Verdicts

The plaintiffs asserted federal subject matter jurisdiction by alleging that the defendants violated EMTALA by failing to provide the child with an “appropriate medical screening examination” so as to detect her emergency condition and by failing to stabilize the child's condition properly before transferring her. The complaint also alleged a Puerto Rico law claim of medical malpractice by the defendants, and invoked the federal court's supplemental jurisdiction. The defendants moved for summary judgment, in part contending a lack of federal subject matter jurisdiction because EMTALA did not apply to the allegations in the complaint as the CDT was not a “hospital” within the meaning of EMTALA. The district court sided with plaintiffs, concluding that “the provisions of EMTALA apply to CDTs in Puerto Rico that offer 24-hour emergency room services, and that consequently, plaintiffs have a colorable claim under said statute.”

On appeal, the U.S. Court of Appeals for the First Circuit noted that Congress enacted EMTALA in large part to solve the problem of “dumping” of uninsured patients – hospital emergency rooms refusing to treat or transferring indigent patients to public hospitals without first assessing and/or stabilizing the patient's condition. EMTALA imposed some limited substantive requirements on emergency rooms of hospitals participating in the federal Medicare program. Specifically, EMTALA requires that a participating hospital afford an appropriate medical screening to all persons who come to its emergency room seeking medical assistance, and, if an emergency medical condition exists, the participating hospital must render the services that are necessary to stabilize the patient's condition unless transferring the patient to another facility is medically indicated and can be accomplished with relative safety. EMTALA created a private cause of action for damages for violations of the act against “participating hospitals.”

The operative question in this case was whether a CDT, defined by Puerto Rico law as “an independent facility … which provides community services for the diagnosis and treatment of ambulatory patients under the professional supervision of persons licensed to practice medicine, surgery or dentistry in Puerto Rico,” qualified as “a hospital that has a hospital emergency department” under EMTALA. It was undisputed that the CDT in this case was an independent facility and was not attached to a hospital. CDTs are unique to Puerto Rico and are “limited health facilities that offer only outpatient services such as dentistry, X-ray, and laboratory services.”

As an amendment to the Social Security Act, EMTALA incorporates the Act's definition of a “hospital:” an institution primarily engaged in providing to inpatients diagnostic and therapeutic or rehabilitative services. 42 U.S.C. ' 1395x. The CDT did not meet these requirements because it was engaged entirely in outpatient, ambulatory care. The district court found, however, that it would be “unconscionable” not to extend EMTALA to cover CDTs with 24-hour emergency services because that would have the effect of “excluding the poor population who primarily rely on CDT services from the reaches of this all important law.” It therefore concluded that the spirit of EMTALA, if not its letter, was meant to cover the action against the defendants. This conclusion was error, the First Circuit held, because Congress' language defining a participating hospital was explicit and federal courts are not free to ignore the letter of the law in favor of the “spirit” of a law. Consequently, the denial of summary judgment to the defendants was reversed, and the federal claims ordered dismissed with prejudice.

Doctor Meets Standard of Care, with Horrific Results

Jurors in Fulton County, GA, returned a verdict of “not guilty” in a malpractice case brought by a woman against a doctor who only partially removed a stillborn fetus from her womb during a dilation and extraction procedure. The plaintiff, Nichole Thebaud, sued Dr. Stephen Blank and his firm, Mount Vernon OB-GYN Associates, seeking damages for mental and physical pain and suffering, as well as punitive damages.

Thebaud, whose child had died in utero, underwent the dilation and extraction procedure, then was sent home afterward. The next day, she was shocked to discover that she had delivered the fetus' head into the toilet. In her suit, Thebaud claimed the doctor should have performed an ultrasound to be sure that the entire fetus had been extracted from her womb. After the verdict of “not guilty” was read, one juror expressed regret that the plaintiff could not receive some compensation for her pain and suffering, but agreed with the rest of the panel that ultrasound following dilation and extraction is not mandated by the current standard of care

EMTALA Not Applicable to Medical Center with Limited Mission

A regional diagnostic and treatment center that treats only ambulatory patients and has an emergency room independent of a hospital was found not subject to the requirements of the Emergency Medical Treatment and Active Labor Act (EMTALA), 42 U.S.C. '1395dd and, therefore, the federal courts lacked subject matter jurisdiction over a suit brought on behalf of the deceased. Rodriguez v. American International Insurance Co. of Puerto Rico, 2005 U.S. App. LEXIS 4719 (1st Cir. 3/23/05).

The plaintiffs, parents of a 4-month-old girl who died after being seen in the emergency room of diagnostic and treatment center Centro de Diagnostico y Tratamiento (CDT) in Puerto, filed a federal suit for damages against Corporacion de Servicios Integrales de Salud del Area de Barranquitas, Corozal, Naranjito y Orocovis (Corporacion), the owner of the CDT, and American International Insurance Company of Puerto Rico (AIICO), Corporacion's insurer. The child died after an emergency ward doctor at the CDT decided to transfer her to the Pediatric Hospital at the Puerto Rico Medical Center.

The plaintiffs asserted federal subject matter jurisdiction by alleging that the defendants violated EMTALA by failing to provide the child with an “appropriate medical screening examination” so as to detect her emergency condition and by failing to stabilize the child's condition properly before transferring her. The complaint also alleged a Puerto Rico law claim of medical malpractice by the defendants, and invoked the federal court's supplemental jurisdiction. The defendants moved for summary judgment, in part contending a lack of federal subject matter jurisdiction because EMTALA did not apply to the allegations in the complaint as the CDT was not a “hospital” within the meaning of EMTALA. The district court sided with plaintiffs, concluding that “the provisions of EMTALA apply to CDTs in Puerto Rico that offer 24-hour emergency room services, and that consequently, plaintiffs have a colorable claim under said statute.”

On appeal, the U.S. Court of Appeals for the First Circuit noted that Congress enacted EMTALA in large part to solve the problem of “dumping” of uninsured patients – hospital emergency rooms refusing to treat or transferring indigent patients to public hospitals without first assessing and/or stabilizing the patient's condition. EMTALA imposed some limited substantive requirements on emergency rooms of hospitals participating in the federal Medicare program. Specifically, EMTALA requires that a participating hospital afford an appropriate medical screening to all persons who come to its emergency room seeking medical assistance, and, if an emergency medical condition exists, the participating hospital must render the services that are necessary to stabilize the patient's condition unless transferring the patient to another facility is medically indicated and can be accomplished with relative safety. EMTALA created a private cause of action for damages for violations of the act against “participating hospitals.”

The operative question in this case was whether a CDT, defined by Puerto Rico law as “an independent facility … which provides community services for the diagnosis and treatment of ambulatory patients under the professional supervision of persons licensed to practice medicine, surgery or dentistry in Puerto Rico,” qualified as “a hospital that has a hospital emergency department” under EMTALA. It was undisputed that the CDT in this case was an independent facility and was not attached to a hospital. CDTs are unique to Puerto Rico and are “limited health facilities that offer only outpatient services such as dentistry, X-ray, and laboratory services.”

As an amendment to the Social Security Act, EMTALA incorporates the Act's definition of a “hospital:” an institution primarily engaged in providing to inpatients diagnostic and therapeutic or rehabilitative services. 42 U.S.C. ' 1395x. The CDT did not meet these requirements because it was engaged entirely in outpatient, ambulatory care. The district court found, however, that it would be “unconscionable” not to extend EMTALA to cover CDTs with 24-hour emergency services because that would have the effect of “excluding the poor population who primarily rely on CDT services from the reaches of this all important law.” It therefore concluded that the spirit of EMTALA, if not its letter, was meant to cover the action against the defendants. This conclusion was error, the First Circuit held, because Congress' language defining a participating hospital was explicit and federal courts are not free to ignore the letter of the law in favor of the “spirit” of a law. Consequently, the denial of summary judgment to the defendants was reversed, and the federal claims ordered dismissed with prejudice.

Doctor Meets Standard of Care, with Horrific Results

Jurors in Fulton County, GA, returned a verdict of “not guilty” in a malpractice case brought by a woman against a doctor who only partially removed a stillborn fetus from her womb during a dilation and extraction procedure. The plaintiff, Nichole Thebaud, sued Dr. Stephen Blank and his firm, Mount Vernon OB-GYN Associates, seeking damages for mental and physical pain and suffering, as well as punitive damages.

Thebaud, whose child had died in utero, underwent the dilation and extraction procedure, then was sent home afterward. The next day, she was shocked to discover that she had delivered the fetus' head into the toilet. In her suit, Thebaud claimed the doctor should have performed an ultrasound to be sure that the entire fetus had been extracted from her womb. After the verdict of “not guilty” was read, one juror expressed regret that the plaintiff could not receive some compensation for her pain and suffering, but agreed with the rest of the panel that ultrasound following dilation and extraction is not mandated by the current standard of care