital for further monitoring. She did not present herself as an emergency patient, and did not herself believe her condition was emergent until after her arrival at her primary hospital. The Third Circuit accordingly held that the parents' EMTALA claim was properly dismissed.
Source: Torretti v. Main Line Hospitals, Inc., 3rd Cir., Sept. 2, 2009, Health Care Compliance Reporter.
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