A recent decision by the court of appeals in Iowa has found that Iowa Methodist Medical Center did not falsely imprison two alien patients when it extrajudicially deported them following fulfillment of its EMTALA obligations.

After the patients were stabilized, a hospital social worker located the patients' families in Mexico and informed them of the men's condition. The social worker then worked with the families to establish a discharge plan which included needed long-term rehabilitation services. The social worker was unable to find a facility in Iowa willing to accept them as patients "due to their undocumented status," although both were insured.

The social worker then worked on a plan to repatriate the men to Mexico, after contacting the U.S. Embassy for a list of suitable rehabilitation facilities. The social worker found a hospital in Vera Cruz, Mexico that was willing to accept the men as patients. After securing a treatment facility, the hospital chartered a plane to fly the semi-comatose and mostly unresponsive patients to Vera Cruz. Treatment of the men did not go well in Vera Cruz.

As a result, the patients sued Iowa Methodist alleging it had violated EMTALA and had falsely imprisoned them by transporting them to the hospital in Vera Cruz without their consent. The plaintiffs dismissed their EMTALA claim shortly after a motion for summary judgment was filed.

As to the tort of false imprisonment, the court found that it requires an unlawful restraint on a person's freedom of movement or personal liberty. Thus, the patients must establish: (1) a detention or restraint against their will, and (2) the unlawfulness of the detention or restraint. Consent to the confinement may nullify a claim of false imprisonment.

The patients argued that their confinement occurred during the transfer to Vera Cruz, as it was effected without consent and therefore unlawful. The social worker claimed she reviewed the families' options with them, which included discharging the men to family members or transferring them to a facility in Mexico. The social worker stated both families verbally consented to the transfer to the Vera Cruz facility. The families contested the social worker's statements, contending they were never asked for consent and never gave it.

The families, however, did not protest the patients' transfer to Mexico. The social worker testified she passed on to the families the names of the Mexican facilities received from the U.S. Embassy. The families then narrowed down their choices to two hospitals. The social worker contacted both facilities and reported her conversations with the hospitals to the families, who decided that the Vera Cruz hospital was the best option. The families' participation in the decision-making process was deemed by the court to be an acquiescence or consent to the medical repatriation.

The court then considered whether the confinement was unlawful. A person generally is subject to liability for false imprisonment if: (1) he intends to confine the person; and (2) in fact, directly or indirectly, causes the person to be confined; and (3) the other is conscious of the confinement or is harmed by it. Restatement (Second) of Torts § 35.

The court held that because the patients were not conscious of their confinement, they must prove they were harmed by it. To prove injury, the patients argued they were injured by the inadequate rehabilitative care received in Vera Cruz. The court found that Iowa Methodist was not responsible for injuries that occurred once the men's care was officially taken over by the hospital in Vera Cruz. The court found that Iowa Methodist more than adequately met its duty of care when it successfully transferred them in stable condition to a care facility that provided all the services these men medically required.

While the outcome in this case was favorable to the hospital, care must be taken in extrajudicial repatriations to assure that consent or, at least acquiescence, is obtained and reasonable processes are followed.