A federal appeals court may have muddied the general understanding of hospital liability under the Emergency Medical Treatment and Active Labor Act last week, reinstating a lawsuit against a Detroit-area hospital that discharged Christopher Howard 10 days before he murdered his wife with an ax.
Appeals court ruling expands EMTALA concerns
The opinion, delivered April 6 in the 6th U.S. Circuit Court of Appeals, Cincinnati, concludes that any person harmed by an EMTALA violationnot just the patienthas a right to sue the hospital (in this case the victims family) and that a hospital hasnt satisfied its obligations under the law when a patient is admitted, contrary to what the CMS said in a 2003 rule.
Both notions are unsettling, said Alan Steinberg, a partner in the health law firm Horty, Springer & Mattern who specializes in EMTALA issues. The whole purpose of EMTALA was to protect people who werent receiving screenings and care in an emergency room and then a hospital, Steinberg said. It just makes sense those are the people who would have standing to sue.
Marie Moses Irons, Howards wife, brought him to the emergency room of Providence Hospital and Medical Center, Southfield, Mich., on Dec. 13, 2002, because he suffered from severe headaches, vomiting, slurred speech and hallucinations, and because he was exhibiting threatening behavior, according to the facts recounted in the opinion. ER physicians decided to admit him.
During Howards six days as an inpatient at Providence, Howards wife told a neurologist who screened him that hed tried to board a plane with a hunting knife and said that hed bought caskets. A psychiatrist recommended that he be transferred to the hospitals psychiatric unit, but he was discharged instead. An internist wrote in Howards record, His affect is brighter. No physical symptoms now, also noting that his wife fears him.
Providence parent St. John Health System, a division of Ascension Health, declined to comment. U.S. District Court Judge Anna Diggs Taylor granted summary judgment to the hospital in 2007, explaining from the bench that the hospital admitted Howard and did not turn him away.
A CMS rule in 2003 said just that: If a hospital admits someone in good faith in order to stabilize the emergency medical condition, the hospital has satisfied its special responsibilities under EMTALA. In the preamble to the rule published in the Federal Register, the CMS noted that federal courts ruled that way in several cases and that a hospital faces liability for negligent inpatient treatment through malpractice lawsuits, as well as consequences for failing to satisfy the Medicare conditions of participation.
Steinberg said that the rule brought needed clarity. We all went, Thank goodness, we now finally have a position CMS is taking, and we know what EMTALA means for inpatients. Judge Eric Clay of the appeals court, however, wrote that the CMS rule is contrary to EMTALAs plain language.
The hospital also argued that Congress never intended EMTALA to give anyone other than the patient an avenue to sue. Clay responds that the text of the statute says any individual who suffers personal harm as a direct result of an EMTALA violation can sue the hospital, regardless of whether thats what Congress intended.
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