A federal appeals court panel ruled last week that hospitals can violate the federal patient anti-dumping law by directing an ambulance elsewhere.
The 2-1 decision by a panel from the 9th U.S. Circuit Court of Appeals in San Francisco could prove controversial. Reversing a lower-court decision, the panel ruled that emergency-room physician Norbert Wong of 451-bed Queen's Medical Center in Honolulu should not have directed an ambulance driver already bound for Queen's to 256-bed Tripler Army Medical Center, a longer distance away.
The incident happened in May 1996. The patient had suffered a heart attack on his way to work. A co-worker called an ambulance, which arrived at the scene within a half-hour and left 25 minutes later bound for Queen's. The court ruled that Wong and Queen's violated the 1986 Emergency Medical Treatment and Active Labor Act (EMTALA) by directing the patient to Tripler. The patient's condition deteriorated, and he died less than an hour after arriving at Tripler.
"The hospital may not deny the individual access unless it is in diversionary status," the majority wrote, and even in that situation the hospital must show that it lacks the staff or facilities to treat a patient.
Queen's lawyer William Hunt said the hospital was disappointed by the decision. He said the hospital hasn't decided whether to appeal.
Lowell Brown, a healthcare lawyer with the Los Angeles office of Foley & Lardner, who specializes in EMTALA cases, said the Queen's case could have far-reaching effects.
"Until now it's been quite clear that a hospital was only responsible to abide by EMTALA with respect to patients who showed up on hospital property," Brown said. "We're going to need more guidance on what diversionary status means. I'm curious to see how HCFA and the HHS inspector general respond to this. They have to live in the real world."