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From Health Law Daily, October 2, 2015

Hospital discharges stroke patient as intoxicated, case proceeds over potential EMTALA violations

By Kayla R. Bryant, J.D.

A claim filed by an estate administrator alleging that Stamford Hospital’s (Stamford) emergency department failed to appropriately treat and stabilize a patient survived a motion to dismiss. The U.S. District Court for the District of Connecticut found that the complaint stated claims under the Emergency Medical Treatment and Active Labor Act (EMTALA) (42 U.S.C. §1395dd) for failure to screen and failure to stabilize. The patient ultimately died of a stroke after the emergency department physicians surmised that she was inebriated and chose not to do other testing (Grenier v. The Stamford Hospital, September 29, 2015, Bryant, V.).

Background. The patient arrived at Stamford on July 7, 2012 and was admitted at 1:30 a.m.. She was evaluated and, according to the hospital, appeared to be “heavily intoxicated,” and in “no acute distress and arousable to touch and name.” The patient had a history of intoxication and had been seen at the hospital in the past in the same physical condition. The hospital did not perform any internal examination initially, but monitored the patient and eventually tested her glucose level. By 7:00 a.m., the hospital noted that the patient had sobered and both walked and moved her limbs normally. She was discharged soon after without a blood alcohol test.

She was readmitted at 7:43 a.m. and the hospital staff observed that she was stumbling and unsteady. They conducted several lab tests, including a blood alcohol test, which revealed that her blood alcohol level was elevated. Her condition appeared to worsen over the rest of the day, but no tests were conducted until 4:30 a.m. on July 8. Lab tests and a CT scan revealed that she was suffering from a stroke. The patient died July 11, 2012.

Screening. EMTALA was enacted to prevent hospitals from refusing treatment to patients based on inability to pay or transferring them before they are stabilized. Hospital emergency rooms are required to (1) perform an appropriate medical screening and (2) stabilize the patient. To satisfy the screening obligation, a hospital must provide an appropriate examination to determine if an emergency medical condition exists. Courts have generally interpreted this requirement to mean that a hospital must perform a screening consistent with its own policies.

Stamford argued that the complaint did not allege “disparate treatment,” but the court found that the complaint stated a failure to screen claim in several ways. The hospital’s failure to perform an initial examination upon admission, the patient’s discharge without any blood work or physical examination, and the hospital’s failure to do more than test the patient’s blood alcohol for nearly 24 hours after readmission would all support a failure to screen claim. The complaint alleged that the hospital’s treatment of this patient deviated from the type of examination typically performed on patients with similar symptoms and history.

Stabilization. The complaint also alleged that the hospital failed to fulfill its second EMTALA duty to stabilize a patient prior to discharge or transfer. The duty to stabilize is defined as the provision of such medical treatment necessary to reasonably assure that the condition will not materially deteriorate during the transfer from the facility. The hospital must have actual knowledge of the emergency condition.

The court found that the allegations in the complaint sufficiently pleaded that this patient suffered from an emergency condition by showing that the patient’s condition changed considerably during the short passage of time between discharge and readmission. This change implies that the patient was discharged before she was stabilized. The motion to dismiss was denied and the case was allowed to proceed to discovery.

The case is Civil Action No. 3:14-cv-0970 (VLB).

Attorneys: Harold R. Burke (Law Offices of Harold R. Burke) for Marc J. Grenier. Eric J. Stockman (Neubert, Pepe & Monteith) for Stamford Hospital and Stamford Health Systems, Inc. Frederick Joseph Trotta (Halloran & Sage LLP) for Emergency Medicine Physicians of Fairfield County LLC.

Companies: Stamford Hospital; Stamford Health Systems, Inc.; Emergency Medicine Physicians of Fairfield County LLC

MainStory: TopStory IPPSNews EMTALANews ConnecticutNews

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