A district court in Rhode Island recently found that an urgent care center is subject to EMTALA requirements.1

The plaintiff presented to the hospital’s urgent care clinic with severe pain and burning in her chest and right arm. She was discharged with a diagnosis of gastroesophageal reflux disease with no follow up ordered, and died of a heart attack the next day.

The central issue was whether the urgent care clinic constituted a “dedicated emergency department” as defined by EMTALA. This would have required the clinic to perform a medical screening exam and stabilize the patient. At issue was whether an individual would perceive the clinic as an appropriate place to go for emergency care. The court found that a person who needs emergency care would not distinguish “urgent” care from an emergency medical condition.

“The court ruling was not surprising for a couple of reasons,” says Douglas B. Swill, JD, a partner at Drinker Biddle & Reath in Chicago. The fact that the urgent care center was hospital-owned was a key factor. “Many of my health system clients set up such urgent or immediate care centers in non-hospital corporate affiliates so as to avoid EMTALA application,” Swill explains.

The case also showed that the facts that may be in dispute, or factual issues that may not be resolved, become important when deliberating on a motion for summary judgment. In this case, the defense argued that the center’s website made it clear it does not offer emergency care.

However, the plaintiff produced text messages she’d sent to coworkers. These indicated she had seen signage for the center, and thought she was going to an ED.

Such factual issues, says Swill, “become especially important where the hospital needs to defend itself more robustly that the urgent care center did not hold itself out as a place to treat emergency medical conditions.”

More Cases Likely

Similar cases challenging urgent care centers’ falling under EMTALA are likely to occur.

“We are already beginning to see more investigations and surveys resulting from complaints similar to this case,” Swill adds.

The increasing number of urgent care centers is one reason. Finances are another, as hospitals strive to guide patients into the most cost-effective facility for appropriate care.

“EPs who work part time in urgent care centers should consider requesting a legal position of their counsel on whether EMTALA applies to their urgent care center,” Swill offers. If so, they should find out:

  • whether they have appropriate procedures and policies to comply;
  • whether the organization and its staff have developed and implemented the appropriate education, training program, and training materials tailored to the facility.

“Attempts by ED staff to ‘suggest’ a more appropriate setting for people with possible urgent medical needs may backfire on them,” Swill warns.

This is more likely if the appropriate setting is an urgent care center operated by a hospital as an outpatient department.

“EMTALA applies to that facility,” Swill notes. “Therefore, staff need to have the training and education related to EMTALA compliance.”

REFERENCE

  1. Friedrich v. South County Hosp. Healthcare, C.A. No. 14-353 S.

SOURCE

  • Douglas B. Swill, JD, Partner, Drinker Biddle & Reath, Chicago. Phone: (312) 569-1270. Fax: (312) 569-3270. Email: Douglas.Swill@dbr.com.