1. Analysis / Application
1.1. The plaintiff argues Wishard violated EMTALA
1.1.1. EMTALA requirement consist of
1.1.1.1. patients transported to a hospital's emergency department are to be propery stabilized and screened.
1.1.1.1.1. All of which is expected to be done prior to transferring to another hospitals emergency room or facility
1.1.2. The department of Health and Human Services ( DHHS)
1.1.2.1. The incident occured in 2001 and the question remained whether the 2003 amendment applied retroactively to determine whether the plaintiff had come to the emergency room at Wishard.
1.1.2.1.1. The district court decided that the amended definition of "comes to the emergency department" was just a clarification to the rule which could be applied retroactively
1.1.2.2. 2001 defined the EMTALA regulations as "hospital property included ambulances regardless of their present location. ( on or off of the hospital grounds)
1.1.2.2.1. Given the definition in the 2001 statement, can the amendment completed in 2003 be applied.
1.1.3. The 2003 DHHS definition of comes to the hospital if the ambulance is operated under EMS protocols that direct it to transport an individual to a hospital other than the hospital that owns the ambulance the person is not considered to have come to the emergency room of that hospital
1.1.3.1. Under the 2003 amendment the plaintiffs would not have come to the Wishard emergency room by their presence in that ambulance
1.1.4. The EMTALA protocol was violated
1.1.4.1. Based on the lack of stabilizing the patient and unborn child before transfer to either location.
1.1.4.1.1. The lack of stabilizing and evaluative measures.resulted in permanent injury to the unborn child.
1.2. Application
1.2.1. Common Law
1.2.1.1. The duty of care associated with the EMT department.
1.2.1.1.1. To render emergency care to those in need.
1.2.2. Statute -
1.2.2.1. 2001 DHHS : Ambulances owned or operated by a hospital then patients are considered in a "comes to emergency room" status
1.2.2.1.1. Appellate and trial court
1.2.2.2. Codified in Emergency Medical Treatment and Labor Act (EMTALA) 1985
1.2.2.2.1. 2003 DHHS regulation:(EMS) protocols Hospital owned ambulances and or operated by a hospital .
1.2.3. Statute
1.2.3.1. (EMTALA) Emergency Medical Treatment and Labor Act 1985
1.2.3.1.1. Definition sections
1.2.3.2. 2) With respect to a pregnant woman who is having contractions
1.2.3.2.1. The transfer may pose a threat to life of the mother or the unborn child.
2. Conclusion
2.1. Summary judgement was granted in favor of the defendant
2.1.1. In favor of the defendants
2.1.1.1. Durring the time in which the plaintif was resinding with in the Wishard ambulance.
2.1.1.1.1. The Wishard emergency department was operating under the EMTALA protocall.
2.2. Appellate court
2.2.1. Judgement in favor of the Health and Hospital Corp. of Marion County.
2.3. Trial Court
2.3.1. Judgement in favor of the Health and Hospital Corp. of Marion County.
2.4. The case insured the support for the diferenve between clarification" and a "substantive material change" it makes sense
2.4.1. A clarificaiton
2.4.1.1. Which clarified the terminology amended in the 2003 DDH terms as unclear in the 2001 stated protocol..
2.4.2. A substantive material change
2.4.2.1. There were no actions taken to restate or alter the terms in anyway. The intent was made clearer not altered.
3. Impact
3.1. Georgetown University Hospital VS Bowden
3.1.1. Georgetown University Hospital -Non profit hospitals
3.1.1.1. Could the Secretary use their rule making authority to retroactive. promulgate cost limits?
3.1.1.1.1. The ruling
3.2. Clay v. Johnson
3.2.1. Clay and Chivers had contracts and mortgages provided by Davenport
3.2.1.1. Davenport assigned Johnson to the contracts as the mortgagee.
3.2.1.1.1. The plaintiffs claim there was a failure to disclose under the Truth in Lending Act
4. Influence
4.1. Hospitals are adding to their better practices routines as preventative measures to avoid EMTALA violations. Additional clarification and awareness of the inner workings of the protocols.
4.1.1. Apply the old adage of, if it is not written down it never happened.
4.1.1.1. The auditing of such reports is necessary to avoid or prevent additional law suites. Thus ensuring patient care and the adherence to all (EMTALA) protocols.
4.1.1.1.1. Such reports indicate if the patient did or did not receive treatment, evaluative care or stabilizing measures.
4.1.1.2. This mentality is also important on the behalf of a patient who is refusing the care provided.
4.1.1.2.1. If the patient refuses then the refusal must be in writing and recorded, to ensure no violations have taken place.
4.1.2. The EMTALA emphasis on the stabilizing of the patient.
4.1.2.1. Once the patient is stabilized, the EMTALA is no longer applicable.
4.1.2.1.1. Once a woman has given birth to the unborn child, than she considered stabilized.
4.1.3. Written consents and or refusals for patients who resist stabilizing treatment and or transfers must be obtained from the patient.
5. Procedural History
5.1. Summary
5.1.1. Trial court
5.1.1.1. Judgment for health and hospital court of Marion County (Wishard)
5.1.1.1.1. Judgment honored (EMTALA)
5.2. Appellate couret
5.2.1. upheld judgment
5.2.1.1. Regarding Health and Hospital Corp of Marion county (Wishard).
5.2.1.1.1. Judgement maintained continued honoring of the (EMTALA)
6. FACTS
6.1. Parties
6.1.1. Plaintiffs
6.1.1.1. Melissa Welch
6.1.1.1.1. Ms Welch filed suit against the hospital
6.1.1.2. Minor Son Joshua Beller
6.1.2. Defendant
6.1.2.1. Health and Hospital Corporation of Marion's County (INDIANA)
6.1.2.2. Wishard Memorial Hospital and Wishard Ambulance service.
6.2. What happened
6.2.1. According to the Plaintiff
6.2.1.1. At 34 weeks pregnant Ms Welch called 911
6.2.1.1.1. Her water had broke.
6.2.2. According to the Defendant's
6.2.2.1. June 14th, 2001 - A Wishard ambulance was dispatched to Melissa Welch's residence
6.2.2.1.1. The call was regarding Ms Welch's water breaking.
6.2.3. The paramedics along with Melissa's OB, agreed immediate transportation to the nearest hospital was necessary.
6.2.3.1. The nearest hospital was St. Fancis Beech Grove, which did not have an OB facility.
6.2.3.1.1. Ms Welch was then transported to St. Francis Hospital South
6.2.4. Ms Welch sued the Hospital
6.2.4.1. The claim - violation of Emergency medical treatment and active labor. Act (EMTALA)
6.2.5. Wishard Ambulance
6.2.5.1. Their actions were to operate under the community wide emergency medical service (EMS) procedures.
6.2.5.1.1. The Department of Health and Human Services (DHHS) later amended the definitions in 2003
7. ISSUE
7.1. Wishard Ambulance Service
7.1.1. Did they violate EMTALA protocol by transferring the plaintiff and her unborn son to Beech Grove i
7.1.1.1. Rather than of stabilizing him by delivering him.
7.1.1.1.1. If so, did this violation cause or resulted in permanent brain damage to the unborn child.
7.2. The question at hand
7.2.1. Did the plaintiff "Come to the emergency room"?
7.2.1.1. As the Wishard Memorial hospital
7.2.1.1.1. When she was transported by the Wishard ambulance.
7.3. Retroatively applied
7.3.1. Can amendments made in 2003 regarding the clarification of term, be applied to the outcome and or actions taken in 2001?
7.4. Issue before the court
7.4.1. The Department of Health and Human Services for Medicare and Medicaid (DHHS) 2003 amendment, is a clarification or a substantive change in definition?
7.4.1.1. The court did not define this as a substantive change in definition.
7.4.1.1.1. The intent of the phrasing remained intact and was not altered.
7.4.1.2. The court decided the 2003 amendment was a clarification not a change of the terms definition.
7.5. Do the actions taken by Wishard Ambulance in 2001
7.5.1. When transferring Joshua and his mother to St Fran Beech south
7.5.1.1. Rather than attempting to stabilize the unborn child
7.5.1.1.1. Violate the EMTALA and result in permanent irreparable damage to Joshua
8. Importance
8.1. This case was fundamental in the process of deeming if specific healthcare law can be applied retroactively.
8.1.1. This case is important in determining whether or not particular health care laws which may have been revised or rewritten can be used retroactively.
8.2. This case is important because it requires the Emergency department to be aware of the laws and regulations governed by the EMTALA.
8.2.1. Specifically as they relate to the evaluative and stabilizing of a patient, prior to transferring them to an additional location.
8.3. This case is important beucase it remind the Emergancy transportaiont services to remain aware of which locaiton provides which serves.
8.3.1. The laws governing EMTALA laws are prohibit the dumping of patients off at a the nearest drop off point location. situation.
8.3.1.1. The protocols with in EMTALA are there to protect both the provider as well as the patient.
8.3.2. By not being aware of this information, the same result as did befall Joshua could occur again. The time wasted moving son and mother from one location to another could have been better spent moving them initially to a location that did provide OB services.
9. Rule Of Law
9.1. Alleged
9.1.1. Violation of Emergency Medical Treatment and Active Labor Act (EMTALA)
9.1.1.1. Defines how a patient "comes to the emergency department" 42 CFR 489.24
9.1.1.1.1. Patient has presented on hospital property and requests treatment for an emergency medical condition.
9.1.1.1.2. If a patient comes to the hospital under EMS protocols in an ambulance the patient is considered to have come to the emergency room to the hospital which they were transferred thus brought onto hospital property
9.1.1.2. (EMTALA) 42 U.S.C. S 1395dd 1985
9.1.1.2.1. An individual with an emergency medical Transferring of a patient seeking medical help,must occur once the patient has been evaluated and stabilized.
9.1.1.2.2. Appropriate transfer
9.1.1.2.3. Examination and treatment for emergency, such as expected for evaluation for and stabilizing of women in labor
9.2. Common Law
9.2.1. Statute - Codified in Emergency Medical Treatment and Labor Act (EMTALA) 1985 Application