Provided below is an overview of four federal court decisions regarding the Emergency Medical Treatment and Labor Act (EMTALA). The cases are from the U.S. District Court for the District of Kansas, the U.S. District Court for the Middle District of Tennessee, and the U.S. District Court for the Southern District of West Virginia.  

Penn v. Salina Regional Health Center, Inc., No. 11-1243-MLB (D. Kan. May 8, 2012)

On May 8, 2012, the U.S. District Court for the District of Kansas granted Defendant Salina Regional Health Center’s motion to dismiss and held that the Plaintiff could not establish a plausible EMTALA claim.  

On January 14, 2011 Theresa Penn began to experience pressure and aching in her upper chest and pain in both arms and her jaw. Seeking relief, Penn presented to a COMCARE clinic in Minneapolis, Kansas1, where her primary care physician, Dr. Yoxall, diagnosed her with acute coronary syndrome and acute myocardial infarction. Since he deemed her in a life-threatening emergency, Dr. Yoxall immediately called the Salina Regional Health Center (Salina Regional) because it was the closest hospital with an emergency room and specialized facilities. However, the on-call cardiologist, Dr. Kauer, refused to receive Penn, stating there were no available beds in the intensive care unit of Salina Regional. Therefore, Penn was taken to the Via Christi Regional Medical Center in Wichita, Kansas by an ambulance not affiliated with Salina Regional. She coded during the transport but all attempts to save her life were unsuccessful. Penn died in Wichita on January 15, 2011.  

After Theresa Penn’s death, her husband, Michael Penn, filed a lawsuit against Salina Regional that asserted a claim under EMTALA. In response, Salina Regional filed a motion to dismiss the EMTALA claim and other state law claims. In ruling on the motion to dismiss, the court addressed three issues: (1) whether Penn “came to” Salina Regional; (2) whether Salina Regional  

Regarding the first issue, Salina Regional argued that EMTALA did not apply because Penn did not “come to” the hospital as she never walked into its emergency room and was not transported in one its ambulances. In response, Plaintiff argued for a broad interpretation of the EMTALA requirement that a patient “comes to” an emergency department and that the requirement was met when the patient was in her physician’s office when he called Salina Regional. The court declined to follow this broad interpretation. More specifically, the court reviewed the statutory language of 42 U.S.C. § 1395dd(a), guidance provided under 42 C.F.R. § 489.24, and persuasive authority from the Third and Ninth Circuits2, and determined that the “comes to” requirement mandates that the patient be physically present on hospital property. Therefore, because Penn had not been in Salina Regional’s emergency room or in one of its ambulances, she had not met the “comes to” element essential to an EMTALA claim.  

In addressing the second issue, the court explained “reverse dumping” occurs when a hospital emergency room refuses to accept an appropriate transfer from another hospital of a patient requiring its specialized capabilities. See St. Anthony Hospital v. U.S. Dept. of HHS, 309 F.3d 680, 686 (10th Cir. 2002). In analyzing the facts of the instant case, the court held that neither COMCARE nor the physician’s office constituted a “hospital” or “transferring hospital” – a prerequisite of any reverse dumping claim. Furthermore, the court rejected Plaintiff’s argument that COMCARE or the physician’s office constitutes an implied or de facto “dedicated emergency” department of OCHC, stating that there is no room in the definition-heavy environment of EMTALA law and regulations for “implied” or “de facto.” Therefore, because the attempted transfer did not originate from a hospital, Salina Regional could not be liable under EMTALA for alleged “reverse dumping.”  

Lastly, the court rejected the Plaintiff’s final argument that a narrow interpretation of EMTALA’s definition of “transfer” would violate the constitutional right to travel as protected by the Due Process Clauses of the Fifth and Fourteenth Amendments because there was no case law presented to support the argument and no interstate travel had occurred in this case.  

Cisneros v. Metro Nashville General Hospital, No. 3:11-0804 (M.D. Tenn. Apr. 19, 2012)

On March 27, 2012, the U.S. District Court for the Middle District of Tennessee dismissed the Plaintiff’s EMTALA claims, reiterating that the civil enforcement provision of EMTALA does not authorize action against individuals such as physicians or contractors.  

On February 20, 2010, the plaintiff, Martin Cisneros went to Nashville General Hospital with complaints of severe pain in his right eye, was seen in the emergency room by Dr. Moore, and sent home after being given some eye drops. When his symptoms worsened, he returned to the emergency room two or three days later, where he was seen by Dr. Nixon and given the same medication in ointment form. A couple of days later, Cisneros returned to the hospital for a third time, claiming that his symptoms continued to worsen. He alleged that during his third visit he was escorted out of the emergency room without being examined or treated, and that by these actions the emergency room physicians and the emergency room physician contractor violated the obligations imposed by the federal regulations promulgated under EMTALA.  

Citing Moses v. Providence Hospital and Medical Centers, Inc., 561 F.3d 573, 587 (6th Cir. 2009), the court reiterated that EMTALA and the regulations promulgated thereunder do not create a private cause of action in favor of the patient against the Defendant emergency room physicians or the emergency room physician contractor, and granted their motion to dismiss.  

Shepeard v. Labette County Medical Center, No. 11-1217 (D. Kan. Mar. 30, 2012)

On March 30, 2012, the U.S. District Court for the District of Kansas dismissed a Plaintiff’s EMTALA claims for failure to state a claim upon which relief can be granted.  

On August 30, 2009, Joshua Shepeard arrived at Labette County Medical Center (LCMC) after sustaining numerous injuries in a motorcycle accident. He was subsequently transferred from LCMC to the Freeman Health Center in Joplin, Missouri, by Air Methods and died on the way. Plaintiff, the administrator of the Shepeard’s estate, claimed LCMC, the doctors, and Air Methods violated EMTALA and were liable for medical negligence.  

In its order granting Defendants’ motion to dismiss, the court highlighted that EMTALA does not apply to individual doctors or Air Methods, which was not owned or operated by a hospital. Moreover, the court reiterated that EMTALA is not a federal malpractice or negligence statute, and that the purpose of EMTALA is to ensure that each patient is accorded the same level of treatment and to prohibit dumping of unstabilized patients. See Repp v. Anadarko Municipal Hospital, 43 F. 3d 519, 522 (10th Cir. 1994). Because the Plaintiff failed to present a viable cause of action against LCMC, the court granted the motion to dismiss. The court also declined to exercise supplemental jurisdiction over the Plaintiff’s state law medical claims.  

Cox v. Cabell Huntington Hospital, No. 3:11-0843 (S.D.W.V. Mar. 2, 2012)

On March 2, 2012, the U.S. District Court for the Southern District of West Virginia found that a Plaintiff could proceed with a private action under EMTALA without receiving a screening certificate of merit beforehand as required by West Virginia state law because the state statute at issue is preempted by EMTALA. On November 6, 2009, Carl B. Cox presented to the emergency treatment facility at Cabell Huntington Hospital (CHH) with an arm fracture and severe pain. In a subsequent complaint, he brought a claim under EMTALA and alleged he was not properly screened or stabilized. CHH moved to dismiss the claim by arguing that the claim was based on negligent medical care, and as such, Plaintiff would have to comply with West Virginia’s Medical Professional Liability Act and obtain a screening certificate of merit prior to filing suit. Further, CHH contended that the state certificate of merit did not directly conflict with EMTALA and therefore the Plaintiff would have to comply with the state statute.  

The court, however, disagreed with CHH and held that the Plaintiff would be able to bring his private action under EMTALA without first meeting the West Virginia state pre-suit requirements. In its order denying the motion to dismiss, the court explained that while two sections of EMTALA do explicitly incorporate state law, neither accepts CHH’s proposed state-based condition for federal liability. First, 42 U.S.C. § 1395dd(d) (2)(A) provides that an individual harmed by an EMTALA violation may “obtain those damages available for personal injury under the law of the State in which the hospital is located, and such equitable relief as is appropriate,” but it does not incorporate any state procedural requirements for pursuing an EMTALA claim. The other section, 42 U.S.C. § 1395dd(f ), provides that “only state and local laws that directly conflict with the requirements of EMTALA are preempted.” The court highlighted that West Virginia’s law, W. Va. Code § 55-7B-6(b), contains specific waiting periods which directly conflict with EMTALA’s statute of limitations. Furthermore, other provisions of the West Virginia statute conflict with the remedial purposes of EMTALA. Therefore, because the requirements of the West Virginia state statute directly conflict with the EMTALA private right of action, the court concluded that the state statute was preempted and denied CHH’s motion to dismiss.