EMTALA court decision ignores '250-yard' rule

No 'dumping' violation found

A woman who fell and was injured in the parking lot of a medical center after arriving for an appointment had no claim against the hospital under the Emergency Medical Treatment and Labor Act (EMTALA), according to a recent decision by a California federal court.

www.medlaw.com) points out that there is no indication that in reaching its conclusion the court considered a Centers for Medicare and Medicaid Services (CMS) regulation involving parking lots and similar locations within 250 yards of a hospital.

That regulation, Frew notes, adds such areas to the definition of what constitutes an individual having presented to a hospital for EMTALA purposes.

The court explained its decision, he adds, by noting that EMTALA is a statute aimed at prohibiting patient dumping and that once the plaintiff was taken to the medical center she received treatment and was not "dumped."

The court further held that EMTALA contains no requirement that a medical center use its own personnel to transport a patient injured on its premises to the emergency department (ED).

According to published accounts, Frew says, plaintiff Maria Addiego was taken by her daughter to the California Pacific Medical Center for an appointment. While exiting the car in the parking garage, she fell and broke her hip.

Although they were located about 30 yards from CPMC's emergency department, he continues, the parking attendant instead called the security department, which refused the plaintiff's request for immediate medical attention from the ED. Instead, Frew adds, security personnel called 911.

After the plaintiff had been lying on the ground for almost an hour, he says, an ambulance came and transported the woman to CPMC's ED.

The plaintiff sued CPMC, alleging the delay made her injuries worse and claiming premises liability and personal injury. She also filed a separate action adding the city and county of San Francisco as a defendant and alleging that CPMC violated EMTALA by refusing to transport her to the ED, instead requiring that the San Francisco fire department do so.

Frew compared the event that sparked the California lawsuit to an incident at Ravenswood Hospital in Chicago in which a hospital ED refused to assist a teenager who had been shot and lay a short distance from the ED entrance.

Chicago's fire department emergency medical service did not respond because the incident was at a hospital, interpreting the call as a transfer request, Frew notes. Chicago police, reportedly frustrated by the standoff between the hospital and EMS, deviated from departmental rules and moved the child to the hospital ED, just yards away, he says. The child, however, died from loss of blood attributed to the delay in care, Frew adds.

In response to the Chicago event, he explains, CMS added the definition to its prospective payment regulations defining the area of 250 yards around a hospital — including access areas and hospital parking areas — as constituting "presenting to the ED" for EMTALA compliance rules. The rules also require the hospital to provide a response to the patient in addition to calling 911.

While the decision in the California case is likely to influence litigation cases arising in the Northern District of California, Frew suggests, it is unlikely to influence CMS enforcement of the 250-yard requirement.