Opinion ID: 199006
Heading Depth: 2
Heading Rank: 2

Heading: Stabilization Claim

Text: 37 In addition to their claim for failure to screen Mr. Reynolds appropriately for DVT, appellants argue that a genuine dispute of material fact exists as to whether MaineGeneral stabilized Mr. Reynolds for DVT before releasing him. Appellants argue extensively about the nature of the stabilization requirements under EMTALA in support of their contention that Mr. Reynolds was not stabilized before release. A critical flaw in this claim of appellants under § 1395dd(b)(1), however, is that appellants have failed to demonstrate that Mr. Reynolds had an emergency medical condition at the time of his discharge from MaineGeneral. 38 As a corollary to the right to be appropriately screened, EMTALA guarantees patients the right, if an emergency medical condition is determined to exist, to have that condition stabilized before discharge or transfer to another hospital. The statute provides, in pertinent part: 39 If any individual . . . comes to a hospital and the hospital determines that the individual has an emergency medical condition, the hospital must provide either - 40 (A) within the staff and facilities available at the hospital, for such further medical examination and such treatment as may be required to stabilize the medical condition, or (B) for transfer of the individual to another medical facility in accordance with subsection (c). 41 42 U.S.C. § 1395dd(b)(1) (emphasis added). This court need not reach any questions about the nature of stabilization if we determine that the predicates to stabilization have not been satisfied. Appellants proffered expert testimony that it was likely that the clot that later became the pulmonary embolism that caused Mr. Reynolds' death formed before Mr. Reynolds was discharged from MaineGeneral. Appellants' expert further testified that a 17 to 30% likelihood existed that Mr. Reynolds had formed blood clots at the time of his discharge. Appellants' expert also proffered testimony that some research indicates a 2% mortality rate in cases of untreated DVT. Evidence of one expert that it is more likely than not in his opinion that the blood clot that eventually caused Mr. Reynolds' death had formed by the time of his discharge, combined with the evidence that 2% of untreated DVT cases result in death, is not sufficient to support a determination that Mr. Reynolds had an emergency medical condition at the time of his discharge. To invoke subsection (b), appellants must proffer more than evidence of a possibility of the existence of a blood clot at the time of Mr. Reynolds' discharge. They must proffer evidence sufficient to support a finding, reasoned from evidence, that an emergency medical condition, within the meaning of the statute, was already in existence at the time of Mr. Reynolds' discharge. Appellants have not proffered evidence sufficient to support a finding that Mr. Reynolds had an emergency medical condition at that time, and for this reason have failed to satisfy a necessary predicate to the duty to stabilize. 42 Furthermore, as noted by Magistrate Judge Beaulieu, appellants' case is centered on the asserted fact that MaineGeneral did not take steps to determine whether Mr. Reynolds was at risk of developing DVT. It is doubtful that the text of the statute would support liability under the stabilization provision for a patient who had DVT, absent evidence sufficient to support a finding that the hospital knew of his DVT. See Marshall v. East Carroll Parish Hosp. Serv. Dist., 134 F.3d 319, 325 (5th Cir. 1998); Summers, supra, 91 F.3d at 1140 (no duty to stabilize unless hospital has actual knowledge of the individual's unstabilized emergency medical condition); Vickers v. Nash Gen. Hosp., Inc., 78 F.3d 139, 145 (4th Cir. 1996) (The Act does not hold hospitals accountable for failing to stabilize conditions of which they are not aware, or even conditions of which they should have been aware.). It appears quite likely that one important respect in which EMTALA's requirements are narrower than those imposed by state law concerns prophylactic care. Subsection (b) requires stabilization of only those conditions that a participating hospital has determined to be emergencies. It may be that in exceptional circumstances of proof of an existing emergency need for immediate stabilization, a hospital would have a duty of stabilization under EMTALA. We need not and do not reach that issue, however, since it is not presented by the record before us in this case.