6th Circuit Decision Broadens Scope of EMTALA and Liability for Hospitals
Although Moses v. Providence Hospital has not yet been adopted in our Circuit, this case is a troublesome one for hospitals because it broadens the Emergency Medical Treatment and Active Labor Act (EMTALA) at 42 USC § 1395dd(a-b), making its scope even larger than what is mandated by the Center for Medicare and Medicaid Services (CMS). On April 6, 2009, the Sixth Circuit Court of Appeals overturned a Michigan district court’s summary judgment ruling in favor of a hospital. In doing so, it extended EMTALA beyond the emergency room and created right for third parties to sue.
The plaintiff in Moses was the estate of a woman, Marie Moses-Irons, who had been murdered by her mentally ill husband after discharge from Providence Hospital. The husband, Howard, had been taken to Providence Hospital’s emergency room after exhibiting various signs of psychological illness and exhibiting threatening behavior toward her. He was admitted as an inpatient to the hospital and was evaluated by at least four medical staff members. He was discharged six days later. Ten days after discharge, Howard murdered his wife. These events all occurred in 2002, prior to CMS’s release of the November 2003 EMTALA regulations, which is significant because the court pointed out that the revised regulations (which clarified that EMTALA does not apply to inpatients) did not apply to this case, even as it said those regulations were inconsistent with the federal statute.
The court addressed the EMTALA issues in two parts. First, it discussed the plaintiff’s standing to sue under EMTALA. The court held that the plain language of the statute provided that any individual who suffers personal harm as a direct result of a hospital’s violation of EMTALA may bring a civil action. See 42 USC § 1395dd(d)(2)(A). The court disregarded legislative history from a congressional committee report which suggested the provision on civil standing should have been read in conjunction with other parts of the statute, which would have narrowed the meaning of “any individual” to only those patients who were admitted to the hospital for treatment. See H.R. Rep. No. 99-241, pt. 3 at 6, reprinted in 1986 USCCAN 726-28.
This ruling on the estate’s standing to sue the hospital is significant because other courts have previously held that only the patient could sue the hospital. The Sixth Circuit rejected that interpretation to hold that an injured third party can sue as well. This ruling opens the door to other potential claims for injuries arising from an alleged EMTALA violation by a third party when their loved one is injured, such as a spouse or parent’s claims for wrongful death, survival or consortium.
Next, the court discussed the obligations imposed on hospitals once the patient is admitted for treatment. CMS regulations state—and most of us have understood—that as long as the hospital admits, in good faith, a patient with an emergency medical condition for treatment and stabilization then the hospital has satisfied its legal obligations under EMTALA. See 42 CFR § 489.24(d)(2)(i). However, the court held that despite the interpretive nature of the CMS’s guidelines, the regulations were invalid and contrary to the plain meaning of EMTALA, which imposes an obligation to affirmatively provide “care . . . until the patient’s emergency medical condition is stabilized” rather than merely admitting in good faith. See Thorton v. Sw. Detroit Hosp., 895 F. 2d 1131, 1135 (6th Cir. 1990); USC § 1395dd(b-c). Therefore, the court found, admitting the patient is not enough. The hospital may still be liable under EMTALA unless the emergency medical condition is stabilized and no further deterioration is likely. For hospitals in the Sixth Circuit’s jurisdiction, the EMTALA obligation does not end at the doors to the emergency room.
Remaining factual questions in the case as to whether the husband actually had an emergency medical condition upon being admitted and whether that condition still existed upon discharge were remanded back to the lower court for a determination by jury.
In considering this case, it’s important to understand the procedural posture. When ruling on the motion for summary judgment, the court was determining whether there was any genuine issue of material fact that precluded a judgment in the hospital’s favor. Here, the court made multiple references to the hospital’s lack of supporting evidence and to its last minute addition of a new argument regarding whether there was an emergency medical condition, suggesting that this was prejudicial to the plaintiff. It is clear that this did have some impact on its decision.
Nevertheless, this decision has a serious impact on the potential liability of hospitals. It gave standing to any party who suffers personal harm as a result of an EMTALA violation and imposed a duty upon hospitals even greater than that imposed by CMS: a hospital must not only admit patients with emergency medical conditions but also provide extensive inpatient treatment to completely stabilize the patient.
While this decision does not come from our Fifth Circuit and has not been adopted by any of the other federal appeals courts, hospitals are wise to take heed of the potential pitfalls it raises. As always, hospitals should clearly document cases where a patient is admitted for an emergency medical condition, being especially careful to provide a detailed description of the patient’s health upon discharge. Detailed accounts of medical staff recommendations and the ultimate rationale for discharge decisions will help hospitals show a good faith compliance with EMTALA.
Ms. Grey is a partner at Breazeale, Sachse, & Wilson, L.L.P. in Baton Rouge and Mr. Odinet is a third year law student at the Paul M. Hebert Law Center at the time this article was written.