1. Sequence of Events
1.1. Baby K born with Anencephaly and condition diagnosed prenatally
1.2. The hospital sought to transfer patient but didn't find a willing hospital, patient transferred to nursing home with condition of acceptance upon distress
1.3. Physician recommended supportive care and discussed "Do Not Resuscitate Order"withholding lifesaving measures which she refused
1.4. Hospital and Mrs. H failed to reach agreement and the hospital sought to transfer Baby K which failed
1.5. Hospital filed action for declaration that hospital is not required to provide aggressive treatment
2. Facts
2.1. Parties
2.1.1. Hospital (Plaintiff)
2.1.2. Mrs. H and Baby"K" (Defendant)
2.2. Procedural History
2.2.1. District Court granted summary judgement in favor of Mrs. H
2.2.2. Decision appealed to the 4th circuit court of appeals which upheld the lower court's decision
3. Issue
3.1. What defines an “Emergency Medical Condition,” and how are hospitals required to act - are they required to provide all necessary treatments available or provide a transfer to another hospital equipped with handling the condition?
4. Rule of Law
4.1. The Court applied the rule of law found within The Emergency Medical Treatment and Active Labor Act (EMTALA) which states that when a patient is diagnosed with an emergency medical condition, the hospital is required to provide all necessary treatments to stabilize and prevent further deterioration or provide a transfer to a facility that can.
5. Analysis
5.1. Plaintiff:
5.1.1. Baby K condition is futile
5.1.1.1. Most babies with anencephaly have no cognitive abilities and die within few days to weeks of birth
5.1.2. The standard of care is to provide supportive care- warmth, nutrition, and hydration
5.1.2.1. Ventilatory care serves no therapeutic or palliative purpose and is outside of the scope of the standard of care for these patients.
5.1.3. The court has previously interpreted EMTALA as requiring uniform treatment of all patients exhibiting the same condition.
5.1.3.1. The current treatment of ventilation is outside of the standard of care accepted in the medical community for anencephaly
5.1.4. By prohibiting disparate emergency medical treatment congress did not intend care outside of prevailing standards hence ventilatory care should be withdrawn
5.1.4.1. An exemption to EMTALA must be made when treatment is "futile"!
5.2. Defendant:
5.2.1. Mom as the only parent involved in Child's care should be able to decide what is in Child's best interest
5.2.1.1. Patient autonomy can instruct physician to continue medical treatment despite low chance of survival
5.2.1.1.1. There is value in each additional moment of life
5.2.1.1.2. Patients should have access to care without economic constraints
5.2.2. Respiratory distress not anencephaly is the emergency medical condition at issue
5.2.3. Given the severity of respiratory distress in Baby K, the law requires aggressive treatment to include mechanical ventilation to ensure no material deterioration of Baby K.
5.3. Court: Its beyond the judiciary function of the court to address the ethical dilemma of providing emergency medical care to anencephalic baby.
5.3.1. The court inteprets EMTALA in accordance with its plain language
5.3.2. EMTALA does not provide exception
5.3.3. Congress rejected case by case approach to EMTALA
6. Conclusion
6.1. Judge Wilkins of the fourth circuit of the US court of appeals held the decision of the district court.
6.2. The majority applied the rule found in Emergency Medical Treatment and Active Labor Act (EMTALA) which requires a hospital in an emergency to provide respiratory support to Baby K who was born with anencephaly.
6.3. The court recognizes the ethical and moral dilemma of physicians.
6.4. Courts interpret federal statutes in accordance with their plain language. Congress must redress policy concerns of the Hospital (Plaintiff), not the courts.
7. Importance
7.1. Medical Futility
7.1.1. Undermines physicians sound medical decisions
7.1.2. Allocation of advanced scarce resources
7.1.3. Clinical Bioethics, declaration of death, nature of personhood, moral standing are all a dilemma for physicians.