Did an Emergency Department Breach EMTALA Policy On Access to Services?

The Emergency Medical Treatment and Labor Act (EMTALA) was passed to end “dumping” of individuals who came to an emergency department (ED) for care but did not have insurance to pay for those services.

As a result of this legislation, EMTALA requires an ED to perform an appropriate medical screening examination when any individual presents in the ED, and if an emergency medical condition exists, provide treatment to stabilize that condition.

EMTALA also includes criteria under which the patient may be transferred to another facility.

In the following case out of the U.S. District Court of Puerto Rico, the question of whether the ED in the Caribbean Medical Center (CMC) met its obligations under EMTALA is assessed.

Specifics of the Case

A 79-year-old male patient had a history of hyperlipidemia, peripheral vascular disease, gastritis, and diabetes. He was also a chronic cigarette smoker and had a history of alcohol use.

One day, the patient developed severe abdominal and chest pain, and his wife called 911 to take him to the hospital. When the ambulance arrived, the paramedics assessed him and documented that he had abdominal pain and an irregular heart rate. The documentation was given to the hospital personnel.

When evaluated a second time, the patient was taken by ambulance to the ED. A nurse triaged him at approximately 7:40 p.m. The nurse documented that the patient’s chief complaint was acute abdominal pain, pain in the thorax with “severe intensity,” and the areas of pain involved “the right and left chest and the upper and lower abdomen.”

The patient’s condition was classified as an emergency, and he was seen by a physician at about 7:49 p.m. The doctor’s diagnosis was “epigastric tenderness.” He ordered an array of laboratory tests and prescribed various medications for the patient.

At about 8:50 p.m., the patient was found unresponsive and without a pulse. Attempts to resuscitate him failed, and he was declared dead at 9:35 p.m. The final diagnosis was acute cardiac arrest.

The patient’s family filed a case against the facility, the physician who treated him in the ED, and various insurance companies, alleging the facility violated the EMTALA by not providing adequate medical screening, which led to the patient’s death. They also alleged the facility was professionally negligent in the patient’s care.

The family alleged the facility didn’t initiate nor follow its diagnosis and treatment protocols for chest pain and/or acute coronary syndrome. The protocols required an EKG be ordered within 10 minutes of a patient’s arrival and certain medications be administered (e.g., anticoagulant, antiplatelet therapy).

CMC and one of the insurance companies filed a Motion to Dismiss the case against them. Their basis for the motion was that the family failed to state a claim under EMTALA and that their case was not filed within the statute of limitations for their state professional negligence claims.

The patient’s family filed a Motion in Opposition to the Motion to Dismiss claiming their case was not time barred because they provided written notice of their claims.

The Court’s Decision

In its Memorandum and Order, the …read more

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