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From Health Law Daily, April 11, 2019

Duty to provide care until stabilization may reach beyond emergency department

By Victoria Moran, J.D., M.H.A.

A Tennessee medical center must continue to defend against EMTALA claims, even though the transferred patient was treated as an inpatient for nine days.

A Tennessee federal district court considered multiple motions to dismiss concerning alleged violations of the Emergency Medical Treatment and Active Labor Act (EMTALA), 42 U.S.C. § 1395dd, and the Patient Protection and Patient Protection and Affordable Care Act (ACA) (P.L. 111-148), related to the death of a 93-year-old patient who was admitted to a Tennessee medical center for nine days and then subsequently transferred to a rehabilitation facility. The estate alleged the patient was not stabilized and safe for transfer and was denied proper medical care based on her age. The court refused to dismiss the EMTALA claim finding that the duty to stabilize an emergency medical condition may continue beyond the emergency room. However, the court was unable to consider the issue of whether the patient’s medical conditions qualified as emergency medical conditions or were new issues since this determination was outside the scope of a motion to dismiss. The ACA claim was dismissed since the estate failed to exhaust its administrative remedies (Galuten v. Williamson Medical Center, April 9, 2019, Richardson, E.).

The case was brought by the son and executor of the estate of a woman who died after being treated at Williamson Medical Center in Tennessee and then transferred to a rehabilitation facility. Specifically, the 93-year-old woman was admitted to the medical center and was diagnosed with multiple medical conditions. The estate alleged that from the time the patient arrived at the medical center she received substandard care. In addition, the patient was not stabilized before being discharged to another facility, and passed away within hours of arriving at the rehabilitation facility.

The estate alleged violations of EMTALA and the ACA by a number of parties including the medical center, the ambulance company, a physician group, and individual employees. The court considered a motion to dismiss filed by the medical center, a motion to dismiss the first amended complaint filed by a physician group and three of its employees. The estate had alleged Section 1983 claims against the physician group and its employees, but the estate conceded the claims were time-barred and the court dismissed the claims.

EMTALA. The court denied the medical center’s motion to dismiss the EMTALA claim despite two arguments by the medical center. First, the medical center argued that EMTALA does not apply because the alleged EMTALA violation did not occur in the emergency department. The patient arrived at the emergency department on June 2, 2011, and was hospitalized for nine days until the time the estate alleges EMTALA violations occurred on June 11, 2016. The court disagreed with the medical center citing the Sixth Circuit view that EMTALA requires emergency care to be provided until the emergency medical condition is stabilized. It does not matter whether the patient remains in the emergency room.

Second, the medical center argued that it did not violate EMTALA because the conditions allegedly not stabilized before the patient’s release were new conditions, not the emergency medical conditions present on admission. The court was unable to decide whether the patient had an "emergency medical condition" on June 11 because that would require evidence and expert testimony, which is improper on a motion to dismiss. Accordingly, the estate sufficiently alleged an EMTALA claim against the medical center.

ACA. The estate alleges that the medical center and individual defendants violated Section 1557 of the ACA by denying the patient proper medical care based on her age. The ACA provides that individuals cannot be denied benefits or discriminated against under any health program that is receiving federal financial assistance; there is a private right and remedy for violations of Section 1557 through the express incorporation of enforcement provisions of four civil rights statutes (Title VI, Title IX, the Age Discrimination Act (ADA), and the Rehabilitation Act). The ACA adopts the enforcement provisions of the ADA, which requires the exhaustion of administrative remedies prior to filing a civil action.

The court concluded it had no jurisdiction to hear the ACA claims since the estate did not exhaust its administrative remedies. The ACA claims were dismissed without prejudice. In a footnote, the court did note that even if it had jurisdiction, the ADA does not authorize monetary damages for a private cause of action, only injunctive relief and attorney fees.

The case is No. 3:18-cv-00519.

Attorneys: G. Franklin Lemond, Jr. (Webb, Klase & Lemond, LLC) for Alvin Galuten. Bryan Essary (Gideon, Cooper & Essary PLC) for Williamson County Hospital District d/b/a Williamson Medical Center and First Call Ambulance Service, LLC.

Companies: Williamson County Hospital District d/b/a Williamson Medical Center; First Call Ambulance Service

MainStory: TopStory IPPSNews EMTALANews QualityNews TennesseeNews

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