A decision rendered on Sept. 10, 2012, by a federal district court in Texas, reminds hospitals to be extra vigilant in documenting the appropriateness of admitting as inpatients those patients who present in the emergency department and the appropriateness of ultimate discharge following inpatient admission.

In its memorandum opinion and order, the Court held, as a matter of law, the federal Emergency Medical Treatment and Active Labor Act (EMTALA) may continue to apply under circumstances in which a patient is seen in an emergency room (ER) and then admitted to the hospital as an inpatient. As such, the Court denied the defendant hospital?s motion to dismiss the plaintiff?s EMTALA claim based on the key fact that the patient had been admitted as an inpatient to the hospital. This holding deviates, however, from federal guidance on the applicability of EMTALA to inpatients. Specifically, as recently as Feb. 2, 2012, the Centers for Medicare and Medicaid Services (CMS) reaffirmed, in a proposed rule, that a hospital?s obligation under EMTALA ends either when the individual is stabilized or when the hospital admits the patient in good faith as an inpatient in order to continue providing stabilizing treatment.[1] CMS originally finalized this rule in September 2003 and previously affirmed it in August 2008.

In the Texas case, the plaintiff, an uninsured patient, presented to the defendant hospital?s ER and was found to be suffering from bilateral pneumonia, adult respiratory distress syndrome and significant lung damage. The hospital admitted the plaintiff into its facility as an inpatient, and he stayed until he was discharged home nearly a month later. The plaintiff alleges that while his condition was still unstable, various doctors and nurses at the defendant hospital attempted to transfer him out of the hospital on 18 separate occasions because he was uninsured. On one specific occasion, the plaintiff went into cardiac arrest at or near the time he was placed in an ambulance for transfer. After being resuscitated, he returned to the defendant hospital?s intensive care unit and was placed on a ventilator. The plaintiff alleges that he was later discharged home improperly because his condition was still unstable.

The hospital moved to dismiss the EMTALA claim on grounds that the plaintiff was admitted to the hospital in good faith as a bona fide inpatient. After recognizing that there is a split among circuits as to whether EMTALA applies to inpatients, the Court denied the hospital's motion to dismiss. In its opinion, the Court held that the statute's application "does not turn on the administrative statusof the patient but on his or her medical status."[2] The Court stated that an EMTALA claim cannot be barred "simply because a patient has been admitted to a hospital as a bona fide inpatient." Because the Court found that, at this stage of the case, the plaintiff pleaded sufficient facts to state a plausible claim that his condition was never stabilized, it must be left to the trier of fact to determine whether the defendant hospital's actions constitute a violation of EMTALA.

This recent decision serves as a reminder that the application (or nonapplication, as the case may be) of EMTALA to inpatients is not well settled. Therefore, hospitals should be especially careful to document their actions any time a patient presents to the facility through the ER.