The case of Moses v. Providence Healthcare System is a good illustration of how a court can interpret the Emergency Medical Treatment and Labor Act (EMTALA) in a surprising way, says Ann Lambrecht, RN, BSN, JD, FASHRM, senior risk specialist with Coverys, a Boston-based company that provides insurance, risk management, and claims service for caregivers who are located in the Northeast.
In this case, a psychiatric patient made threatening statements and was taken to the ED of a hospital. He was admitted for treatment and observation to a general medical floor, Lambrecht notes. (The decision from the appeals court is available to readers online at http://1.usa.gov/1U2Rhdd.)
“After about five days of inpatient care, the psychiatric resident believed the patient made some progress and crafted a progress note about the patient’s insurance company needing to authorize care in a psychiatric unit,” Lambrecht says. “The patient was not transferred to the psych unit reportedly because he refused, was discharged, and 10 days later, killed his wife.”
The patient later testified he was not given the option for inpatient psychiatric care. The wife’s family alleged an EMTALA violation, and the hospital responded that EMTALA did not apply to inpatients.
The district court granted summary judgment to the hospital and said EMTALA did not apply because the patient had been admitted. The lower court said, “The patient was undisputedly completely screened, as the statute requires, even if on the basis of a wrong diagnosis; and he was thereafter admitted to the Defendant hospital, and no emergency medical condition was recognized on the screening.”
When the plaintiffs appealed, the hospital argued that even if the man had an emergency medical condition at the time of his admission, the hospital physicians no longer believed that he had such a condition when they released him. He was stable upon discharge, the hospital said. The appeals court disagreed, saying, “Because issues of fact exist relating to [the patient’s] medical condition — upon his initial screening as well as prior to his release — the district court erred in granting summary judgment on this ground.”
The appeals court concluded that it was at least arguable that the patient was still in an emergency condition and not stable when discharged, and that the defendant hospital had been required to ensure that the patient, even as an inpatient, was stabilized under EMTALA before discharge. The appeals court sent the case back to the district court.