Opinion ID: 1713706
Heading Depth: 3
Heading Rank: 2

Heading: Implementing Regulations

Text: ¶ 26. Regulations interpreting EMTALA further support our conclusion that the proper interpretation of § 1395dd(a) requires a hospital to provide an emergency medical screening examination to an individual requesting emergency care, regardless of where he or she presents in the hospital. ¶ 27. Congress expressly charged the Department of Health and Human Services (DHHS) with enforcing EMTALA. See 42 U.S.C. § 1395dd(d). [7] DHHS promulgated regulations in 1994 that were in effect in 1999 at the time of Bridon's birth. These regulations define the phrase comes to the emergency department to mean: with respect to an individual requesting examination or treatment, that the individual is on the hospital property (property includes ambulances owned and operated by the hospital, even if the ambulance is not on hospital grounds). 42 C.F.R. § 489.24(b) (1999) (emphasis added). [8] ¶ 28. We review DHHS's construction of § 1395dd(a) in accordance with Chevron U.S.A., Inc. v. Natural Resources Defense Council, Inc., 467 U.S. 837 (1984). See St. Anthony Hosp. v. United States Dep't of Health & Human Servs., 309 F.3d 680, 691-92 (10th Cir. 2002) (applying Chevron deference to DHHS enforcement of EMTALA); Arrington v. Wong, 237 F.3d 1066, 1070-72 (9th Cir. 2001) (applying Chevron deference to DHHS interpretation of EMTALA). ¶ 29. Under Chevron, the determination of the proper deference to afford an agency interpretation is a two-step process. 467 U.S. at 842-43. First, a court must determine whether the statute is ambiguous. Id. at 842. If the statute is unambiguous and Congress has directly spoken to the precise question at issue, both the court and the agency must give effect to the clearly expressed intent of Congress. Id. at 842-43. Only if a statute is ambiguous or silent on the precise question does a court reach the second step. Id. In the second step, the inquiry shifts to whether the agency interpretation is a permissible construction of the statute. Id. at 843. ¶ 30. Courts employ one of two tests to determine whether an agency interpretation is permissible. If Congress expressly delegated rule-making authority to an agency, the agency's interpretation is permissible unless it is procedurally defective, arbitrary or capricious in substance, or manifestly contrary to the statute. United States v. Mead Corp., 533 U.S. 218, 227 (2001); see also Chevron, 467 U.S. at 843-44. Alternatively, if Congress impliedly delegated authority to an agency, the agency's interpretation is permissible unless it is unreasonable. Id. at 844; Mead Corp., 533 U.S. at 229. ¶ 31. Since Congress expressly delegated to DHHS the authority to make and publish rules concerning EMTALA, and because EMTALA provides no definition for the phrase comes to the emergency department, we must give DHHS's definition of comes to the emergency department controlling weight unless it is arbitrary or capricious. See Chevron, 467 U.S. at 844. ¶ 32. Under the arbitrary and capricious standard, the scope of review is narrow and a court is not to substitute its judgment for that of the agency. Motor Vehicle Mfrs. Ass'n of U.S., Inc. v. State Farm Mut. Auto. Ins. Co., 463 U.S. 29, 43 (1983). A regulation may be arbitrary or capricious if: [T]he agency [1] has relied on factors which Congress has not intended it to consider, [2] entirely failed to consider an important aspect of the problem, [3] offered an explanation for its decision that runs counter to the evidence before the agency, or [4] is so implausible that it could not be ascribed to a difference in view or the product of agency expertise. Id.; Prometheus Radio Project v. Fed. Communications Comm'n, 373 F.3d 372, 390 (3d Cir. 2004); Arent v. Shalala, 70 F.3d 610, 616 (D.C. Cir. 1995). However, if the agency can satisfactorily explain its regulatory decision and if there is a rational connection between the facts found and the choice made, a court should defer to the agency. See Motor Vehicle Mfrs., 463 U.S. at 43. ¶ 33. We conclude that the regulation defining comes to the emergency department is not arbitrary and capricious for several reasons. ¶ 34. First, DHHS drafted proposed regulations and solicited public comments, allowing it to take into consideration any objections from interested parties. [9] In the course of this notice-and-comment history, DHHS satisfactorily explained why it defined emergency department to be coextensive with hospital property. Two explanations stand out: (1) DHHS deemed a functional definition of emergency department necessary to impose EMTALA duties upon hospitals that may not have a formally labeled emergency department or emergency room, see 59 Fed. Reg. 32,101; [10] and (2) DHHS concluded that a narrowly drawn definition would thwart the primary objective of EMTALA: to ensure that those in need of emergency care receive it. See id. at 32,098. ¶ 35. Second, although DHHS has refined its definition of comes to the emergency department, the agency has consistently defined the phrase to include all hospital property. Compare 42 C.F.R. § 489.24(b) (1999) with 42 C.F.R. § 489.24(b) (2004). [11] DHHS's adherence to the core concept that an emergency department extends to all hospital property, despite periodic reconsideration of the definition, demonstrates a carefully considered policy choice. ¶ 36. Third, DHHS's interpretation advances the purpose of EMTALA. By broadly defining comes to the emergency department, the regulation better ensures that all individuals in need of emergency care actually receive it. See 59 Fed. Reg. 32,098 (June 22, 1994) (noting that if the screening duty imposed by § 1395dd(a) depended upon where an individual entered a hospital, such an interpretation would frustrate the objectives of the statute in many cases and lead to arbitrary results). We conclude that there is a rational connection between defining comes to the emergency department to include the entire hospital property and the primary EMTALA objective of ensuring access to emergency medical treatment. See e.g., Individual Reference Svcs. Group, Inc. v. Fed. Trade Comm'n, 145 F. Supp. 2d 6, 31 (D.D.C. 2001) (noting that the regulation at issue was not arbitrary and capricious since it was consistent with and promoted the policy of the underlying statute). ¶ 37. Finally, the DHHS regulation is not manifestly contrary to the statute. When a statute is ambiguous, an agency's interpretation cannot, by definition, be found to directly contravene it. Hagen v. LIRC, 210 Wis.2d 12, 21, 563 N.W.2d 454 (1997) (quoting Harnischfeger Corp. v. LIRC, 196 Wis. 2d 650, 662, 539 N.W.2d 98 (1995)). ¶ 38. For these reasons, we conclude that the proper interpretation of comes to the emergency department in this case imposes a duty upon a hospital to provide a medical screening examination to a newborn who (1) presents to the emergency room of the hospital or (2) is born in the birthing center of the hospital and otherwise meets the conditions set forth in 42 C.F.R. § 489.24(b) (1999).