A Colorado District Court has dismissed an EMTALA claim upon a finding that the physician and hospital did not violate hospital medical screening policies and was not aware of the patient’s emergency medical condition upon discharge.
A 13 year old girl presented and received a medical screening examination from the ED physician. Upon reaching a diagnosis of influenza and pneumonia, the physician cancelled certain metabolic tests that he had ordered, medicated the patient, and discharged her. She died the following day.
The Court concluded that patient received a medical screening exam within EMTALA standards and it had failed to disclose the patient’s emergency medical condition. When the physician discharged the patient, the hospital policy had been complied with and the personnel were not aware of the emergency medical condition, according to the court. Court interpretations of EMTALA have consistently concluded that in the circumstances where the policies are followed, there is no “disparate” or discrimination in the care provided, and no one is aware of the emergency medical condition the case does not fall under EMTALA, but may be grounds for a malpractice case.
The plaintiffs had argued that the triage nurse had deviated from policies and procedures by improperly categorizing the patient at an incorrect triage level that resulted in a 30 minute additional delay in the exam. The Court ruled it was a “de minimus” deviation that did not contribute to the misdiagnosis or death of the child.
CMS does not follow the same standards as a civil court. CMS routinely cites for improper triage and looks more closely at the quality of the medical screening examination. If CMS were to have reviewed the case, it is likely that the hospital would have been cited for the allegedly improper triage classification and perhaps have been cited for the discharge based on the cancelled tests amounting to a failure to complete an appropriate medical screening examination. To reach that conclusion, the case would have to be reviewed by a QIO panel emergency physician and found deficient, but CMS has received medical support for similar findings. Each case is reviewed and determined by CMS on an individual basis.
Etter v. Bibby No-cv-00557 (D. Colo. Mar 15, 2013