Courts remain divided on whether state medical malpractice damage caps apply to EMTALA claims.
- EMTALA explicitly incorporates state law for the determination of damages available in EMTALA claims.
- Most courts have interpreted that damage caps apply to EMTALA claims.
- Delays in implementing orders expose EDs to EMTALA and medical malpractice claims.
Courts are split on whether state medical malpractice damage caps apply to Emergency Medical Treatment and Labor Act (EMTALA) claims. A recent pending case in the 5th U.S. Circuit Court of Appeals is under scrutiny.1
The case involves a young girl who was paralyzed after a hospital allegedly failed to properly diagnose an injury to her spinal cord. The judge ruled that the damages payable for their EMTALA claims could be capped by the state law, because the failure to diagnose was included in Louisiana’s definition of malpractice.2 This contrasted with a previous ruling in the state, in which damage caps were found not to apply to an EMTALA claim.3
“As the Scott [decision] points out, EMTALA explicitly incorporates state law for the determination of damages available in EMTALA claims,” notes Timothy C. Gutwald, JD, a healthcare attorney in the Grand Rapids, MI, office of Miller Johnson.
Most courts have interpreted that language to mean damage caps apply to EMTALA claims. “However, by granting an interlocutory appeal, the Scott [decision] acknowledges that this area of law is not settled,” Gutwald notes.
The case is a good example of how a delay in implementing an order can expose EDs to EMTALA and medical malpractice claims. “Here, it took a long time to get the MRI done,” Gutwald says. Even if the delay in performing the MRI was not a breach of the standard of care, it still may be a viable EMTALA claim.
“This case presents another good example of how emergency physicians face an additional level of liability that other physicians simply do not face,” Gutwald adds.
The Scott case is the latest in a long series of cases dating back to the early EMTALA cases, says Stephen A. Frew, JD, vice president of risk consulting at Johnson Insurance Services and a Rockford, IL-based attorney.
“Courts have taken a state-by-state analysis approach to whether or not EMTALA incorporates state malpractice caps,” Frew explains. This results in an inconsistent pattern of rulings across the country. Rulings focus on different aspects of the state damage caps rule.
“If I were to attempt to draw a set of rules from what I have seen in cases so far, it would be a generalization that state procedural rules that require administrative hearings before a court case may be brought are not applicable to federal court cases,” Frew offers. This is because state court procedure generally does not limit federal courts.
The question of damages is more difficult. “EMTALA language appears to incorporate the elements of damages allowed by the state where the hospital is located,” Frew explains. Where damage caps are applicable to all tort actions in the state, courts have split on whether that means that caps apply to EMTALA, which might be argued to be a tort law. Other cases have argued that the elements of damages apply to EMTALA, but the caps do not.
“This inconsistent palette of rulings probably has only one direct impact on ED physicians,” Frew says. How a state views the applicability of caps to EMTALA will influence how much EPs pay for professional liability insurance.
“Most major professional liability insurance carriers have built the caps issues into their general pricing, but may adjust premiums based on changes in state cap rulings,” Frew explains.
- Scott v. Ruston La. Hosp. Co., 2017 BL 120167, W.D. La., No. 3:16-cv-376, April 12, 2017.
- Power v. Arlington Hosp. Assn, 42 F.3d 851 (4th Cir. 1994).
- Jeff v. Universal Health Services, Inc., No. 2:04-cv-1507, 2005 BL 26244 (E.D. La. July 27, 2005).