Beller v. Health and Hospital Corp. of Marion County 703 F.3d 388 (2012) Rovner, Circuit Judge
1. Facts
1.1. Parties
1.1.1. Joshua Beller
1.1.2. Health and Hospital Corp. of Marion County
1.2. What Happened
1.2.1. A Wishard ambulance was dispatched to home of Melissa Welch due to a 911 call from Welch (June 14, 2001).
1.2.2. paramedics reported Welch was 34 weeks pregnant and her water had broke and a prolapsed umbilical cord
1.2.3. paramedics tried to relive the pressure from the cord
1.2.4. paramedics consulted with nurse from Melissa Welch's obstetrician's office and agreed Welch required immediate transportation to nearest hospital
1.2.5. nearest hospital was St. Francis Beech Grove (no obstetrics facility)
1.2.6. St. Francis Beech Grove physician examined Melissa Welch and baby and determined further transport required to St. Frances Hospital South
1.2.7. WIshard ambulance transported Melissa Welch and unborn son (Joshua Beller) to St. Francis Hospital South
1.2.8. Joshua Beller was delivered by Caesarian section in St. Francis Hosptial South but has suffered hypoxia resulting in severe brain damage
1.2.9. Wishard Ambulance was operating under communitywide emergency medical services (EMS) protocols
1.2.10. Department of Health and Human Services for Medicare and Medicaid (DHHS) subsequently amended their definitionin 2003 to exclude "comes to emergency room" for hospital owned ambulances operating under communitywide emergency medical services (EMS) protocols
1.3. Procedural History
1.3.1. Trial Court summary judgment for Health and Hospital Corp. of Marion County (Wishard)
1.3.1.1. Judgement held EMTALA "comes to emergency room" definition in 2001 and amended in 2003 by DHHS does not include hospital owned property (ambulance) operating under EMS protocols
1.3.2. Appellate court upheld the judgement for Health and Hospital Corp. of Marion County (Wishard)
1.3.2.1. Judgement upheld EMTALA "comes to emergency room" definition in 2001 and amended in 2003 by DHHS was a clarification of the 2001 definiton and not a substantive change
2. Issue Before the Court
2.1. was the amended 2003 definition of "comes to the emergency room" by Department of Health and Human Services for Medicare and Medicaid (DHHS) a clarification OR a substantive change in definition
3. Rule of Law
3.1. Common Law
3.2. Statute - Codified in Emergency Medical Treatment and Labor Act (EMTALA) 1985
4. Application
4.1. Common Law
4.1.1. "hospital emergency departments have a duty to evaluate all patients who present for service and to render emergency care to those who need it" (Showalter, The Law of Healthcare administration, 7th ed, Chicago, IL 2015
4.1.1.1. Evaluation criteria was met at St. Francis Beech Grove
4.2. Statute - Codified in Emergency Medical Treatment and Labor Act (EMTALA) 1985
4.2.1. definition enforced during 2001 DHHS regulation: Ambulances owned or operated by a hospital then patients are considered in a "comes to emergency room" status
4.2.1.1. this was the plaintiff's definition since the was the definition during the time period of the event
4.2.2. definition amended in 2003 DHHS regulation: Ambulances owned or operated by a hospital then patients are considered in a "comes to emergency room" status unless said ambulances are "operating under communitywide emergency medical services (EMS) protocols"
4.2.2.1. The trial and appellate court both considered this a clarification vice a substantial material change since DHHS in the 2003 amendment clearly and repeatedly stated this was a clarification and the title states "Clarifying policies Related to the Responsibilities... Emergency Medical Conditions" (Showalter, The Law of Healthcare administration, 7th ed, Chicago, IL 2015
4.2.2.2. Additionally, per the appellate court majority opinion "We therefore defer to an agency's expressed intent that a regulation be deemed a clarification unless the prior interpretation of the regulation is "patently inconsistent" with the later one"
4.2.3. In the definitions section of EMTALA (section (e)) The term "emergency medical condition" means -
4.2.3.1. (A) a medical condition manifesting itself by acute symptoms of suffcient severity (including severe pain) such that the absence of immediate medical attention could reasonably be expected to result in (i) [(or, with respect to a pregnant woman, the health of the woman or her unborn child) in serious jeopardy
4.2.3.2. (B) with respect to a pregnant woman who is having contractions- (ii) that the transfer may pose a threat to life of the safety of the woman or the unborn child