Opinion ID: 200059
Heading Depth: 2
Heading Rank: 1

Heading: Reasonably Calculated to Identify Critical Medical Conditions

Text: 22 In pressing their claim that HIMA failed to provide Figueroa with an appropriate medical screening under the terms of EMTALA, plaintiffs argued that [t]he medical examination and treatment [offered to Figueroa] ... was totally inadequate and inappropriate for a man in his condition. In moving for summary judgment in response to this claim, HIMA focused on concessions elicited from the plaintiffs' expert witness, Dr. Nateman, during his deposition. Although Dr. Nateman concluded that there had been an improper screening, he also conceded that he could not be certain whether Figueroa suffered from a life-threatening condition when he arrived at HIMA. Dr. Nateman also admitted that Figueroa was treated rapidly at the hospital, noting that Figueroa was triaged, [had] some vital signs done, had a physical exam by the doctor, and chest x-rays [and] laboratory tests were ordered. 23 Figueroa's wife, del Carmen Guadalupe, confirmed this testimony in her deposition. She also testified that Figueroa was given medication at the emergency room. She stated that, at the close of their visit, she was given a prescription and told to come back in the morning for the x-rays. Del Carmen Guadalupe also stated at the deposition that her husband did not appear to be in critical condition when he left the hospital with her: 24 Q: [B]y five in the morning ... your husband was doing well in the car. 25 A: Yes. 26 Q: That is, conscious and talking and all that. 27 A: Yes. 28 Q. Did he express any complaints about the way he was attended in there? 29 A: No. 30 Q: Some sort of malcontent? 31 A: No. 32 Q: You personally, did you feel you were attended? 33 A: Yes. 34 Given the concessions of Dr. Nateman and del Carmen Guadalupe, HIMA argues that it was clear that HIMA's screening of Figueroa was reasonably calculated to identify critical medical conditions afflicting him. 35 In response, the plaintiffs argue that, while this screening examination may have been adequate for many emergency room patients, it was totally inadequate and inappropriate for a man in [Figueroa's] condition. According to Dr. Nateman, Figueroa's co-morbid conditions — his obesity, age (51), edematous legs, catheterization, and high respiration rate — made him a vascular nightmare waiting to happen, a man with an obvious potential for death. Dr. Nateman concluded that an appropriate screening examination would have included, at a minimum, an electrocardiogram, a fuller assessment of Figueroa's respiratory function, and an immediate reading of the chest x-ray by a radiologist. 3 At the very least, say the plaintiffs, these contentions created a genuine issue of material fact regarding the appropriateness of the screening examination offered to Figueroa. 36 Although plaintiffs' arguments have some force, they ignore the important distinction between an EMTALA claim and a malpractice claim. EMTALA does not create a cause of action for medical malpractice, and faulty screening, in a particular case ... does not contravene the statute. Correa, 69 F.3d at 1192-93. Dr. Nateman's criticisms of HIMA's diagnosis of Figueroa in the emergency room are indistinguishable from the standard of care criticisms that one would hear from an expert in a malpractice case triggered by a misdiagnosis. Under EMTALA the issue is not what deficiencies in the standard of emergency room care contributed to a misdiagnosis. See Gatewood, 933 F.2d at 1041 (observing that EMTALA is not intended to ensure each emergency room patient a correct diagnosis). Rather, the issue is whether the procedures followed in the emergency room, even if they resulted in a misdiagnosis, were reasonably calculated to identify the patient's critical medical condition. Dr. Nateman's criticisms do not address this precisely formulated EMTALA standard. 37 Moreover, whereas malpractice liability usually attaches when a health care provider fails to adhere to a general professional standard of care, W. Page Keeton et al., Prosser and Keeton on the Law of Torts § 32, at 188 (1984), EMTALA only requires an appropriate medical screening examination within the capability of the hospital's emergency department. 42 U.S.C. § 1395dd(a). As the Fourth Circuit has observed: 38 This section establishes a standard which will of necessity be individualized for each hospital, since hospital emergency departments have varying capabilities. Had Congress intended to require hospitals to provide a screening examination which comported with generally accepted medical standards, it could have clearly specified a national standard. Nor do we believe Congress intended to create a negligence standard based on each hospital's capability. EMTALA is no substitute for state law medical malpractice actions. 39 Baber, 977 F.2d at 879-80. Although Dr. Nateman criticized HIMA for failing to perform certain tests for Figueroa, plaintiffs offered no evidence indicating that such tests were within HIMA's capability. For example, Dr. Nateman stated during his deposition that, at his hospital, he would test oxygen saturation [for] anybody who comes in with any kind of respiratory complaints. However, he also admitted that he did not know if [HIMA has] the machine necessary for such a test. Dr. Nateman suggested that HIMA should have had a radiologist examine Figueroa's x-rays as soon as they were developed. However, he also said that he had no idea whether the hospital's radiology department was in full operation at that time. Plaintiffs offered no evidence that HIMA had an electrocardiogram machine available, or had staff on hand qualified to perform a respiratory differential — two other items Dr. Nateman deemed essential to an appropriate medical screening examination. A claim of inappropriate medical screening based on a failure to provide certain diagnostic tests must at least address whether the hospital was capable of performing such tests. Because plaintiffs failed to present such evidence or evidence that HIMA's screening was not reasonably calculated to identify critical medical conditions, Correa, 69 F.3d at 1192, summary judgment for HIMA on the substantive component of EMTALA was appropriate.