Hospitals could face greater legal liability in the wake of a U.S. Supreme Court ruling last week that makes it easier for "dumped" patients to sue them for damages.
In a unanimous decision last week, the nation's highest court sided with Wanda Johnson, a Kentucky woman who claimed that University of Louisville (Ky.) Hospital violated federal law when it transferred her to an Indiana nursing home.
Johnson's guardian, Jane Roberts, sued the hospital in 1993, alleging that Johnson was dumped because she could not pay her ballooning hospital bill.
The 1986 Emergency Medical Treatment and Active Labor Act (EMTALA) prohibits patient dumping, or denying basic medical screenings to emergency patients because they are unable to pay. The law also prohibits transferring medically unstable patients for economic reasons.
The high court's pithy, four-page ruling reversed opinions by federal and appellate courts, which had required Johnson to prove that the hospital acted with an "improper motive" in order to make a valid claim against the facility.
"The provision at issue in this case contains no requirement of appropriateness," the nine justices said in an unsigned opinion.
Attorneys for the 269-bed hospital declined to comment on the decision, because the case is being sent back to U.S. District Court in Louisville for further action.
When the case reached the Supreme Court, hospital attorneys conceded that the law did not specifically require Roberts to meet that burden of proof. Instead, they argued that Roberts had no case, because Johnson did not have an emergency condition when she was transferred (Dec. 7, 1998, p. 8).
Joseph Mattingly, a Lebanon, Ky. attorney representing Johnson and Roberts, said he expects a trial to take place, but he did not rule out the possibility of a settlement with the hospital.
"We feel strongly that we can win on the merits of this case," Mattingly said. "This ruling makes it a better and easier case to try."
While the justices struck down the improper motive standard, their opinion included no guidance on what the standards could be.
The improper motive standard was established in a separate case and adopted by the 6th U.S. Circuit Court of Appeals in the Johnson case.
"That issue is still going to be batted around out there in the district courts," Mattingly said. "This decision doesn't throw improper motive out the window and make it irrelevant. What it means is that the bar raised by the 6th Circuit was way too high, that it was not what Congress intended. But it will continue to be an issue."
Hospitals shouldn't worry too much, said Richard Wade, senior vice president for communications at the American Hospital Association, which filed a friend-of-the-court brief in support of the hospital.
"This is the best decision we could have hoped for," Wade said. "We didn't believe that improper motive was the most important issue in this case. We're a long way from a definitive ruling on most of these EMTALA issues."