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Santiago Canyon College *

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CL727

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Medicine

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Feb 20, 2024

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MEMORANDUM To: Thomas Koracick, Managing Partner From: Junior Associate Date: November 22, 2020 RE: Catherine Fox Foundation – Grey Sloan Memorial Hospital; EMTALA Claim QUESTION PRESENTED Our client, the Catherine Fox Foundation, which operates Grey Sloan Memorial Hospital, located near West Chester, Pennsylvania, has come to us seeking advice as to whether Teddy Altman, a former patient, has a valid claim under the Emergency Medical Treatment and Active Labor Act (EMTALA). Altman was screened for an emergency medical condition pursuant to the hospital’s standard protocol and was discharged from GSMH in what appeared to be stable condition but with lingering symptoms. However, she was readmitted to the hospital’s Intensive Care Unit (ICU) the next day for worsening symptoms. Thus, does she have a valid claim pursuant to EMTALA for failure to screen and/or failure to stabilize? BRIEF ANSWER Altman is not likely to have a successful EMTALA screening claim because GSMH followed standard screening procedures in a timely manner. However, Altman likely does have a valid EMTALA stabilization claim because the hospital failed to complete a chest x-ray and discharged her with lingering symptoms, which resulted in her being admitted to the ICU the next day. STATEMENT OF FACTS 1

Teddy Altman, a 64-year-old woman, visited the GSMH emergency room on Friday, January 17, 2020, around 9:00 p.m., for flu-like symptoms: headache, cough, nausea, dizziness, and a fever. Upon entering the emergency room, Altman was asked to fill out paperwork that is mandatory for all emergency room patients and underwent triage screening by a nurse. Due to the timing of the visit – a Friday night in the middle of flu season – the emergency room was crowded. After the triage check (approximately twenty-five minutes since her arrival), she was taken back to a room for treatment. Based on the time of the visit as well as the time of year, this wait time for the emergency room was normal. Altman was evaluated by Dr. Miranda Bailey, who ordered several tests in line with the hospital’s “Influenza Protocol” due to the nature of Altman’s symptoms. The tests included a white blood cell count, temperature monitoring, a chest x-ray, IV fluids, and medication. By 1:00 a.m., Altman’s symptoms had improved, and her fever had dropped by a few degrees to 101 Fahrenheit, which was still above the average temperature of 98.6 degrees Fahrenheit. Despite Altman stating that she did not “feel quite right,” and was still experiencing dizziness, Dr. Bailey determined that “she was simply suffering from the flu and that there was not much else they could do in the hospital to treat her.” Just prior to discharge, Altman continued to state that she felt “pretty unwell” but was told by Dr. Bailey to return if she felt worse. She was discharged around 2:10 a.m., approximately five hours after initially entering the emergency room. Due to the busy environment at the GSMH emergency room, the chest x-ray ordered by Dr. Bailey was never administered to Altman. The following night, Altman returned via ambulance, with more severe symptoms. She was diagnosed with bacterial pneumonia, a lung infection that can be critical to anyone over the 2

age of 60. GSMH misdiagnosed Altman because bacterial pneumonia exhibits similar symptoms to the flu and is typically determined via a chest x-ray, which was never administered. She was admitted to the ICU and sustained significant medical costs due to the week-long hospitalization. Altman’s attorney notified GSMH of Altman’s intentions to sue due to GSMH’s failure to (1) adequately screen her upon her arrival; and (2) stabilize her prior to discharge. DISCUSSION The Emergency Medical Treatment and Labor Act (EMTALA), which is a federal law enacted in 1986, was established to prevent hospitals from refusing to treat individuals with emergency conditions. Torretti v. Main Line Hospitals, Inc., 580 F.3d 168 (3d Cir. 2009). Also known as “patient dumping”, the intention of EMTALA was to ensure a standard level of emergency medical care to all patients, regardless of income-level or insurance status. EMTALA requires hospitals provide medical care to individuals that present to the emergency treatment including (a) appropriate medical screening, and (b) stabilization of known emergency medical conditions and labor. Torretti v. Main Line Hospitals, Inc., 580 F.3d 168 (3d Cir. 2009). Furthermore, while there is no established legal duty for hospitals to accept and treat all individuals, EMTALA hold that any individual who suffers personal harm as a direct result of a hospital’s violation of the statute may bring a private civil action for damages. “42 U.S.C. § 1395dd(d).” Torretti v. Main Line Hospitals, Inc., 580 F.3d 168, 173 (3d Cir. 2009). In order for a plaintiff to establish a valid screening or stabilization claim under EMTALA, the plaintiff must meet certain threshold elements: (1) the patient must have sought treatment at a hospital emergency department, and (2) the patient must have presented with an emergency medical condition. An emergency medical condition is defined as “a condition manifesting itself by acute symptoms of sufficient severity such that the absence of immediate 3

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