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From Health Law Daily, November 29, 2017

Crash victim’s stabilization claim under EMTALA survives summary judgment

By Leah S. Poniatowski, J.D.

An individual critically injured in a rollover automobile accident failed to state a claim under the "failure to screen" prong of the federal Emergency Medical Treatment and Active Labor Act (EMTALA) (42 U.S.C. § 1395dd) in light of evidence proffered by the treating hospital, but his "failure to stabilize" claim was plausible in light of the facts in the record, the federal district court in Maryland ruled, granting the hospital’s motion in part and denying in part without prejudice (Williams v. Dimensions Health Corp., Inc., November 27, 2017, Grimm, P.).

Background. An emergency medical services team brought the crash victim to Prince George’s County Hospital Center t/a Dimensions Health Corporation, Inc. (the hospital) on "Bravo" status—the second highest level of trauma. He had lost an extensive amount of blood, his limbs were mangled, he had no pulse, he had open fractures, and severe pain. Four minutes after arriving at the hospital, he was screened and evaluated by a physician assistant who upgraded his status to "Alpha." The on-call trauma surgeon arrived 20 minutes later and concurred with the physician assistant’s assessment of the individual, noting that there was the possible need for amputation and that the individual could "succumb" on account of his injuries.

Although the individual was to have gone immediately to the operating room for treatment, the surgical specialists did not show up to the emergency room and were "extremely tardy" to the operating room. The individual was admitted to the intensive care unit and underwent surgery several hours after arriving at the hospital. At the time of the surgery, his lower extremities had been deprived of oxygen to the degree that they became "ischemic, gangrenous, and ultimately necrotic," and another procedure was performed on the belief that compartment syndrome developed as a result of the "duration of time since the injury." The individual was transferred to another facility 11 days later. Although the record indicated his legs had been amputated, it was unclear where the amputation was performed.

EMTALA claim. The individual filed the present lawsuit against the hospital under EMTALA, and the hospital moved to dismiss the claim. The court explained that EMTALA was enacted in order to protect patients from not being treated at emergency rooms for non-medical reasons, i.e., for inability to pay, and prohibited hospitals from failing to screen patients and provide with basic emergency treatment, or from failing to stabilize the patient before transferring to another hospital. It has been held repeatedly by the Fourth Circuit and the federal district court that EMTALA is not a federal malpractice statute.

Failure to screen. Under EMTALA, hospitals with emergency departments "must provide for an appropriate medical screening examination within the capability of the hospital’s emergency department … to determine whether or not an emergency medical condition . . . exists." Case law has clarified that an "appropriate medical screening examination" is one that identifies the acute/severe symptoms and alerts a physician to the need for immediate medical attention in order to prevent serious bodily injury. The record in the present case showed that the individual was screened by a physician assistant (a "physician extender") within a few minutes of arriving at the hospital and had his status elevated; additionally, the surgeon arrived within the hospital’s (and state’s) required 30 minutes. The hospital complied with its procedures pursuant to EMTALA and, thus, the individual’s failure to screen claim was unsupported by the facts in the record.

Failure to stabilize. Under EMTALA and case law interpreting the act, hospitals must stabilize a patient with an emergency medical condition after determining such a condition exists before admitting the patient or transferring the patient, and stabilization depends on the diagnosis of the condition—not on the correctness of the diagnosis. According to EMTALA, "stabilize" means "to provide such medical treatment of the condition as may be necessary to assure, within reasonable medical probability, that no material deterioration of the condition is likely to result from or occur during the transfer of the individual from a facility." Pursuant to Fourth Circuit precedent, this statute applies even when a patient is not transferred. In the case at bar, the individual had received treatment in the first half-hour of arriving at the emergency room—intubation, blood transfusions, diagnostic peritoneal aspiration, mini-laparotomy, diagnostic lab work—and received continued resuscitation of blood and blood products while waiting for the vascular surgery team.

However, the record also showed that he continued to bleed from his injuries for over 11 hours after arriving at the ER and, ultimately, his legs had to be amputated. In light of the plausibility that the individual’s condition materially deteriorated in the time before the hospital admitted him, he has a valid claim under EMTALA. There was not enough information in the record to determine if the hospital "stabilized" the individual as required by the act and, thus, the hospital’s motion on the issue of failure to stabilize was dismissed without prejudice.

The case is No. 8:16-cv-04123-PWG.

Attorneys: J. Wyndal Gordon (The Law Office of J. Wyndal Gordon, P.A.) for Terence Williams. Gina Marie Smith (Meyers, Rodbell & Rosenbaum, PA) for Dimensions Health Corp. t/a Prince George's Hospital Center.

Companies: Dimensions Health Corp. t/a Prince George's Hospital Center

MainStory: TopStory CaseDecisions EMTALANews QualityNews SafetyNews MarylandNews

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