1. FACTS
1.1. Parties
1.1.1. Plaintiff Melissa Welch; son Joshua Beller (Minor)
1.1.2. Defendant Health and Hospital Corporation of Marion County, Indiana
1.2. What Happened
1.2.1. June 12, 2001 Welch called 911
1.2.2. Wishard ambulance arrived
1.2.3. She was 34 weeks pregnant
1.2.3.1. Paramedics determined Welch's water broke
1.2.3.1.1. Also determined she had a prolapsed umbilical cord
1.2.4. Paramedics contacted Welch's obstetrician's office; both determined Welch needed to go to the nearest hospital.
1.2.5. Welch was transported to St. Francis Beech Grove Emergency Room
1.2.5.1. Beech Grove ER did not have an obstetrics facility
1.2.5.1.1. Welch was examined and transferred to St. Francis Hospital South via Wishard ambulance
1.2.5.1.2. Ambulance is operating under Emergency Medical Services (EMS) protocol
1.2.6. Joshua Beller was delivered at St. Francis Beech Hospital by C-Section
1.2.6.1. Beller was born with brain damage due to hypoxia/umbilical cord complications
1.2.7. Plaintiff's view
1.2.7.1. Defendant violated Emergency Medical Treatment & Labor Act (EMTALA)
1.2.7.1.1. Transported the patient versus delivering him at Beech Grove
1.2.8. Defendant's view
1.2.8.1. Under the 2003 version of EMTALA there is no violation
1.3. Procedural History
1.3.1. November 4, 2011 case decided by the U.S. District Court of Indiana
1.3.1.1. In favor of Defendant
1.3.2. Appealed on April 20th, 2012 and decided on December 20, 2012
2. ISSUE
2.1. Within the EMTALA statue, which definition of "comes tot he Emergency Room" applies in this case?
2.1.1. The 2001 definition or 2003 definition?
3. RULE OF LAW
3.1. EMTALA is a statue that provides examination and treatment for emergency medical conditions and women in labor
3.1.1. Under this statue there is a medical screening requirement
3.1.2. Also requires the necessary stabilizing treatment for emergency medical conditions and labor
3.1.2.1. Requirement is in effect the moment a patient comes to a hospital or emergency room and seeks treatment
3.1.2.2. Emergency Medical conditions for pregnant women with contractions are defined as:
3.1.2.2.1. Insufficient time for a safe hospital transfer before dlievery
3.1.2.2.2. Transfer may threaten the healthy/safety of mother and child
4. ANALYSIS
4.1. "Comes to the Emergency Room" is defined in 2001 and again in 2003
4.1.1. Department of Health and Human Services' Center for Medicare and Medicaid Services (DHHS) enacts and supports the definitions and amendments.
4.1.2. The 2001 definition specifies that "Comes to the ER" means the individual is on hospital property
4.1.2.1. Property includes ambulances owned and operated by the hospital
4.1.3. In 2003 the regulation was amended.
4.1.3.1. An ambulance is not considered an extension of the emergency room of the hospital that owns it if action in the capacity of community wide emergency medical service (EMS).
4.1.4. Plaintiff and Defendant agree that under the 2003 regulation the plaintiff would not have "come to the emergency room".
4.2. Plaintiff Position
4.2.1. The 2003 amendment of EMTALA should not be retroactively applied for an event that took place in 2001
4.2.2. Used Bowen v. Georgetown University Hospital as support against the retroactive application of statue
4.2.3. The 2001 and 2003 definitions are inconsistent.
4.2.3.1. 2003 definition was created to address an issue with how hospital owned ambulances would be directed with EMS use versus hospital use
4.2.3.1.1. Ambulances were used for EMS protocols and not under the direction of hospitals
4.2.4. 2003 amendment created two exceptions to the 2001 rule, making it a new definition and not a clarification
4.2.5. Unclear if DHHS intentions were for the 2003 amendment to be a clarification or a new definition.
4.2.5.1. District court did not conduct impartial analysis on what DHHHS meant for the 2003 amendment to be a substantive change or clarification
4.3. Defendant's Position
4.3.1. The 2003 amendment did not change the 2001 regulation but instead clarified it
4.3.1.1. EMS protocol created confusion around an ambulance being owned by a hospital but under the direction of EMS.
4.3.1.1.1. Person has not "come to the emergency room" if the ambulance is under EMS direction
4.3.2. Plaintiff only focused on the "hospital owned " aspect of the 2001 definition
4.3.2.1. Disregards part about the ambulance being "operated" by a hospital.
4.4. United States Court of Appeals
4.4.1. Used Clay v. Johnson to support that new amendments do not always change the law but restate the law.
4.4.1.1. Also used Clay v. Johnson in justification for citing the DHHS intent for the 2003 rule
4.4.2. DHHS stated that 2003 changes were for clarification and to address confusion within the 2001 definition
4.4.2.1. Title of document is: Clarifying Policies Related to the Responsibilities of Medicare Participating Hospitals in Treating Individuals with Emergency Medical Conditions.
4.4.2.1.1. EMTALA does not apply to ambulances operated under community wide direction that transport people to hospitals other than the hospital that owns the ambulance.
4.4.3. Both 2001 and 2003 uphold the same rule
4.4.3.1. 2003 clarifies the "operated by" aspect of the initial rule
5. CONCLUSION
5.1. The United States Court of Appeals affirmed the decision made by the District Courts in favor of the defendant.
5.2. Defendant was not guilty of violating the Emergency Medical Treatment and Active Labor Act.
6. IMPACT
6.1. McDaniel v. Colvin
6.1.1. Case was about the legal obligation of care for hospitals in emergency situations.
6.1.1.1. Beller v. health and Hospital Corp was used as a reference of how EMTALA was applied in emergency situations
6.2. HCA Health Services of Tennessee v. Blue Cross Blue Shield of Tennessee
6.2.1. Beller v. Health was used in reference to patient dumping and the requirement to stabilize and run assessments on a patient