This month we look at a case involving the Emergency Medical Treatment and Labor Act, commonly referred to as EMTALA. EMTALA was enacted by Congress in 1986 as part of the Consolidated Omnibus Budget Reconciliation Act (COBRA) of 1985. The act was designed to prevent hospitals from ‘patient dumping’; transferring uninsured or Medicaid patients to public hospitals without, at a minimum, ensuring that the patient is stable for transfer. Basically, EMTALA requires that Medicare-participating hospitals with emergency departments screen and stabilize emergency medical conditions of patients in a non-discriminatory manner, regardless of ability to pay, insurance status, national origin, race, color, or creed.

Mrs P was 61 when the accident happened that would change her life forever. She tripped and fell, dislocating her left knee. An ambulance was called which took her to the nearest hospital emergency department, located in Hospital A. The emergency department physician who examined the patient recognized the need for a consult, and called in Dr O, an orthopedic surgeon at the hospital. Dr O was able to manually treat the dislocation, but at 1:05 pm he noted that Mrs P did not have a pulse or detectable blood flow to her lower leg. The lack of blood flow meant that a peripheral vascular surgeon was needed, but Hospital A did not have one.

Dr O contacted the state’s Trauma Communication Center (TCC) for direction on where to transfer Mrs P. The TCC informed Dr O that Hospital B, an hour away, had a peripheral vascular surgeon, and the TCC then connected Dr O to Dr I, a physician at Hospital B. Dr O explained the patient’s injury and the fact that she had no pulse in her left foot, and told Dr I that his hospital did not have a vascular surgeon capable of treating the patient. Dr I said he believed Hospital B could treat the patient, and that he understood a peripheral vascular surgeon was needed. He accepted Mrs P’s transfer on behalf of Hospital B. At 1:37 pm, the orders were put in to transfer Mrs P to Hospital B.

At 2:05 pm, Mrs P signed a transfer consent form. Forty minutes later, Hospital A’s emergency department physician called Dr I at Hospital B to inform him of Mrs P’s computed tomography angiography results, current state, medical records, and transfer status. At 2:55 pm, Mrs P was loaded into an ambulance for the hour-long transport to Hospital B. Midway through the trip, however, Hospital B called the Trauma Communication Center to report that its surgeon had reviewed Mrs P’s medical records and could not perform the type of surgery she required. Mrs P was now midway between the two hospitals. The TCC instructed Hospital B to continue with the transfer, and once she arrived to transfer her to a third hospital which had the capacity to treat her.

Mrs P arrived at Hospital B at about 4 pm. Arrangements were made to medivac the patient to Hospital C. Once she arrived at Hospital C, a peripheral vascular surgeon performed surgery on the leg in an attempt to restore blood flow. However due to the length of time that the leg was without blood circulation, the surgeon could not save the leg, and Mrs P had an above-the-knee amputation.

After she recovered from the amputation, Mrs P sought the counsel of a plaintiff’s attorney who filed numerous lawsuits against most of the clinicians and hospitals involved for medical malpractice and negligence. A claim was also filed against Hospital A, alleging violations of the Emergency Medical Treatment and Labor Act. This is the claim we will be discussing here.