Medical Malpractice Newsroom

Emergency Medical Condition Exists The Participating Hospital Must Render The Services That Are Necessary To Stabilize The Patient's

Congress enacted EMTALA in response to "the increasing number of reports that hospital emergency rooms are refusing to accept or treat patients with emergency conditions if the patient does not have medical insurance." Correa v. Hosp. San Francisco, 69 F.3d 1184, 1189 (1st Cir. 1995) (internal quotation marks omitted). EMTALA imposes two primary requirements on participating hospitals: 

EMTALA defines a participating hospital as a "hospital that has entered into a provider agreement under section 1395cc of this title." 42 U.S.C. § 1395dd(e)(2). Neither side disputes that Auxilio Mutuo is a participating hospital.

First, it requires that a participating hospital afford an appropriate medical screening to all persons who come to its emergency room seeking medical assistance.  See 42 U.S.C. § 1395dd(a). Second, it requires that, if an emergency medical condition exists, the participating hospital must render the services that are necessary to stabilize the patient's condition, see id. § 1395dd(b)(1)(A) 

Id. at 1190. As an enforcement mechanism for these requirements, EMTALA creates a private right of action for violations. See 42 U.S.C. §§ 1395dd(d)(1), (2).

B.  EMTALA screening claim

Although EMTALA does not define an "appropriate medical screening examination," our circuit law does:

A hospital fulfills its statutory duty to screen patients in its emergency room if it provides for a screening examination reasonably calculated to identify critical medical conditions that may be afflicting symptomatic patients and provides that level of screening uniformly to all those who present substantially similar complaints.  

Correa, 69 F.3d at 1192. "The essence of this requirement is that there be some screening procedure, and that it be administered even-handedly." Id. When a hospital prescribes internal procedures for a screening examination, those internal procedures "set the parameters for an appropriate screening." Id. 

This is the view of other circuits as well. See, e.g.,Summers v. Baptist Med. Ctr. Arkadelphia, 91 F.3d 1132, 1138 (8thCir. 1996) ("It is up to the hospital itself to determine what itsscreening procedures will be. Having done so, it must apply themalike to all patients."); Baber v. Hosp. Corp. of Am., 977 F.2d872, 878 & 879 n.7 (4th Cir. 1992) ("EMTALA only requires hospitalsto apply their standard screening procedure for identification ofan emergency medical condition uniformly to all patients.")
Close A hospital thus must adhere to its own procedures in administering the screening examination.

The plaintiffs do not dispute that Cruz received a screening examination, nor do they contend that Auxilio Mutuo's screening protocol was per se inappropriate. Rather, they argue that the hospital failed to follow its own protocol when it placed Cruz in Category IV despite his complaint of chest pains that should have placed him in Category II (acute chest pain with stable vital signs), and that this departure from hospital protocol violated EMTALA's appropriate screening requirement. 
Plaintiffs contend that Cruz should have been placed ineither Category I or II, emphasizing that both categories includeacute chest pain. Category I, however, applies specifically toacute chest pain with unstable vital signs. The triage officerdetermined that Cruz's vital signs were stable, and Cruz does notdispute that determination. Therefore, he did not meet therequirements for Category I.

Close In short, they challenge the district court's conclusion that they "have no claim under EMTALA" because "Cruz was screened and evaluated according to Auxilio Mutuo protocol." There is more to this challenge than may initially meet the eye.

In its brief, Auxilio Mutuo devotes a great deal of attention to the aspects of its triage protocol that were followed in this case. It points out that Cruz was examined and placed in a triage category upon his appearance in the emergency room, and that he was subsequently evaluated by the emergency room physician. Auxilio Mutuo asserts that Cruz's screening therefore did not deviate from the standard hospital protocol and that, at bottom, the plaintiffs' claim is really one of medical malpractice rather than of an EMTALA violation. See id. at 1192-93 ("EMTALA does not create a cause of action for medical malpractice. Therefore, a refusal to follow regular screening procedures in a particular instance contravenes the statute, but faulty screening, in a particular case, as opposed to disparate screening or refusing to screen at all, does not contravene the statute." (internal citations omitted)).

Auxilio Mutuo's reasoning overlooks one key factor namely, our inference, for purposes of summary judgment, that emergency room doctors were aware that Cruz was suffering from chest pain. Under Auxilio Mutuo's written triage policy, a patient with stable vital signs who complains of chest pain must be assigned to triage Category II. Indeed, the hospital conceded in its motion for summary judgment that, under its own standards, "[i]f the patient [had] referred a complaint of chest pains, he would have been placed in Category I or II with an emergency condition." Cruz's placement in Category IV despite a complaint of chest pains thus marked a departure from the hospital's standards, which "set the parameters for an appropriate screening." Id. at 1193; see also id. ("under EMTALA § 1395dd(a), the same screening examination must be made available to all similarly situated patients"). Accordingly, Auxilio Mutuo is not entitled to summary judgment on the plaintiffs' claim that Cruz was denied an appropriate screening in violation of EMTALA.