Opinion ID: 701833
Heading Depth: 2
Heading Rank: 2

Heading: Violation of the EMTALA

Text: 31 Eberhardt claims that the hospital's failure to place a 72-hour protective hold on his son violated the EMTALA because the hospital should have known that his son was suicidal. The district court concluded that triable issues of fact remain as to whether the hospital properly evaluated or stabilized the decedent, but that the hospital was still entitled to summary judgment because any alleged violation of the EMTALA was not the legal cause of nor a substantial factor in bringing about the decedent's death. District Court's Order at 4-6. 32 We conclude that the district court did not need to reach the causation issue because Eberhardt failed to proffer any evidence to show that the hospital violated the requirements of the EMTALA. 33 42 U.S.C. Sec. 1395dd(a) requires a hospital emergency department to provide for an appropriate medical screening examination to determine whether an emergency medical condition exists. Eberhardt argues that the hospital did not provide his son with an appropriate medical screening examination because it failed to detect his suicidal tendency. We disagree. 34 The text of Sec. 1395dd(a) does not define the term appropriate medical screening examination, other than to state that its purpose is to identify an emergency medical condition. 42 U.S.C. Sec. 1395dd(e)(1)(A) defines an emergency medical condition as: 35 a medical condition manifesting itself by acute symptoms of sufficient severity (including severe pain) such that the absence of immediate medical attention could reasonably be expected to result in--(i) placing the health of the individual ... in serious jeopardy; (ii) serious impairment to bodily functions; or (iii) serious dysfunction of any bodily organ or part. 36 (Emphasis added.) 37 Thus, the plain language of the EMTALA informs us that a medical screening examination is appropriate if it is designed to identify acute and severe symptoms that alert the physician of the need for immediate medical attention to prevent serious bodily injury. The EMTALA does not require physicians to detect medical conditions that are not manifested by acute and severe symptoms, nor those that do not require immediate medical attention to prevent serious bodily injury. 38 Eberhardt has failed to proffer sufficient evidence to show that his son's suicidal tendency was manifested by acute or severe symptoms, or that the condition required immediate medical attention. The decedent's acute symptoms were that of a drug overdose, which Dr. Orosz diagnosed through a physical examination and then stabilized with an additional dosage of Narcan. 39 In hindsight, the decedent's medical record, which indicated that he had a history of psych, and the decedent's anger at Dr. Orosz for having treated him may have suggested a self-destructive disposition. But the decedent erased any misgivings Dr. Orosz could have had by signing the Patient Instruction Sheet, in which he agreed to seek follow-up care at a methadone treatment center. Moreover, the decedent's fatal encounter with the police officers did not occur until 30 hours after the hospital discharged him, suggesting that the decedent's alleged suicidal condition arose well after he had been discharged, and thus, that he did not require immediate treatment for the condition while he was at the hospital. 40 The hospital's failure to detect the decedent's alleged suicidal tendency may be actionable under state medical malpractice law, but not under the EMTALA. The statutory language of the EMTALA clearly declines to impose on hospitals a national standard of care in screening patients. The applicable provisions only require that the screening be within the capability of the hospital's emergency department, including routinely available ancillary services. 42 U.S.C. Sec. 1395dd(a). As 42 U.S.C. Sec. 1395dd(f) makes clear, the EMTALA does not preempt any State or local law requirement, except to the extent that the requirement directly conflicts with the requirements of the EMTALA. 41 Consistent with the statutory language, the legislative history shows that Congress enacted the EMTALA not to improve the overall standard of medical care, but to ensure that hospitals do not refuse essential emergency care because of a patient's inability to pay. See H.R.Rep. No. 241, 99th Cong., 1st Sess. (1986), reprinted in 1986 U.S.C.C.A.N. 726-27. 42 Other circuits that have assessed the appropriateness of a screening examination have all held that the test is whether the challenged procedure was identical to that provided similarly situated patients, as opposed to whether the procedure was adequate as judged by the medical profession. See Cleland v. Bronson Health Care Group, Inc., 917 F.2d 266, 272 (6th Cir.1990) (EMTALA precludes resort to a malpractice or other objective standard of care as to the meaning of the term appropriate); Gatewood, 933 F.2d at 1041 (same); Baber, 977 F.2d at 879-80 (same). 43 Of course, Congress's refusal to impose a national standard of care does not mean that a hospital can discharge its duty under the EMTALA by not providing any screening, or by providing screening at such a minimal level that it properly cannot be said that the screening is appropriate. See Baber, 977 F.2d at 879 n. 7 (contemplating that a hospital's standard may be so low that it amount[s] to no 'appropriate medical screening' ). The touchstone is whether, as Sec. 1395dd(a) dictates, the procedure is designed to identify an emergency medical condition, that is manifested by acute and severe symptoms. 44 Eberhardt does not allege, nor is there any evidence to show that the screening provided to his son was not comparable to that provided to other patients who manifested similar symptoms, or that his son's alleged suicidal condition was manifested by acute or severe symptoms that the hospital ignored. Accordingly, we hold that the hospital did not fail to provide the decedent an appropriate medical screening examination. 45 Eberhardt also contends that the hospital violated the EMTALA by failing to stabilize his son's alleged suicidal tendency. 42 U.S.C. Sec. 1395dd(b) provides that if any individual ... comes to a hospital, and the hospital determines that the individual has an emergency medical condition, the hospital must provide ... such treatment as may be necessary to stabilize the medical condition, or transfer the patient to another medical facility. 46 As the text of the statute clearly states, the hospital's duty to stabilize the patient does not arise until the hospital first detects an emergency medical condition. Thus, because the hospital here did not detect the decedent's alleged suicidal tendency, it had no obligation to stabilize this unapparent medical condition. 3 See Baber, 977 F.2d at 883 (rejecting contention that hospital is liable for failing to stabilize conditions of which it should have known); Gatewood, 933 F.2d at 1041 (stabilization and transfer provisions are triggered only after a hospital determines that an individual has an emergency medical condition); Cleland, 917 F.2d at 271 n. 2 (hospital cannot be charged with duty to stabilize condition that was not ascertained, even though an appropriate screening was provided) (citations omitted).