Summary Judgment on EMTALA Claim

HALE v. N.E. VERMONT REGIONAL HOSPITAL, INC. (D. V.T. September 30, 2011)

The Emergency Medical Treatment and Active Labor Act (EMTALA), also known as the “anti-dumping” statute, is the federal law which requires all Medicare-provider hospitals to provide medical screening and stabilization to any patient entering its emergency room, regardless of the patient’s ability to pay. The purpose of the statute was to prevent hospitals from turning away indigent patients in need of emergency treatment. The medical screening aspect of the statute is the element which requires hospitals to determine whether the patient is in need of emergency treatment to stabilize their condition, and the stabilization element of statute requires the hospital to take steps to treat emergency medical conditions, at least to the point of stabilizing the patient. Although this statute was not intended to replace or supplement individual states’ medical malpractice laws, many medical malpractice plaintiff’s attorneys allege violations of EMTALA along with medical malpractice claims.

In this case, the federal District Court in Vermont addressed the defendant hospital’s motion for summary judgment on negligence and EMTALA claims against it. The plaintiff had presented to the hospital emergency room complaining of neck pain radiating into her temples and back. Torticollis (muscle spasms resulting in stiff neck) was diagnosed. She was discharged with a prescription for a muscle relaxant and instructions to return to the emergency room if she did not improve. Three days later the plaintiff returned with a worse headache and continued neck and upper back pain. The emergency room physician ordered a lumbar puncture and a CT scan which resulted in a diagnosis of brain aneurysm. During surgery to treat the aneurysm it ruptured and the plaintiff was left with severe neurologic deficits. The court granted summary judgment on the EMTALA “stabilization claim” but denied summary judgment on the EMTALA “screening claim”.

Impact: The interesting aspect of the case is that the stabilization claim was dismissed because, at the first emergency room visit, it was determined that torticollis is not an emergency medical condition within the meaning of the statute (e.g., a condition placing the patient’s health in serious jeopardy). As such, the plaintiff failed to meet the predicate element of an EMTALA stabilization claim that an emergency medical condition was not stabilized by the hospital. Curiously, however, the diagnosis of torticollis was clearly an error and, in fact, the court did not account for this misdiagnosis while granting summary judgment on the stabilization claim. The screening claim, however, resulted in denial of summary judgment. The court noted that the plaintiff had come to the same emergency room on two prior occasions, two and three years earlier, with complaints of headache, back and neck pain. On each occasion a lumbar puncture was performed as part of the medical workup in the emergency room. Since no workup was performed during the emergency room visit at which torticollis was diagnosed, and because the hospital did not put in evidence of its lumbar puncture policy, the court found that a question of fact existed as to whether the hospital discharged its EMTALA obligation to perform appropriate screening. On this basis alone summary judgment was denied on the EMTALA screening claim. In sum, the misdiagnosed condition was sufficient to grant summary judgment on the stabilization claim, since that condition (even as misdiagnosed) was not an emergency medical condition, but the misdiagnosis was indirectly accounted for in that a proper screening was not done, which may have revealed the misdiagnosis.