No Good Deed Goes Unpunished

The Emergency Medical Treatment and Active Labor Act

Posted on March 23, 2020 by Barry Zalma

Shortly after midnight on May 3, 2014, Terence Williams was seriously injured when his vehicle rolled over in a single-vehicle accident. Williams’ most serious injuries were to his lower body. He was subsequently transported to Prince George’s Hospital Center (the “Hospital”) in Prince George County, Maryland. He arrived at the Hospital at 1:33 A.M., and Hospital staff began screening procedures. Within twenty minutes, he was intubated to protect his airway, and a trauma surgeon performed a right antecubital cutdown to insert a catheter to infuse large volumes of fluid and blood quickly. After the insertion of the catheter, Williams was repeatedly given blood for the next several hours. Between 2:21 A.M. and 2:57 A.M., various CT scans were performed on his head, chest and spine. At 3:23 A.M., Williams was removed off the back board provided by paramedics in the field. At the same time, he was given additional units of blood and plasma. Twenty minutes later, x-rays were performed on his chest, abdomen, pelvis, forearm, femur, spine, tibia and fibula. After the x-rays, Williams was transported to the operating room and began receiving anesthesia. At 5:13 A.M., Williams’ first surgery began and lasted more than six hours. Although the formal documentation is ambiguous, at some point on May 3, Williams concedes he was admitted to the Hospital.

For the next eleven days, Hospital staff performed a variety of surgeries and medical treatments on Williams. On May 13, 2014, he was transferred to the University of Maryland Medical Center. Despite the treatment he received at the Hospital and at the University of Maryland, the injuries to Williams’ lower body required amputating both of Williams’ legs.

In Terence Williams v. Dimensions Health Corporation, trading as Prince George’s Hospital Center, – No. 18-2139, United States Court Of Appeals For The Fourth Circuit (March 13, 2020) Williams sued the Hospital alleging it violated the Emergency Medical Treatment and Active Labor Act (“EMTALA”) by failing to properly screen him and stabilize his condition.

The district court treated the motion as a motion for summary judgment because Williams attached exhibits to his opposition that were not attached or referenced in his complaint. It then held that the Hospital was entitled to judgment as a matter of law on Williams’ failure to screen claim stating:

“[The hospital] followed its own standard screening procedures when it provided an initial screening for Williams. Whatever shortcomings Williams may perceive in the physician assistant’s screening or the physicians’ involvement, those are matters for a medical malpractice action, and outside the scope of an EMTALA action. The district court denied the Hospital’s motion with respect to Williams’ failure to stabilize claim, holding “until a patient is transferred, discharged, or admitted, ‘the Hospital must provide that treatment necessary to prevent the material deterioration of each patient’s emergency medical condition.'”

Williams was admitted to the hospital at some point. The district court granted the Hospital’s motion for summary judgment noting that the timing of a patient’s admission to the hospital is not essential because the good faith admission of an individual as an inpatient is a complete defense to an EMTALA failure to stabilize claim. The district court found that Williams was in fact admitted and held that Williams failed to present evidence that created a genuine issue of material fact about the Hospital’s good faith in admitting Williams.

The Emergency Medical Treatment and Active Labor Act

Congress enacted EMTALA in 1986 to prevent patient dumping, a practice by which hospitals would either refuse to provide emergency medical treatment to patients unable to pay for treatment or transfer those patients before their emergency medical conditions were stabilized. In keeping with this purpose, EMTALA imposes two main obligations on hospitals with emergency rooms. First, EMTALA requires a hospital to screen an individual to determine whether he has an emergency medical condition.

EMTALA also requires a hospital to stabilize an individual’s emergency medical condition in certain limited circumstances. Critically, EMTALA defines “to stabilize” as “to provide such medical treatment of the [emergency medical condition] as may be necessary to assure, within reasonable medical probability, that no material deterioration of the condition is likely to result from or occur during the transfer of the individual from a facility . . . .” (emphasis added). EMTALA defines transfer as “the movement (including the discharge) of an individual outside a hospital’s facilities. Consistent with this definition, EMTALA’s stabilization requirement is defined entirely in connection with a possible transfer and without any reference to the patient’s long-term care within the system.

If a hospital has screened an individual and found the individual to have an emergency medical condition, and admits that individual as an inpatient in good faith in order to stabilize the emergency medical condition, the hospital has satisfied its special responsibilities under this section with respect to that individual. Importantly, the regulations refer to an admission that is “in good faith.”

Analysis

Williams challenges the district court’s conclusion that his admission was in good faith. In arguing his admission was not, Williams asserts that his admission was based on non-medical reasons. More specifically, he argued the Hospital failed to provide the full number of specialized on-call doctors required by law and by its internal procedures; the Hospital’s trauma surgeon, who was available on call, refused to perform surgery; and the Hospital attempted to hoard Williams as a patient to collect his premium insurance benefits.

The good faith admission requirement seems to flow logically from the text and the intent of EMTALA.  EMTALA’s obligations end once a patient is admitted for treatment. The good faith requirement simply clarifies that any admission must be legitimate and not in name only.

Williams faild to point to evidence that creates a genuine issue of material fact. The record reveals no evidence that the Hospital admitted Williams as a subterfuge with no intent to treat him. In fact, the record demonstrates that Hospital staff provided extensive treatment and surgeries to Williams right after his arrival on May 3 and for the next eleven days.

The courts have generally acknowledged that this limitation on the scope of the stabilization requirement does not protect hospitals from challenges to the decisions they make about patient care; only that redress may lie outside EMTALA. Williams does not have EMTALA available but may pursue recovery under state malpractice law.

In conclusion, although Williams has perhaps produced evidence questioning the Hospital’s treatment of him, he has failed to produce evidence creating a genuine issue of material fact that his admission to the Hospital lacked good faith. Consequently, because the Hospital admitted Williams in good faith, it satisfied its obligations under EMTALA.

ZALMA OPINION

Williams is not without a remedy. He was treated with vigor by the Hospital and made stable before he was passed to another hospital. He was stabilized and provided with multiple treatments including multiple, lengthy surgeries. That he lost his legs could be either due to the malpractice of the hospital and its physicians or due to the extent of the injuries caused by the accident. EMTALA did not apply and the case was appropriately dismissed. If he can prove the hospital failed to treat him properly he is not without a remedy. His suit merely misread or misapplied EMTALA. The hospital kept him alive and probably received no payment for their services only to be sued for its good deeds keeping him alive.

? 2020 – Barry Zalma

This article, and all of the blog posts on this site, digest and summarize cases published by courts of the various states and the United States. The court decisions have been modified from the actual language of the court decisions, were condensed for ease of reading, and convey the opinions of the author regarding each case.

Barry Zalma, Esq., CFE, now limits his practice to service as an insurance consultant specializing in insurance coverage, insurance claims handling, insurance bad faith and insurance fraud almost equally for insurers and policyholders. He also serves as an arbitrator or mediator for insurance related disputes. He practiced law in California for more than 44 years as an insurance coverage and claims handling lawyer and more than 52 years in the insurance business. He is available at https://www.zalma.com and [email protected].

Mr. Zalma is the first recipient of the first annual Claims Magazine/ACE Legend Award.

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