Provided below is an overview of three federal court decisions regarding the Emergency Medical Treatment and Labor Act (“EMTALA”). The cases are from the U.S. District Court for the Eastern District of Texas, the U.S. District Court for the District of Colorado, and the U.S. District Court for the District of Nevada.

Liles v. TH Healthcare, LTD, et al.,
No. 2:11-cv-528-JRG (E.D. Tex. Sept. 10, 2012)

On September 10, 2012, the U.S. District Court for the Eastern District of Texas denied the defendant hospital’s motion to dismiss and held that the plaintiff pled facts sufficient to establish a plausible EMTALA claim. The Court also partially granted the individually-named physician and nurse defendants’ motion to dismiss on the basis that individual liability is not permitted under EMTALA.

The allegations in the complaint provided that Jesse Liles – who was uninsured – initially came to the Nacogdoches Medical Center (the “Hospital”) on December 28, 2009 complaining of fever, cough and shortness of breath. He was admitted as having severe dehydration and lung disease. During the course of treatment, the Hospital doctors determined that Liles suffered from bilateral pneumonia, Adult Respiratory Distress Syndrome, and significant lung damage. Despite this determination, Liles claimed that various doctors and nurses attempted 18 different times to transfer him out of the Hospital and that two of his doctors, Suraparaju and Hernandez, falsely certified that he was stable for transfer.

At 3:35 a.m., on January 1, 2010, EMS personnel arrived to pick up Liles from the Hospital. At or near the time he was placed in the ambulance, Liles went into cardiac arrest. He was resuscitated in the ambulance and then brought back into the Hospital where he was placed on a ventilator in the Intensive Care Unit (“ICU”). Liles remained at the Hospital for over three more weeks until January 24, 2010, at which time he was discharged to his home. Two days later, on January 26, 2010, Liles’s medical conditioned worsened and he returned to the Hospital. However, the Hospital refused to admit Liles because there was no pulmonologist on staff. The Hospital’s personnel made numerous calls to other potential receiving hospitals to identify a facility capable of accommodating the needs of Liles. The Hospital’s doctors and nurses classified Liles as “stable” and transferred him to East Texas Medical Center Tyler (“ETMC Tyler”) as a cardiac resident.

Upon arrival at ETMC Tyler, Liles was admitted to the ICU and a medical examination revealed that he was suffering significant lung damage and that his lung had been collapsed to some degree for quite some time. On January 29, 2010, ETMC Tyler physicians performed surgery on Liles to repair his lung.
Liles’s lawsuit against the Hospital and the individually-named physicians and nurses asserted, among other claims, an EMTALA claim and claims for conspiracy to violate EMTALA during his initial stay at the Hospital. In response, the Hospital and the physicians and nurses filed motions to dismiss the EMTALA and other state law claims. In ruling on the motions to dismiss, the Court (1) addressed the term “stabilized” as it is applied under EMTLA and (2) held that an EMTALA claim cannot be brought against individual.

Regarding the first issue, the Hospital argued that Liles’s EMTALA claims based on his initial stay were barred because he had been admitted to a hospital as a bona fide patient. The Court rejected this argument and cited the statutory language of 42 U.S.C. § 1395dd(c)(1) and authority from the Fifth Circuit. More specifically, tracking the Fifth Circuit’s stance on these issues, the Court held that the plain language of the EMTALA statute specifically indicates that a hospital may not transfer an individual with an emergency medical condition which has not been “stabilized.” The term “stabilized,” with respect to an emergency medical condition, is defined by the statute to mean “that no material condition is likely, within a reasonable medical probability, to result from or occur during the transfer of the individual from a facility.” The Court acknowledged the Fifth Circuit’s holding that a hospital’s responsibility under EMTALA ends when it has stabilized the individual’s medical condition. See Green v. Touro Infirmary, et al., 992 F.2d 537, 539 (5th Cir. 1993). Therefore, the Court found that the EMTALA statute’s application does not turn on the patient’s administrative status (i.e., admitted as a bona fide patient) but on his or her medical status and whether it was “stabilized.” Accepting Liles’s allegation as true in ruling on the motion to dismiss, the Court necessarily concluded that the Complaint pled sufficient facts to state a plausible EMTALA claim that Liles’s medical condition was not “stabilized” prior to his discharge from his first visit to the Hospital.

In addressing the second issue, the Court dismissed the EMTALA claims against the individually named physicians and nurses because liability under EMTALA is imposed upon the hospital by the acts of the hospital’s doctors, nurses and other personnel, but EMTALA does not impose liability beyond the hospital to the individuals themselves. 42 U.S.C. § 1395dd(d)(1). After dismissing the EMTALA claims against the individuals, the physicians and nurses still remained in the case because the Court declined to dismiss the state law claims, choosing instead to exercise supplemental jurisdiction under 28 U.S.C. § 1367 over those “related claims.”

Genova v. Banner Health, et al.,
No. 11-cv-01139-RBJ-MJW (D. Co. July 11, 2012)

On July 11, 2012, the U.S. District Court for the District of Colorado granted the defendant hospital’s motion for summary judgment which dismissed the plaintiff’s claim that was asserted under the whistleblower provision of the EMTALA statute.

The lawsuit arose out of a serious of events that began on the night of January 21, 2010 when Dr. Ron Genova, an emergency medicine specialist with North Colorado Emergency Physicians (“NCEP”), was contacted as the on-duty physician in the emergency room of Banner Health’s hospital (the “Hospital”). At approximately 10:30 p.m., Dr. Genova claimed that an administrative representative for the Hospital informed him that they were facing a potential serious overcrowding situation. All of the in-patient beds and emergency beds in the Hospital were full, four ambulances were out on call, and the Hospital had no physical capacity to take another patient. Further, a nurse recommended that the emergency department be placed on diversion.

In response, Dr. Genova proposed that the Hospital implement a “Code Purple,” which was designed to maintain safety when the hospital population was at critical level and to provide a mechanism to decompress patient volume. However, the administrative representative refused to implement the “Code Purple” because, according to Dr. Genova, the representative believed that the Hospital’s CEO, Rick Sutton, would not want to divert ambulances. Dr. Genova then called Ms. Sutton to discuss the situation.

After talking with Dr. Genova, Mr. Sutton declined to order the “Code Purple” and then contacted Dr. Campain, the medical director of NCEP. Dr. Campain in turn called Dr. Hutchinson, another emergency department physician at the Hospital that night, who reported that “we’re busy, but we’re getting through it.” Dr. Campain then notified Mr. Sutton that neither ambulance diversion nor the “Code Purple” was necessary. Approximately two weeks later, Mr. Sutton sent a letter to Dr. Campain requesting, pursuant to the contract between Banner and NCEP, that Dr. Genova be removed from all duties at the Hospital.

In response to Mr. Sutton’s letter, Dr. Genova filed a lawsuit that contained three claims: (1) a breach of contract claim; (2) a tortious interference claim; and (3) a claim of violation of the EMTALA statute. In its review of the third claim, the Court analyzed the whistleblower provision of the EMTALA statute, which provides:

A participating hospital may not penalize or take adverse action against a qualified medical person described in subsection (c)(1)(A)(iii) of this section or a
physician because the person or physician refuses to authorize the transfer of an individual with an emergency medical condition that has not been stabilized or
against any hospital employee because the employee reports a violation of a requirement of this section.

42 U.S.C. § 1395dd(i).

Dr. Genova’s EMTALA claim alleged that Banner retaliated because of his refusal to cooperate with practices that he thought would potentially violate EMTALA. In support thereof, he asserted a host allegations regarding the Hospital’s insufficient staffing, failure to follow internal procedures, and focus on business revenues at the sake of patient care and safety. However, the Court recognized the limitations of liability under the EMTALA statute by concluding that, even if his allegations were true, they fail to support a cognizable EMTALA claim under the whistleblower provision. More specifically, Dr. Genova failed to present any evidence that the Hospital, its emergency department, or any person employed by the Hospital ever: (a) refused to conduct an initial medical examination of any person appearing at the Hospital to determine if an emergency medical condition exists; or (b) transferred a person to another hospital that had not been stabilized. See Phillips v. Hillcrest Medical Center, 244 F.3d 790, 796 (10th Cir. 2001). Accordingly, the Court found that nothing in the EMTALA statute provided a legal basis for Dr. Genova’s claim.

Money v. Banner Health, et. al,
No. 3:11-cv-00800 (D. Nev. July 13, 2012)

On July 13, 2012, the U.S. District Court for the District of Nevada granted the defendant hospital’s motion to dismiss because the plaintiff failed to allege sufficient facts to establish that he was screened in an inappropriate manner.

The complaint provided that on November 4, 2010, Kenneth Money presented at the emergency room at Banner Health (“Banner”) in Fallon, Nevada, complaining of chest pain radiating to his jaw. After examination and review of his medical history by Dr. Gandy, Money was given a series of medications including clonidine and morphine. A second doctor, Dr. Thai, also examined Money and diagnosed hypertension, back pain, and morbid obesity. Thereafter, Doctors Gandy and Thai ordered an EKG. Although the EKG reading appeared to be normal, Money’s condition started to deteriorate and the doctors ordered additional EKGs, several blood tests, a chest x-ray, a CT scan, and “repeated cardiac lab” reports. Money was subsequently diagnosed with acute myocardial infarction, and treated for heart attack and cardiac ischemia. However, after being moved to Banner’s intensive care unit, Money went into cardiac arrest and died on November 5, 2010.

The patient’s estate filed suit against Banner and two doctors, alleging that the circumstances surrounding the patient’s death give rise to a federal cause of action under EMTALA for failing to screen and stabilize. The defendants moved to dismiss, alleging failure to articulate a viable EMTALA claim.

The Court’s review of the motion to dismiss revealed that the plaintiff’s compliant did not contain the requisite factual allegations to support a viable EMTALA cause of action. More specifically, the Court concluded that plaintiff’s allegations regarding “failure to screen” did not state a claim on which relief could be granted.

Regarding the “failure to screen” assertion, the Court reaffirmed the concept that faulty or incorrect screening does not violate EMTALA. See Jackson v. East Bay Hospital, 246 F.3d 1248, 1255-56 (9th Cir. 2001). A viable EMTALA claim for “failure to screen” occurs only in instances where a patient is not screened at all, or if screened, that screening differs significantly from that provided to other patients. See id. The Court explained that a hospital’s obligations under EMTALA end when an individual is screened and thereafter admitted for inpatient care. Since the doctors at Banner screened Money and admitted him, the Court found that the plaintiff failed to make a viable screening claim.

After dismissing the EMTALA claims, the Court declined to exercise supplemental jurisdiction under 28 U.S.C. § 1367 over those “related” the state law claims for medical negligence/malpractice.