After sitting in a hospital emergency room (“ER”) for more than four hours, waiting to see a doctor, Fred dies of a heart attack. No one can explain how ER personnel had failed to immediately admit Fred, a seriously overweight 55 year-old who had come to the ER complaining of headache, nausea, dizziness and chest pains. Although it promptly took Fred’s medical insurance information, the hospital failed to follow its own procedures for screening patients who came to the ER with symptoms indicating potential heart attacks.
Fred’s survivors consider a malpractice action against the hospital, and the doctors and nurses involved. They also consider a claim under the federal Emergency Medical Treatment and Active Labor Act, 42 U.S.C. 1395dd (“EMTALA”).
However, the hospital claims that EMTALA is available only to indigent persons and not those capable of paying for treatment, through insurance or otherwise. As explained below, the hospital’s defense is unfounded. Although one purpose of EMTALA is to prevent hospitals from refusing to treat patients who lack insurance or other means to pay, EMTALA has a much broader reach.
EMTALA applies to almost all hospitals and governs a hospital’s obligations to patients who go to the ER or who are in or near the hospital and either ask for emergency treatment or are obviously in need of such treatment. The statute requires hospitals: (1) to provide an appropriate medical screening to persons who come to the ER seeking medical assistance and (2) if an emergency medical condition exists, to render the services that are necessary to stabilize the patient’s condition. Cruz-Queipo v. Hospital Espanol Auxilio Mutuo de Puerto Rico, 417 F.3d 67, 70 (1st Cir. 2005), quoting Correa v. Hosp. San Francisco, 69 F.3d 1184, 1190 (1st Cir.1995). (Emphasis added). In addition, EMTALA restricts a hospital’s ability to transfer a patient suffering from an emergency medical condition to another hospital before stabilizing the patient’s condition.
“The essence of [the screening] requirement is that there be some screening procedure, and that it be administered even-handedly…. When a hospital prescribes internal procedures for a screening examination, those internal procedures set the parameters for an appropriate screening…. A hospital thus must adhere to its own procedures in administering the screening examination.” Cruz-Queipo, 417 F.3d at 70, quoting Correa, 69 F.3d at 1190.
Notably, EMTALA does not provide a cause of action for medical malpractice. Correa, 69 F.3d at 1192. See also Ramos-Cruz v. Centro Medico del Turabo, 642 F.3d 17, 18 (1st Cir. 2011); Del Carmen Guadalupe v. Negron Agosto, 299 F.3d 15, 21 (1st Cir. 2002); Rosado-Gonzalez v. Alejandro Otero Lopez Hosp., 836 F. Supp. 2d 48, 56 (D.P.R. 2011). The mere fact that a patient receives substandard care or that ER personnel perform the required screening negligently does not, by itself, violate EMTALA. “[A] refusal to follow regular screening procedures in a particular instance contravenes the statute, … but faulty screening, in a particular case, as opposed to disparate screening or refusing to screen at all, does not contravene the statute.” Correa, 69 F.3d at 1192-93.
A patient can sue a hospital for damages arising from an EMTALA violation. 42 U.S.C. §1395dd(d)(2)(A).
Does EMTALA apply only to indigent patients?
Some defendants argue that EMTALA protects only patients who are indigent, and not those capable of paying for their own care, through insurance or otherwise. That is not correct.
It is well established that both EMTALA’s screening requirement and its stabilization requirement apply without regard to a patient’s ability to pay or the hospital’s motivation. In Roberts v. Galen of Virginia, Inc., 525 U.S. 249, 252-53, 119 S.Ct. 685, 686-87 (1999), the United States Supreme Court held that EMTALA §1395dd(b), requiring that a hospital stabilize the patient before discharge, applies regardless of the hospital’s motivation. Nor is the screening requirement applicable only to the indigent or uninsured. In Correa, the Court of Appeals for the First Circuit stated:
[The hospital] maintains that depriving a patient of an appropriate screening, in and of itself, will not support an EMTALA claim. It suggests that a hospital can be liable for transgressing the statute only if economic concerns, such as the suspicion that the patient will be unable adequately to pay her way, drive the hospital’s actions. Since Ms. Gonzalez had insurance that permitted her hospital visit if an emergency existed, its thesis continues, its handling of her case could not have been motivated by concerns about her ability to pay….
Every court of appeals that has considered this issue has concluded that a desire to shirk the burden of uncompensated care is not a necessary element of a cause of action under EMTALA. … We think that these cases are correctly decided, and that EMTALA does not impose a motive requirement…. We hold, therefore, that EMTALA, by its terms, covers all patients who come to a hospital’s emergency department, and requires that they be appropriately screened, regardless of insurance status or ability to pay. See 42 U.S.C. § 1395dd(a).
69 F.3d at 1193-94. (Emphasis added). Monrouzeau v. Asociacion Del Maestro, 354 F.Supp.2d 115, 118 (D.P.R. 2005); Torres Otero v. Hospital General Menonita, 115 F.Supp.2d 253, 257 (D.P.R. 2000); Fuentes Ortiz v. Mennonite General Hospital, 106 F.Supp.2d 327, 332 (D.P.R. 2000).
By failing to screen Fred as required by its own procedures, the hospital may have violated EMTALA. Fred’s family is not barred from bringing an EMTALA claim merely because Fred was not indigent. Any patient who has been injured by a hospital’s breach of its EMTALA obligations should consider bringing an EMTALA claim.