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This Case Tests The Scope Of Hospital Liability Under The Emergency Medical Treatment And Active Labor Act

This case tests the scope of hospital liability under the Emergency Medical Treatment and Active Labor Act (EMTALA), 42 U.S.C. § 1395dd. EMTALA requires a hospital to even-handedly administer an appropriate screening procedure to all emergency room patients and, if it determines that an emergency medical condition exists, to stabilize the patient's condition before discharge or transfer to another hospital. See id. Asserting that Hospital Español Auxilio Mutuo de Puerto Rico (Auxilio Mutuo) did not comply with its own protocol in screening Edgardo Cruz-Queipo (Cruz) and that it failed to stabilize him prior to discharge, the plaintiffs appeal a grant of summary judgment against them. For the reasons set forth below, we vacate the district court's grant of summary judgment on both the screening and stabilization claims and remand for further proceedings.

In reviewing a grant of summary judgment, we view the record in the light most favorable to the nonmovant. See Del Carmen Guadalupe v. Negron Agosto, 299 F.3d 15, 17 (1st Cir. 2002). Accordingly, we draw the following facts from the summary judgment record, "indulging all reasonable inferences in [the plaintiffs'] favor." Griggs-Ryan v. Smith, 904 F.2d 112, 115 (1st Cir. 1990).

At approximately 4 p.m. on August 31, 2001, Cruz visited the Auxilio Mutuo emergency room complaining of pain in his chest, arm, and wrist. Pursuant to Auxilio Mutuo's written policy, emergency room patients receive a screening examination upon arrival to determine the severity of their conditions and are then classified in one of four categories. Category I encompasses the most serious conditions, including acute chest pain with unstable vital signs, and Categories II, III, and IV encompass progressively less serious conditions. Triage officer Dr. Miguel Rodríguez performed an initial screening evaluation of Cruz pursuant to Auxilio Mutuo's policy. After checking Cruz's vital signs and noting that Cruz complained of pain in his left arm and warmth in his wrist, Dr. Rodríguez placed Cruz in Category IV, which includes back and muscle pain. Notes from the screening examination do not indicate that Cruz complained of chest pain. For purposes of summary judgment, however, we must credit Cruz's assertion that he did, in fact, report such pain, and, drawing all reasonable inferences in Cruz's favor, we must assume that the emergency room doctors were aware of the chest pain.
A second physician, Dr. James Davison, performed a more thorough examination of Cruz at approximately 5:30 p.m. Like Dr. Rodríguez, Dr. Davison did not document a complaint of chest pain. Finding that Cruz suffered from shoulder pain, however, Dr. Davison ordered an electrocardiogram (EKG) and a cervical spinal x-ray. He interpreted the results of both tests as negative. Based on his examination and the test results, Dr. Davison diagnosed Cruz with thoracic outlet syndrome, a non-emergency disorder that involves the compression of blood vessels and nerves in the shoulder region. See National Institute of Neurological Disorders and Stroke, Thoracic Outlet Syndrome Information Page, at http://www.ninds.nih.gov/disorders/thoracic/thoracic.htm (last visited July 20, 2005). Dr. Davison prescribed Celebrex (an anti-inflammatory) and Clonazepan (an anti-convulsant) and discharged Cruz, encouraging him to follow up with a specialist.

The following day (September 1, 2001), Cruz returned to the Auxilio Mutuo emergency room with severe chest pain radiating to his left arm and jaw. Doctors determined that Cruz had suffered an acute myocardial infarction (heart attack). He was admitted to the coronary care unit, where he remained for approximately one week before being transferred to another hospital where he underwent sextuple bypass surgery. As a result of the infarction, Cruz suffered permanent damage to his heart, including scarring and decreased cardiac performance.

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