1. Facts
1.1. Parties
1.1.1. Plaintiff
1.1.1.1. Melissa Welch and her minor son, Joshua Beller
1.1.2. Defendant
1.1.2.1. Health & Hospital Corp. of Marion County (Wishard Memorial Hospital)
1.2. What Happened
1.2.1. Patient, 34 weeks pregnant, called 911 after water broke at home on June 14, 2001. Wishard ambulance, The Ambulance was owned by Wishard Memorial hospital, was dispatched.
1.2.2. Paramedic diagnosed prolapsed umbilical cord; ambulance transferred patient to nearest hospital, which did not have an obstetrics unit.
1.2.3. Emergency room physician examined patient and requested transfer to hospital with appropriate facilities; subsequently, the baby was delivered by Caesarean section with severe brain damage.
1.3. Procedural History
1.3.1. District Court
1.3.1.1. Granted summary judgment for the defendant.
1.3.1.2. Held that the 2003 regulation was a clarification and that transport in a hospital ambulance was not "coming to an emergency room" if the ambulance were following community EMS protocols.
2. Issue
2.1. The issue at hand was when did the "duty" of the hospital begin, and under EMTALA at what point has someone "come to the emergency room".
2.2. Also, whether the plaintiff's permanent injuries were a result of the failure to stabilize the patient (and her minor son), in violation of EMTALA, because the plaintiff(s) had "come to the emergency room" when they were transported in the hospital's ambulance per the 2001 regulation.
3. Rule of Law
3.1. EMTALA
3.1.1. Enacted in 1986, Know as the "anti-dumping" law prohibits hospitals from choosing which patients to treat based on ability to pay
3.1.2. 1. The hospital must provide medical screening for any medical condition 2. If emergency condition exists, the patient may not be transferred to another hospital or discharged until he/she is stabilized
3.2. Evolving Regulation
3.2.1. The 2001 Dept of Health & Human Services (DHSS) regulation, based on EMTALA, specifies that a patient has presented to the emergency room when he / she is in a hospital owned and operated ambulance (even if the ambulance is not on the hospital campus).
3.2.2. The 2003 DHHS regulation, an amendment of the 2001 regulation, allowed that a patient did not come "to an emergency room" if the hospital's ambulance was operating under communitywide EMS protocols.
4. Analysis/Application
4.1. How the rule of law is applied
4.1.1. Arguments
4.1.1.1. Plaintiff Argument - Because the ambulance was owned and operated by the hospital, the transport of the patient constituted "[coming] to the emergency room" and, per the 2001 regulation, violated EMTALA by failing to stabilize patient and son during an emergency medical situation.
4.1.1.2. Defendant Argument - The 2003 regulation should be applied to the case because it represented a clarification (rather than a substantive change) to the 2001 regulation. Patient did not "come" to the hospital, but was transported by an ambulance operating under community EMS protocols; therefore, a claim cannot be made under EMTALA.
4.1.2. Court
4.1.2.1. The Circuit Court found that the language in the 2003 regulation was unambiguous; the regulation makes it clear that it was intended as a clarification of the earlier regulation. Hence, it can and should be applied.
4.2. Cases that have cited the holding
4.2.1. Hatzell v. Health & Hospital Corp of Marion County
4.2.1.1. Cheryl Hatzell, and mentally disabled adult, was brought to the hospital by her mother Alice. The patient presented with constipation and the inability to urinate. She was given a laxative and sent home with orders to follow up with her primary care physician. The laxative was effective but the patient was still unable to urinate.
4.2.1.2. The following day Cheryl fell down the stairs at the family hime and was brought back to the hospital by way of an ambulance. After testing it was determined that she had only suffered a broken nose. Alice (mother) again states that Cheryl still had not been able to urinate and was concerned of a UTI. Throughout both visits hospital Doctors states that they could not find anything wrong with Cheryl. She was again, discharged with orders to follow up with her primary.
4.2.1.3. Cheryl worsened over the weekend and was found unresponsive the following Tuesday morning. She was agin rushed to the hospital and treated for renal failure and brain damage due to toxicity of the urine backup.
4.2.1.4. The judge cited Beller v. Health & Hospital.. as the standard for adequately gathering health history, and for "patient dumping" It was determined that the defendants had not violated EMTALA in regards to its treatment of Cheryl
4.2.2. Muzaffar v. Aurora Health Care Southern Lakes, Inc.
4.2.2.1. Dr. Muzaffar claims Aurora retaliated against him because he complained about patient transfers that he believed violated EMTALA
4.2.2.1.1. Does the complaint allege a violation under the whistleblower provision?
4.2.2.2. It is argued by Aurora that Dr. Muzaffar is not a hospital employee, but a physician who is privileged to practice at the hospital; therefore, the whistleblower provision does not protect him
4.2.2.3. This case cites Beller v. Health & Hospital.. as the statute to prevent "patient dumping"
4.2.2.4. Defendant's motion to dismiss was denied as the whistleblower provision covers physicians privileged to practice as employees
4.2.3. Johnson v. University Chicago Hospitals
4.2.3.1. Lenise Johnson, a one month old child, stopped breathing. his mother Emerald Johnson contacted emergency services
4.2.3.1.1. Lenise is taken to St. Bernard's Hospital where she is stabilized and transferred to Cook County Hospital where they had a pediatric intensive care unit. Lenise later died
4.2.3.2. Claims that the defendant violated the Comprehensive Omnibus Budget Reconciliation Act (COBRA), and that the telemetry systems being used as a resource were owned and operated by the University of Chicago Hospitals owed a duty to Lenise since it voluntarily assumed the responsibility's of a hospital.
4.2.3.2.1. Under COBRA a hospital owned telemetry system is distinct from that hospitals emergency room and that no duty is implied by the use of that hospitals telemetry system.
4.2.4. Gatewood v. Washington Healthcare Corp
4.2.4.1. Mr Gatewood, a fully insured patient, arrived WHC complaining of pain radiating down his left arm into his chest. he was diagnosed with musculoskeletal pain and discharged. Within 24 hours Mr. Gatewood Died of a heart attack.
4.2.4.1.1. Two years later Mrs. Gatewood brought action against WHC, the treating physicians, as well as the EMS transport company. This action was predicated under the EMTALA claiming patient dumping through failure to diagnose.
5. Conclusion
5.1. Finding
5.1.1. Held that the District Court was correct in interpreting the 2003 regulation as a "clarification" rather than a "substantive change" to the 2001 regulation.
5.1.1.1. Held for the Defendant. No EMTALA violation exists because the patient had not presented to Wishard Memorial Hospital's ER.
5.2. Importance
5.2.1. DHHS's clarification of EMTALA's reach over hospital-owned ambulances operating under EMS protocols had been a source of confusion
5.2.2. EMTALA provides a private right of action for individuals who sustain person harm as a result of hospital's violation of the statute
5.2.2.1. Also contains a whistleblower provision
5.2.2.1.1. A participating hospital may not penalize or take adverse action against a qualified medical person 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..
5.3. Influence
5.3.1. Business practices that have been influenced by the holding
5.3.1.1. Hospital-owned ambulances and other medical transport activities are common arrangements (and, pursuant to both local regulations and the 2003 DHHS language, follow EMS protocols regarding decisions for transport).