Beller v. Health and Hospital Corp. of Marion County, Indiana

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Beller v. Health and Hospital Corp. of Marion County, Indiana by Mind Map: Beller v. Health and Hospital Corp. of Marion County, Indiana

1. Facts

1.1. Plaintiff: Joshua Beller (minor) and Melissa Welch (mother)

1.1.1. Defendants: Health and Hospital Corp. Of Marion County, Indiana, d/b/a Wishard Memorial Hospital, d/b/a Wishard Ambulance Service

1.2. June 14, 2001 Melissa Welch was 34 weeks pregnant and called 911 because her water broke. Paramedics identified that she had a prolapsed umbilical cord. Decision was made to transport her to the nearest hospital

1.2.1. She was transported to St Francis Beech Grove ER which did not have an OB facility. She was examined and then sent to St Francis Hospital South.

1.2.1.1. At St Francis Hospital South her son, Joshua Bellar, was delivered by Caesarean section but had suffered hypoxia resulting in severe brain damage.

1.2.1.1.1. Plaintiffs allege that Wishard violated EMTALA by transferring her to Beech Grove instead of stabilizing him by delivering him thus resulting in permanent injuries

2. Issue

2.1. Had the plaintiffs "come to the emergency room" of Wishard Memorial Hospital when they were transported in the ambulance? Does the 2001 definition or the 2003 amended definition apply (can the 2003 definition be applied retroactively)?

3. Rule

3.1. EMTALA was enacted to counteract the problem of "patient dumping" (not treating uninsured patients or transferring to an alternate facility). It creates two duties:

3.1.1. 1) Duty to screen for emergency condition(s)

3.1.2. 2) Duty to stabilize the patient prior to transfer to another facility

3.2. EMTALA created a definition of when a patient had "arrived at the emergency room".

3.2.1. 2001: "Comes to the emergency department means...the individual is on the hospital property...[p]roperty...includes ambulances owned and operated by the hospital..."

3.2.2. 2003: A person is NOT considered to have come to the emergency room if "...the ambulance is operated under communitywide emergency medical service (EMS) protocols that direct it to transport the individual to a hospital other than the hospital that owns the ambulance..."

4. Analysis

4.1. Plaintiffs argument

4.1.1. Since the event occurred in 2001, the 2003 amendment can not be retroactively applied

4.2. Defendants argument

4.2.1. The 2003 amendment did not create substantive change in the law and thus was merely a clarification, thus the 2003 amendment could be applied to this case.

4.3. District courts decision

4.3.1. Agreed that the amended definition was a clarification and granted summary judgement in favor of defendant.

4.3.1.1. Plaintiffs appealed judgement challenging that the 2003 amendment was a clarification.

4.3.1.1.1. Plaintiffs argument

4.3.1.1.2. Courts reasoning

5. Conclusion

5.1. Affirmed district courts decision granting the defendant summary judgement.

6. Impact

6.1. McDaniel v. Covin

6.1.1. Debra McDaniel seeks judicial review of denial of her SSI claim. She claims that the administrative law judge failed to take all evidence into account and analyze medical record appropriately and he also misjudged her credibility.

6.1.1.1. In the course of her claim the administrative law judge reasoned that her claim of inability to seek medical care or obtain medications was false and used evidence of recent gallbladder surgery to substantiate his claim.

6.1.1.1.1. Mrs. McDaniel presented to the ED with chest pain. Through the course of her cardiac work-up it was determined that her gallbladder was the source of her pain and underwent urgent surgery. Beller v Health and Hospital Corp was cited to demonstrate that since she presented to the ED, under EMTALA there was an obligation to treat despite her lack of insurance whereas outpatient physicians are under no obligation to treat or give prescriptions if patient lacks insurance.

6.2. Muzaffar v. Aurora Health Care Southern Lakes, Inc.

6.2.1. Dr. Muzaffar brought action against hospital claiming he was retaliated against for reporting violations of EMTALA.

6.2.1.1. The hospital moved to dismiss claiming that Dr Muzaffar raised no federal question because, although he had hospital privileges, he was not an employee and was therefore not covered under EMTALA's whistle-blower provision.

6.2.1.1.1. Beller v Health and Hospital was cited to describe the intended purpose of EMTALA which is to prevent "patient dumping".

7. Importance

7.1. A healthcare provider would care about the decision because it helps clarify where the obligations under EMTALA begin. In other words, in a hospital owned and operated ambulance the duties to assess and stabilize in a non-discriminatory fashion begin when the patient enters the ambulance. However, if the ambulance is under communitywide EMS protocols the duty begins with actual arrival to hospital grounds.

8. Influence

8.1. Has served to curb discrimination based on lack of insurance ("wallet biopsies" or "patient dumping"). In so doing it has also incentivized hospitals to create regional and communitywide standards of acceptable behaviors for transfers.

8.2. It gave patients an affirmative right to treatment. It recognized patients general right to access healthcare, particularly in the case of emergencies.