What is necessary for a “medical screening examination”?

The question of how in-depth the medical screening examination must be to pass EMTALA scrutiny has been addressed by many courts, with many different answers.

– In a recent case, a hospital was fined $45,000 after failing to provide an adequate medical screening exam to a patient who was 38-weeks pregnant and complaining of abdominal and lower back pain. No exam was performed on the patient, no vitals were taken, no medical history, no fetal monitoring or tests for fetal movement. Instead the patient was advised to see her own physician. The patient went to another hospital where she delivered a stillborn baby.

– In another case, an intoxicated patient presenting to the emergency room was not properly examined because she was known to hospital personnel who expected her to “sleep it off.” Instead, the patient’s condition worsened and she eventually died as a result of a stroke. The clinicians only took one blood alcohol test, and performed no other screening exams for over 12 hours.

– A 72-year old woman lost consciousness and fell face-first onto a concrete floor. She went to the emergency department complaining of severe pain in her face and head. She had bruising, two black eyes and an abrasion, which was treated in the ED, but the patient was not given any diagnostic tests, such as a CAT scan, and received no treatment for the head pain. This was not considered an appropriate medical screening examination.

It’s important to point out, however, that an “appropriate medical screening” is not necessarily the most extensive one, and that simply missing a condition or misdiagnosing a patient does not automatically create an EMTALA violation. Courts have also held that if a physician performed a medical screening and did not believe a medical emergency existed, even if it did, this does not necessarily violate EMTALA. However, the physician or hospital could certainly be sued for malpractice in civil court.