1. Is being in a hospital owned ambulance constitute "coming to the hospital's emergency room?"
2. Facts
2.1. Parties
2.1.1. Melissa Welch, Plaintif
2.1.2. Health and Hospital Corporation of Marion County, Indiana d/b/a Wishard Memorial Hospital d/b/a Wishard Ambulance Service
2.2. What happened
2.2.1. June 14, 2001, Plaintiff who was 34 weeks pregnant called for an ambulance
2.2.1.1. Paramedics showed up and determined her water had broken and she had a prolapsed cord
2.2.1.1.1. Paramedics consulted with plaintiffs OB nurse, determined she needed to be transported to nearest hospital, "Beecher Grove" and transported her there
2.2.1.2. The Ambulance was owned and operated by Wishard Memorial Hospital
2.2.2. Physicians at Beecher Grove Hospital ED examined the plaintiff, but did not treat because Beecher grove did not have an OB department
2.2.2.1. Plaintiff was transferred on the Wishard owned ambulance to St. Francis Hospital South
2.2.3. At St. Francis Hospital South, Joshua Beller (son of Melissa Welch) was delivered via C-section
2.2.3.1. Joshua Beller had suffered hypoxia and permanent brain damage
2.3. Procedural History
2.3.1. Plaintiffs sued claiming that Wishard (the hospital that owned the ambulance) had violated EMTALA by transferring the patient to Beech grove instead of stabalizing him by delivering him themselves
2.3.1.1. The Plaintiffs argue that by the 2001 EMTALA act, being in a Wishard owned ambulance constituted "coming to the hospital's emergency room
2.3.1.1.1. the 2001 act had specified that an ambulance constitutes a hospitals emergency room even if the ambulance is not on hospital grounds
2.3.2. Court ruled summary judgement in favor of the defendants
2.3.2.1. Wishard hospital did not violate EMTALA because the ambulance was operating under countywide EMS protocols which dictated the patient was to be taken to the nearest hospital, which was not Wishard
2.3.2.2. Plaintiffs appealed
2.3.3. in 2003, a clarification was issued that clarified that an ambulance was considered to be part of a hospital's emergency room except
2.3.3.1. i). If the Ambulance is operating under communitywide EMS protocols that direct the ambulance to transport the patient to a hospital other than the owners hospital
2.3.3.2. ii). the ambulance is operated at the direction of a physician who is not employed or otherwise affiliated with the hospital that owns the ambulance
2.3.4. Both parties agree that under the 2003 amendment, the ambulance would not constitute Wishard's emergency room
2.3.4.1. in their appeal, the plaintiffs argue that the amendment was a change to the 2001 law, and that under the original language made the Wishard ambulance count as the hospital's emergency room
2.3.4.1.1. which definition should be used?
2.3.5. The appeals court confirmed the lower court's judgement
2.3.5.1. ruled that the amendment did not change the law, but clarified the existing language
3. Issue before the Court
3.1. Did the amendment constitute a change of the 2001 law?
3.1.1. If so, can the language of the amendment be used to justify a court ruling retroactively to the court's decision?
4. Rule of Law
4.1. EMTALA
4.1.1. A hospital is obligated to treat and stabilize a patient who comes to the hospital's emergency room such that the patient's condition will not deteriorate before the hospital can transfer or discharge the patient
4.1.1.1. A patient is considered to have come to a hospital's emergency room if the patient is located anywhere on hospital property, or within 250 yards from one
4.1.1.1.1. Ambulances owned by the hospital are considered to be hospital property even when they are not on hospital grounds
4.1.1.2. a 2003 amendment clarified that there were 2 exceptions when a patient in an ambulances owned by the hospitals that do not compel the hospital to treat the patient under EMTALA
4.1.1.2.1. if the ambulance is operating under communitywide protocols that dictate the patient be transported to a hospital other than the one that owns the ambulance
4.1.1.2.2. if the ambulance is operating under the direction of a physician who is neither employed by nor affiliated with the hospital
4.1.2. The law was enacted to prevent hospitals from "patient dumping," a practice by which a hospital transfers a patient to another facility, or does not provide the same care for an uninsured as to an insured patient such as to avoid treating indigent and other patients who are unable to pay
5. Analysis
5.1. Is a hospital obligated to treat under EMTALA
5.1.1. Is the patient on hospital property
5.1.1.1. no
5.1.2. Is the patient within 205 yards of a hospital property
5.1.2.1. no
5.1.3. Is the patient in an ambulance owned and operated by the hospital
5.1.3.1. Yes
5.1.3.1.1. Does an exception apply?
5.2. Does the 2003 amendment constitute a change to the 2001 law as the plaintiffs claim?
5.2.1. No. as the circuit court points out, the 2003 issuance by DHHS repeatedly states, starting with the title of the issuance, that the 2003 amendments are clarifications needed to ensure uniform and consistent application of policy
5.2.1.1. As there is no change to the law, there is no question of retroactive application
5.2.1.2. the 2001 law claims the ambulance must be "owned and operated by" the hospital
5.2.1.2.1. an ambulance operating under community wide EMS protocols is not "operated" by the hospital.
6. Conclusion
6.1. Court determined that the 2003 amendment did not constitute a change to the EMTALA law
6.1.1. And upheld the ruling of the lower court
7. Impact
7.1. No court cases were found which materially referenced the findings in Beller v. Health and hospitals corp in deciding on the obligations under EMTALA for hospitals owning ambulance services
8. Importance
8.1. Just because a hospital owns an ambulance, doe not make the hospital itself responsible for the treatment of all the patients that ambulance may transport, such as those who never come close to the hospital itself
8.2. Hospitals are willing to run ambulance services under their own medical direction
8.2.1. this can provide patients with a higher standard of care compared to unaffiliated ambulance organizations or fire departments due to the training and resources available to the ambulance through its association with the hospital