June 7, 2021

Failure to X-Ray Implicates Emergency Medical Treatment and Active Labor Act

Holland & Knight Healthcare Blog
Shannon Britton Hartsfield
Healthcare Blog

The Emergency Medical Treatment and Active Labor Act of 1986 (EMTALA) is designed to prevent patient "dumping." It applies to all individuals coming to the emergency department (ED) of a hospital that accepts Medicare funding. If someone comes to the ED requesting care, the hospital has to screen the person to determine whether an emergency medical condition exists. If the patient has an emergency medical condition, the hospital does not necessarily have to completely resolve the patient's problem, but it does have to stabilize the individual or transfer the patient, when permitted under limited circumstances, if the condition cannot be stabilized.

The patient has an emergency medical condition if there are acute symptoms so severe that, if immediate medical attention is not provided, the person's health could be put in serious jeopardy. An emergency medical condition may also exist if there is danger of serious impairment of bodily functions or serious dysfunction of body parts or organs, as well as if the patient is pregnant and having contractions, and there is not enough time to safely transfer the patient or the transfer may pose a threat to the patient or the unborn child.

A recent federal case from the U.S. District Court for the Middle District of Pennsylvania, Shaw v. Wayne Memorial Hospital, 3:20-CV-01594 (May 7, 2021), discusses EMTALA requirements. The case was brought by Norman Shaw Jr., an inmate who was bitten by a fellow prisoner. He went to the ED of the defendant's hospital with an "open fracture" of one of his fingers. The ED staff cleaned and dressed the finger, but did not take an x-ray because he was told the machine was broken. He was given a Tetanus shot and antibiotics. The patient was discharged even though the wound was not sutured and his pain level was at a 10 on the pain scale. More than a month later, the plaintiff's finger was x-rayed, revealing he required surgery. The plaintiff argued pro se that the hospital violated EMTALA by failing to provide him with appropriate screening and stabilization prior to discharge.

The court denied the defendant hospital's motion to dismiss for a number of reasons. For procedural reasons, when reviewing a motion to dismiss, the court accepts all factual allegations in the complaint as true and construes the complaint in a manner most favorable to the nonmoving party. The court found that the complaint stated two claims upon which relief could be granted: an EMTALA failure-to-screen claim and an EMTALA failure-to-stabilize claim.

With respect to the requirement under 42 U.S.C. §1395dd(a) to provide an appropriate screening exam, the court noted that the law does not define "appropriate medical screening." Since the law is aimed at avoiding patient dumping or providing patients with disparate treatment, the court noted that EMTALA has been interpreted to require similarly situated patients to be screened using the same procedures. The plaintiff alleged that the hospital treated him differently from similar patients. The court found that the plaintiff's allegations with respect to this survived the motion to dismiss, and the relevant facts would have to be established at a later stage of the proceedings.

The court noted that, to plead a failure-to-stabilize claim, the plaintiff must allege that he had an emergency medical condition, the hospital knew of the condition, and the patient was transferred without being stabilized. Although the defendant argued that the plaintiff did not have an emergency medical condition, the court stated that "[c]onstruing the facts in the light most favorable to Shaw, as we must in connection with a motion to dismiss, and given that Shaw alleges that he had an open facture of his finger, we cannot say as a matter of law at this early stage of the proceedings that Shaw did not have an emergency medical condition as defined by EMTALA." The court also found that it would be premature to conclude as a matter of law that the hospital did not know of the open fracture.

It is important for hospitals to adhere to an EMTALA compliance program for a number of reasons. In addition to the patient care concerns that can arise out of a failure-to-comply with EMTALA, significant civil monetary penalties may be imposed. EMTALA violations could also potentially lead to civil actions and even termination or exclusion from Medicare. To reduce the chances of penalties, a hospital should ensure that its medical staff is trained regarding EMTALA requirements.

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