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

Heading: EMTALA Standards

Text: 11 The parties agree that HIMA provided Figueroa with a screening; they disagree over whether it was an appropriate medical screening under the terms of EMTALA. 42 U.S.C. § 1395dd(a). HIMA argues that a plaintiff can prevail under EMTALA only if she can demonstrate that the hospital offered no screening at all, or deviated from its standard screening procedures applicable to other patients with similar conditions. 1 As HIMA puts it in its brief, [w]hat EMTALA prohibits is disparate screening or no screening at all. Although appellants agree with the disparate screening standard, they also contend that a hospital can violate EMTALA if its screening is so cursory or inadequate that it is tantamount to no medical screening. As we explain, neither party has it exactly right. 12 By its terms, EMTALA is designed to assure that any person visiting a covered hospital's emergency room is screened for an emergency medical condition and is stabilized if such a condition exists. 2 With respect to screening, it requires the following: 13 In the case of a hospital that has a hospital emergency department, if any individual ... comes to the emergency department and a request is made on the individual's behalf for examination or treatment for a medical condition, the hospital must provide for an appropriate medical screening examination within the capability of the hospital's emergency department, including ancillary services routinely available to the emergency department, to determine whether or not an emergency medical condition (within the meaning of subsection (e)(1) of this section) exists. 14 42 U.S.C. § 1395dd(a). EMTALA does not define the term appropriate medical screening examination. However, it does indicate that the purpose of the screening is to identify an emergency medical condition. An emergency medical condition is defined as 15 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 — 16 (i) placing the health of the individual (or, with respect to a pregnant woman, the health of the woman or her unborn child) in serious jeopardy, 17 (ii) serious impairment to bodily functions, or 18 (iii) serious dysfunction of any bodily organ or part[.] 19 42 U.S.C. § 1395dd(e)(1)(A). To identify such conditions, hospitals are expected to employ ancillary services routinely available to the emergency department. 42 U.S.C. § 1395dd(a). However, they are not liable for failing to conduct examinations (or parts thereof) that are not within the capability of the hospital's emergency department. 42 U.S.C. § 1395dd(a). 20 With the statutory language as a guide, we have said previously that [t]he essence of [EMTALA's] screening requirement is that there be some screening procedure, and that it be administered even-handedly. Correa v. Hosp. San Francisco, 69 F.3d 1184, 1192 (1st Cir.1995). Thus, there is both a substantive and a procedural component to an appropriate medical screening under EMTALA: [a] hospital fulfills its statutory duty to screen patients in its emergency room if it provides for a screening examination reasonably calculated to identify critical medical conditions that may be afflicting symptomatic patients and provides that level of screening uniformly to all those who present substantially similar complaints. Id.; see also Jackson v. East Bay Hosp., 246 F.3d 1248, 1256 (9th Cir.2001) (We hold that a hospital satisfies EMTALA's `appropriate medical screening' requirement if it provides a patient with an examination comparable to the one offered to other patients presenting similar symptoms, unless the examination is so cursory that it is not `designed to identify acute and severe symptoms that alert the physician of the need for immediate medical attention to prevent serious bodily injury.' (quoting Eberhardt v. City of Los Angeles, 62 F.3d 1253, 1257 (9th Cir.1995))).