1. Analysis/Application
1.1. The plaintiff argues Wishard violated EMTALA because they did not stabilize the patient and unborn child prior to transfer to another hospital, thus resulting in permanent injury to the child and whether the plaintiff had come to the emergency room of the hospital.
1.1.1. EMTALA requires patients who come to the emergency department of a hospital to be screened and stabilized prior to being transferred to another facility.
1.1.2. The Department of Health and Human Services (DHHS) under EMTALA regulations have defined when a person has come to the emergency room under 2001 definition as an individual on hospital property includes ambulances owned and operated by the hospital even if the ambulance is not on hospital grounds.
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.
1.1.3. 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.
2. Conculsion
2.1. Summary judgement was granted in favor of the defendant
2.1.1. The Wishard ambulance was operating under EMS protocol at the time the plaintiff was in it and therefore the plaintiff had not come to the Wishard emergency department under the EMTALA and have no base for their claim.
3. Impact
3.1. Bowden v. Georgetown University Hospital
3.1.1. Non profit hospitals providing in-patient Medicare services brought action against Secretary of Health and Human Services wage index rule to calculate reimbursable wage costs.
3.1.1.1. The question presented in this case was whether the Secretary could use their rulemaking authority to promulgate cost limits that are retroactive.
3.1.1.1.1. It was ruled that retroactive rule could not be upheld under the Secretary's authority and could not make retroactive adjustments.
3.1.1.1.2. The Supreme Court ruled that an administrative agency may not promulgate retroactive rules unless Congress grants the agency to do so and a rule cannot be used retroactive unless it uses language in the rule requiring that result.
3.2. Clay v. Johnson
3.2.1. Clay and Chivers had contracts and mortgages provided by Davenport who assigned the contracts to Johnson the mortgagee. The plaintiffs are suing for failure to disclose under the Truth in Lending Act.
3.2.1.1. Summary judgement was initially awarded to the plaintiffs however the defendants appealed. The defendants motion for reconsideration was based on the interpretation of the TILA which stated the creditor could satisfy the TILA by defining the beginning payment date by reference to the occurrence of a particular event rather than a calendar date. The court rejected this argument because Comment 18 (g)-4 had not been issued at the time the defendants made their disclosures to the plaintiffs. The court said it could not be applied retroactively.
3.2.1.1.1. The district court ruled that Comment 18(g)-4 does not have a retroactive effect and does apply to the defendants disclosure and the judgement was reversed.
4. Importance
4.1. This case is important in determining whether or not particular health care laws which may have been revised or rewritten can be used retroactively.
4.2. This case is also a reminder for emergency departments to understand the laws outlined by EMTALA in regards to stabilizing a patient prior to transfer to another location.
4.3. Emergency transport should be aware of laws and which hospitals they should be routed to for instance in this case they went to a hospital that did not have OB services however they had a patient with an OB emergency. Should the patient initially have been routed to the proper hospital if it were within proper and appropriate distance to save the patient.
4.3.1. EMTALA laws are enacted to prohibit patient dumping and to ensure patients are routed to the nearest and safest emergency location appropriate to the situation.
5. Influence
5.1. Emergency room procedures to avoid EMTALA violations are becoming more widely accepted and best practices for hospitals are being outlined to adhere to the current laws. Avoiding EMTALA Penalties | Holland & Hart Health Law Blog
5.1.1. Emergency department logs are required in order to track patients and whether or not they received treatment stabilized or transferred to another site. These logs can be audited if an incident occurs
5.1.2. Emergency rooms are required to stabilize the patient and once this is done the EMTALA no longer applies. A woman in labor is considered stable once she has delivered the baby.
5.1.3. Written consents and or refusals for patients who resist stabilizing treatment and or transfers must be obtained from the patient.
6. Facts
6.1. Parties involved include the plaintiff Melissa Welch and her minor son, Joshua Beller and the defendant Health and Hospital Corporation of Marion County, Indiana dba Wishard Memorial Hospital and Wishard Ambulance Service.
6.2. Ms. Welch who was 34 weeks pregnant called 911 because her water broke and she had a prolapsed umbilical cord. She was transported to the nearest hospital which was St. Francis Beech Grove. St. Francis Beech Grove did not have a OB facilities and she was then transported to St. Francis Hospital South where Joshua Beller was delivered via Caesarean section and the child suffered hypoxia and resulted in severe brain damage.
6.3. The incident occurred on June 14, 2001 when Ms. Welch initially called 911. The plaintiff, Ms. Welch filed a suit against the Hospital claiming a violation of Emergency Medical Treatment and Active Labor Act(EMTALA). Summary judgement was initially denied for the hospital and later reconsidered and granted summary judgement for the hospital.
7. Issue
7.1. Did Wishard Ambulance Service violate EMTALA by transferring Joshua to Beech Grove instead of stabilizing him by delivering him and this failure resulted in permanent brain damage.
7.2. This case must determine whether the plaintiff had "come to the emergency room" of Wishard Memorial Hospital when they were transported in the Wishard ambulance.
7.3. Can the 2003 amendment to EMTALA be applied retroactively in this case even though the incident had occurred in 2001.
8. Rule of Law
8.1. Alleged violation of Emergency Medical Treatment and Active Labor Act (EMTALA)
8.1.1. Examination and treatment for emergency medical and women in labor 42 U.S.C. S 1395dd
8.1.1.1. An individual with an emergency medical condition must be stabilized before they can be transferred.
8.1.1.2. Appropriate transfer if the transferring hospital provided medical treatment within it's capacity to minimize risk to the patient and health of an unborn child.
8.1.2. Defines how a patient "comes to the emergency department" 42 CFR 489.24.
8.1.2.1. Patient has presented on hospital property and requests treatment for an emergency medical condition.
8.1.2.2. 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.