On April 6, 2009, the Sixth Circuit Court of Appeals issued a decision in the case of Moses v. Providence Hospital and Medical Centers in which the Court rejected one of the EMTALA regulations promulgated by CMS.

The CMS regulation, 42 C.F.R. 489.24(d)(2)(i), states: “If a hospital has screened an individual [pursuant to 42 C.F.R. 489.24(a)] 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.” In the Moses case, a patient was screened, admitted, and treated by the hospital for six days for psychiatric issues. The patient was discharged and subsequently murdered his wife. The victim’s estate alleged that the hospital violated EMTALA by discharging the patient who was not stabilized.

Among the defenses presented was that since the patient had been admitted and treated, EMTALA did not apply based on 42 C.F.R. 489.24(d)(2)(i). Courts give administrative regulations deference unless the regulation is contrary to the clear congressional intent of the related statute. This is often referred to as “Chevron deference,” named after the U.S. Supreme Court case establishing this principle.

The regulation 42 C.F.R. 489.24(d)(2)(i) was adopted by CMS to implement EMTALA. But the Sixth Circuit Court of Appeals ruled that the regulation was contrary to the EMTALA statute and did not deserve Chevron deference. The Court held:

The CMS rule appears contrary to EMTALA’s plain language, which requires a hospital to “provide . . . for such further medical examination and such treatment as may be required to stabilize the medical condition[.]” § 1395dd(b)(1)(A) (emphasis added). Although “treatment” is undefined in the statute, it is nevertheless unambiguous, because it is unreasonable to believe that “treatment as may be required to stabilize” could mean simply admitting the patient and nothing further. Moreover, the statute requires the patient to be “stabilized” upon release; “[i]f an individual at a hospital has an emergency medical condition which has not been stabilized . . . the hospital may not transfer the individual unless” the patient requests a transfer in writing or a physician or qualified medical person certifies that the risks of further treatment outweigh the benefits. § 1395dd(c)(1)(A). Therefore, a hospital may not release a patient with an emergency medical condition without first determining that the patient has actually stabilized, even if the hospital properly admitted the patient. Such a requirement would be unnecessary if a hospital only needed to admit the patient in order to satisfy EMTALA. Because the CMS rule is contrary to the plain language of the statute, this Court does not afford it Chevron deference. [Italics in original.]

The Sixth Circuit has federal jurisdiction over Ohio, Michigan, Kentucky and Tennessee, and this decision is controlling in these states. Hospitals in the Sixth Circuit should be aware of the Moses decision and the Court's rejection of 42 C.F.R. 489.24(d)(2)(i). That CMS regulation, stating that EMTALA obligations cease upon admission, should not be relied upon by hospitals in the Sixth Circuit. Rather, in the Sixth Circuit, EMTALA has now been determined to mean that a hospital may not release a patient with an emergency medical condition without first determining that the patient has actually stabilized, even if the hospital properly admitted the patient.