Supreme Court will test legal interpretation of EMTALA

Louisville, KY-In one of the biggest tests yet of the federal Emergency Medical Treatment and Active Labor Act (EMTALA) laws, the U.S. Supreme Court is expected to hear a controversial patient-dumping case that had been previously dismissed by two lower courts. The lower courts ruled against the plaintiff in the case, based on the lack of any evidence that the physician attending the patient was driven by an "improper motive" in authorizing the transfer.

The case has attracted widespread interest within emergency medicine circles because of the unusual interpretation of the federal EMTALA, which bars providers from refusing emergency medical care to patients based on their ability to pay.

At issue for the high court will be whether a plaintiff in an EMTALA case has to prove that a provider had an improper motive in transferring or discharging a patient in order to recover damages. In recent EMTALA cases, federal courts have not used the improper motive-test in rulings.

But two of the three judges on the Sixth Circuit Court of Appeals in Cincinnati, OH, who heard the case agreed with a trial court, which found against the plaintiff based on the lack of any improper motive by providers. (Roberts vs. Galen of Virginia, No. 93CV544-S, U.S. District Court Western District Of Kentycky, August 30, 1993.)

The Supreme Court's interpretation of the law could affect future EMTALA suits, possibly involving millions in damages against providers. In 1994, the plaintiff, Jane Roberts, sued Humana Hospital-University of Louisville in Kentucky for violating EMTALA in the transfer of her badly injured niece to an out-of-state nursing home. Roberts sued Humana for $10 million in punitive and compensatory damages.

The niece, 40-year-old Wanda Johnson, had been struck by a car while she was crossing a street and was left permanently disabled. The case is also unusual because Johnson had already been admitted to the hospital and was ordered transferred by a surgeon, not an emergency physician. According to Robert's attorney Joseph Mattingly, JD, of Lebanon, KY, Johnson was transferred to the nursing home because she was uninsured at the time.

The hospital could not be reached for comment. The American Hospital Association (AHA) in Chicago, IL, has filed an amicus brief with the court in support of the improper-motive argument. The American Medical Association expects to join in the AHA's brief.