1. Application
1.1. EMTALA applies for patients that "come to the emergency room"
1.2. The 2001 definition of EMTALA states that a patient is on hospital property if they are in an ambulance that is owned and operated by the hospital
1.2.1. It doesn't matter if the ambulance is not even on hospital grounds
1.3. In 2003, this definition was changed so that an ambulance operating under EMS protocols is not considered to have come to the emergency room of the hospital that owns the ambulance
1.3.1. If this is applied retroactively to this case, the plaintiffs did not come to the Wishard emergency room by being in a Wishard ambulance
1.4. District court decided that the 2003 amendment was just a clarification
1.4.1. Therefore, this could be applied retroactively to this case
2. Conclusion
2.1. Summary judgment was in favor of the defendants
2.1.1. Wishard ambulance was operating under EMS protocols and therefore relieved of EMTALA obligations
3. Impact
3.1. Bowden v. Georgetown University Hospital
3.1.1. Nonprofit hospitals sued Health and Human Services for wage index rule to calculate reimbursable wage costs
3.1.1.1. Supreme Court decided that a rule can not be used retroactively unless there is language in the rule requiring that
3.2. Clay v. Johnson
3.2.1. Plaintiff Clay had mortgages assigned to Defendant Johnson
3.2.1.1. Plaintiff suing for not being disclosed the Truth in Lending Act
3.2.1.1.1. Argument was that defendant satisfied Truth in Lending Act by defining the beginning payment date in reference to a specific event rater than an actual date
4. Importance
4.1. Ambulances operating under EMS protocols are not under the same obligations as emergency rooms under EMTALA
4.1.1. The definition of the "come to the emergency room" in EMTALA was clarified
4.2. Case is important in determining when a revision or amendment can be applied retroactively
4.2.1. Clarifications can be applied retroactively
4.2.2. Substantial changes can not be applied retroactively
5. Influence
5.1. Common practice is to collect insurance information after patient has been stabilized or seen by an emergency physician
5.2. Logs are kept of all transfers out of the emergency room
5.2.1. Transfers should be because patient can not be stabilized or treated at the initial hospital
5.2.2. Transfers should not be due to ability to pay (patient dumping)
6. Facts
6.1. Parties
6.1.1. Plaintiff
6.1.1.1. Joshua Beller
6.1.1.1.1. Son of Melissa Welch
6.1.2. Defendant
6.1.2.1. Health and Hospital Corp. of Marion County
6.1.2.1.1. Owners of Wishard ambulance and Wishard Memorial Hospitall
6.2. What happened
6.2.1. Melissa Welch was 34 weeks pregnant and her water broke with a prolapsed umbilical cord
6.2.2. On June 14, 2001, the EMS system was activated and Wishard ambulance responded
6.2.2.1. Paramedics contacted nurse at Ms. Welch's obstetrician
6.2.2.2. Patient transported to St. Francis Beech Grove
6.2.3. St. Francis Beech Grove did not have obstetrics facility
6.2.3.1. Physician examined patient
6.2.3.2. Patient then sent to St. Francis Hospital South
6.2.4. Emergent C-section was performed
6.2.4.1. Joshua Beller was born with severe brain damage from hypoxia
6.3. Procedural history
6.3.1. District court granted summary judgment for Health and Hospital Corp. of Marion County
6.3.2. Plaintiff appealed
7. Issue
7.1. Was WIshard responsible for stabilization of this patient under EMTALA?
7.1.1. Wishard ambulance was owned and operated by Wishard Memorial Hospital
7.1.2. Did the patient "come to the emergency room" when picked up by Wishard ambulance?
7.1.3. If so, then EMTALA should apply to WIshard
8. Rule
8.1. Emergency Medical Treatment and Labor Act (EMTALA)
8.1.1. Law to prevent "patient dumping" and treatment discrimination based on ability to pay
8.1.2. Hospitals must stabilize patient and provide treatment for patients with an emergency medical condition
8.1.3. If the hospital does not have the capability to stabilize the patient, the patient should be appropriately transferred