Joshua Beller v Health and Hospital Corp. of Marion County 703F.3d 388 (7th Cir 2012)
1. Facts of the Case
1.1. Parties
1.1.1. Joshua Beller, Minor and his Mother ( plaintiff- Appellants)
1.1.2. Health and Hospital Corp. of Marion County d.b.a.Wishard Memorial Hospital d.b.a. Wishard Ambulance Service ( Defendant- Appellee
1.2. What happened
1.2.1. Mother and Minor Son filed suit against the defendant for violation of EMTALA
1.2.2. June 14th 2001 Ms Welch called 911 and Wishard Ambulance Service was dispatched to her call
1.2.3. EMS found the she was pregnant and in labor and that she had a prolapsed umbilical cord.
1.2.4. EMS in route to hospital called the Ms Welch's obstetricians office and consulted with a nurse who stated that the patient needed to be taken to the nearest hospital (Beech Groove)
1.2.5. EMS arrived at the nearest hospital and was turned away before stabilizing the unborn infant due to a lack of an OB/GYN department. After being examined by a the doctor at Beech Groove she was sent to St Francis Hospital South and the baby was born via c - section with sustained injuries due to hypoxemia
1.2.6. Plaintiff filled suit for Violation of EMTALA against Wishard Memorial Hospital
1.2.6.1. Violation of EMTALA
1.2.6.1.1. Duty to stabilize
1.2.6.1.2. Violation of that duty given Joshua was not stabilized
1.2.6.1.3. That breach of duty was the proximate cause of plaintiff's brain damage
1.3. Procedural history
1.3.1. Plaintiff files for relief in District Court of the southern District of Indiana
1.3.1.1. Summary judgement for the hospital was initially denied but later granted in favor of the defendant.
1.3.1.2. Plaintiffs appealed
2. Issue
2.1. Does the EMTALA definition of " comes to an emergency room" fall under the 2001 regulation of the 2003 amendment to that regulation.
2.1.1. Does the 2003 definition apply retroactively?
3. Rule
3.1. EMTALA
3.1.1. The facility must stabilize and treat an emergencies that can endanger a patients life or cause permanent harm.
3.1.1.1. The ambulance is an extension of the Emergency room under the 2001 regulation
3.1.1.1.1. Under the 2003 amendment the ambulance is not considered an extension of the hospital that owns it if the ambulance is participating in a community EMS program. Thus the question of who is in fact operating the ambulance is clarified.
3.2. In 1988 Supreme Court Case ( ...) it was ruled that " an administrative agency may not promulgate retroactive rules unless Congress has provided the agency with express authority to do so and even if such authority is given , an agency rule will not be accorded retroactive effect unless the agency uses language in the rule expressly requiring that result (Showalter 2017)
3.2.1. Is this a change in law?
3.2.2. Or is this a clarification?
4. Application
4.1. EMTALA applies when the patient in question "comes to the emergency room"
4.1.1. 2001 regulation and the 2003 amendment was this Clarification or a Change in the Law?
4.1.1.1. Retroactive application is allowed by the appellate court. The 2003 amendment is held to be a clarification of what always was with regard to the 2001 regulation.
4.2. The plaintiff claims that Joshua should have been stabilized and not transfered to another facility thus prolonging the hypoxic state of the unborn baby.
4.2.1. Plaintiff claims that prolonged state of hypoxemia was the proximate cause of damage
4.2.2. Plaintiff claims that under EMTALA stabilizing treatment should have been given before the transfer to the second hospital.
4.2.3. Plaintiff argued that the 2001 regulation and 2003 amendment were not consistent when defining EMTALA
4.3. The defendant claims that EMTALA was not violated and a transfer was warranted
4.3.1. No obstetrics department at the hospital
4.3.2. The 2003 amendment was intended to clarify not change law.
4.3.3. That the plaintiff focused on owned by but not " operated by"
5. Conclusion
5.1. The higher court finds:
5.1.1. Under the 2003 amendment the ambulance is not considered an extension of the hospital that owns it if the ambulance is participating in a community EMS program. Thus the question of who is in fact operating the ambulance is clarified.
5.1.2. Retroactive application is allowed by the appellate court. The 2003 amendment is held to be a clarification of what always was with regard to the 2001 regulation.
5.1.3. Court finds no inconsistency between the 2001 and 2003 EMTALA definitions
5.1.3.1. finds a difference between "owned" and operated"
5.1.4. That that the patient did not " come to the emergency room" at Wishard Hospital
5.2. The judgment of the lower court is affirmed
6. Impact
6.1. United States District Court, S.D. Illinois. Debra E. McDaniel, Plaintiff, v. Carolyn W. Colvin, Acting Commissioner of Social Security, Defendant.1 Civil No. 12–cv–1000–DRH–CJP Signed May 30, 2014
6.1.1. Hospitals face legal requirements to treat uninsured patients in certain circumstances. See, Beller v. Health and Hospital Corporation, 703 F.3d 388, 390 (7th Cir.2012), discussing the Emergency Medical Treatment and Active Labor Act. Individual doctors and pharmacies are not similarly required to provide care and medications to patients who cannot pay. McDaniel v. Colvin, No. 12-CV-1000-DRH-CJP, 2014 WL 2442543, at *7 (S.D. Ill. May 30, 2014)
6.2. United States District Court, E.D. Wisconsin. Kamal Muzaffar, M.D., Plaintiff, v. Aurora Health Care Southern Lakes, Inc., Defendant. Case No. 13–CV–744 Signed 11/18/2015
6.2.1. EMTALA provides a private right of action for individuals who sustain personal harm as result of a hospital's violation of the statute. See 42 U.S.C. § 1395dd(d)(2)(A). It also contains a whistleblower provision in 42 U.S.C. § 1395dd(i), which reads: (i) Whistleblower protections. A participating hospital may not penalize or take adverse actions against a qualified medical person described in subsection (c)(1)(A)(iii) or a physician because the person or physician refuses to authorize the transfer of an individual with an emergency medical condition that has not been stabilized or against any hospital employee because the employee reports a violation of a requirement of this section. Muzaffar v. Aurora Health Care S. Lakes, Inc., No. 13-CV-744, 2015 WL 12616164, at *5 (E.D. Wis. Nov. 18, 2015)
7. Influance
7.1. Regarding the interpretation of EMTALA and what constitutes the statement " come to the emergency room" was futher defined.
7.1.1. EMS protocols further defined
7.1.2. Hospitals may be willing to invest in more hospital owned EMS resources such as ambulances of aircraft for patient transfers
8. Imporatance
8.1. Standard of care further defined to incorporate EMS community protocols.
8.2. Provides a degree of protection for EMS protocol operated medical transports
8.2.1. This is important because hospitals can feel protected when deciding to transfer patients to more appropriate facilities