Beller v. Health and Hosp. Corp. of Marion County, Indiana, 703 F.3d 388, 390 (7th Cir. 2012).
1. Impact
1.1. Guardian v. Health and Hospital Corporation of Marion County 2016 WL 6822468, *5, S.D.Ind
1.1.1. Plaintiff brought a suit against defendant for failure to administer an "appropriate medical screening" and negligence in stabilizing plaintiff in an emergency situation, which resulted in acute renal failure. Plaintiff required acute rehabilitation, and plaintiff claims that Wishard Memorial Hospital's negligence in proper screening and stabilization was the proximate cause of injury.
1.1.2. Defendant argues that plaintiff's claim of malpractice does not apply under EMTALA
1.1.3. The case describes the intent of EMTALA, that the law attempts to prevent emergency rooms from transferring patients before they are stabilized, and sites the Beller case as an example of a suit filed with a claim of negligence for that reason
1.1.4. Court granted defendants' motion for summary judgement. Court reasoned that a reasonably prudent physician would have administered similar tests, and another patient with similar symptoms would have received different treatment, thus no evidence of malpractice or negligence under EMTALA.
1.2. Gillispie v. RegionalCare Hospital Partners, Inc. 2014 WL 12599597, *1, W.D.Pa
1.2.1. Plaintiff brought 5 complaints against defendant for retaliatory discharge in violation of EMATLA, as well as wrongful termination. Defendants filed a motion to dismiss wrongful termination claims due to lack of evidence or facts.
1.2.2. Plaintiff was employed for 13 years by Southwest Regional Medical Center, and claims she was terminated after attempting to report patient care that did not meet the standard of care. Plaintiff claims the termination violated EMTALA and PA public policy. The Plaintiff claimed that SWRMC violated EMTALA by providing emergency room care that was negligent, patients were wrongfully discharged, and in one instance negligence resulted in the death of a patient.
1.2.3. The case sites the Beller case as an example of the purpose of EMTALA to prevent Emergency Departments from refusing to treat uninsured patients.
1.2.4. The court denied the defendants' motion to dismiss 4 counts of the Plaintiff's complaint, citing PA law that "an employer may terminate an employee for any reason (or none) unless parties are bound by a contract."
1.2.4.1. The court also argues that EMATLA looks to state law for remedies for violations of the law, and EMATLA itself does not have a statutory remedy.
2. Influence
2.1. The DHHS regulation and court's ruling "clarifies the responsibilities of hospital-owned ambulances to encourage better integration with citywide and local community EMS procedures for responding to medical emergencies"
2.2. The holding upheld precedent set by "seventh circuit case law that recognized an agency's regulation or rule that clarifies an unsettled or confusing area of law may be applied retroactively."
3. Importance
3.1. The case set a precedent based on the interpretation of the EMTALA amendment of what constitutes "come to the emergency room." Ambulances not operated by a specific organization, even if owned by the health care organization, are immune to liability if they are operating under community wide EMS protocols and are diverted to facility that may be closer or more appropriate than the owning organization.
4. Facts
4.1. Parties
4.1.1. Plaintiff: Joshua Beller
4.1.2. Defendant: Health and Hospital Corp of Marion County (Wishard Memorial Hospital)
4.2. What Happened
4.2.1. 2001:Melissa Welch called a Wishard ambulance at 34 weeks pregnant
4.2.2. Paramedics determined that Welch's water broke, and tried to relieve pressure from a prolapsed umbilical cord
4.2.3. Paramedics called Welch's OB office, and agreed with the nurse that Welch should be taken to the nearest hospital
4.2.4. Paramedics took Welch to St. Francis Beech Grove Emergency Room, which did not have an OB facility
4.2.5. Physicians examined Welch, and afterwards Wishard ambulance took Welch to St Francis Hospital South
4.2.6. Son, Joshua Beller, was delivered via C-Section at St Francis Hospital South
4.2.7. Baby Beller Had severe brain damage from hypoxia
4.2.8. Welch filed a malpractice suit against Wishard Memorial Hospital
4.2.8.1. Claim: Wishard Memorial Hospital violated EMTALA
4.2.8.1.1. Hospital was negligent in stabilizing Melissa Welch and her son, Joshua Beller (a minor) during a medical emergency
4.2.8.1.2. Argued that wishard should have delivered baby Beller to stabilize him
4.2.8.1.3. Claim that Wishard's negligence in transferring baby Beller to St Francis Beech Grove was the proximate cause of Joshua Beller's ensuing brain damage and permanent injuries
4.3. Procedural History
4.3.1. Plaintiffs brought malpractice suit against Health and Hospital Corp of Marion County (Wishard Memorial Hospital)
4.3.2. District court granted a summary judgement for the Hospital
4.3.3. Plaintiffs appealed
4.3.4. Appeals court upheld holding of district court
5. Issue
5.1. Should the EMTALA definition of "comes to the emergency room" from the 2001 law or amended 2003 definition apply in the case of Joshua Beller?
5.1.1. If the 2001 definition applies, "comes to the emergency room" means that the individual is on hospital property when in the ambulance, and Wishard would have violated EMTALA and there would be grounds for negligence
5.1.2. If the 2003 definition applies, the plaintiff would not have come to the emergency room of Wishard Memorial Hospital when transported by the Wishard ambulance, and Wishard would not have violated EMTALA and been negligent in transferring the patient
6. Rule
6.1. Violation of EMTALA
6.1.1. EMTALA regulations define when an individual has "come to the emergency room"
6.1.1.1. The definition at the time of the incident (2001) was amended
6.1.1.1.1. Under the 2001 definition, "comes to the emergency room" means that the individual is on the hospital property
6.1.1.1.2. Under the 2003 definition, plaintiff would not have "come to the emergency room" by means of transport by a Wishard Ambulance
6.2. Negligence
6.2.1. If the 2001 definition applies, "comes to the emergency room" means that the individual is on hospital property when in the ambulance, and Wishard would have violated EMTALA and there would be grounds for negligence
6.2.1.1. Hospital failed to stabilize Melissa Welch and her son, Joshua Beller (a minor) during a medical emergency and negligence was the proximate cause of Joshua Beller's brain damage and permanent injuries
7. Analysis
7.1. Regulatory Amendment
7.1.1. Should the 2003 amendment be applied retroactively?
7.1.1.1. 1988 Supreme Court precendent: Congress must endow agency (DHHS) with authority to declare retroactive rules
7.1.1.2. DHHS must also specifically indicate that rules should be applied retroactively
7.1.2. Was the amendment a clarification or change in law?
7.1.2.1. Did the 2003 amendment clarify the meaning of "come to the emergency room" as it had been understood by the DHHS? Or did the rule pose a change in the law?
7.1.2.1.1. Wishard ambulance was operating under EMS protocols at time of transport of plaintiff to Beech Grove Hospital
7.1.2.1.2. 2001 regulation would nullify the claim brought against Wishard Hospital
7.2. District Court Holding:
7.2.1. District court granted summary judgement in favor of Wishard Hospital
7.2.1.1. Held that amended definition was a clarification, not a change in definition
7.2.1.2. Reasoned that 2003 amendment served to clarify nuances of hospital-owned ambulances operating under EMS protocols
7.3. Plaintiff's Take:
7.3.1. Appealed district court summary judgement
7.3.2. Argued that DHHS may or may not have meant the 2003 amendment to be a clarification
7.3.3. Argued that court failed to conduct independent analysis of whether the amendment was a change or clarification to the 2001 definition
7.4. DHHS's Take:
7.4.1. DHHS considered the 2003 amendment to be a clarification of the definition of "comes to the emergency room"
7.4.1.1. "clarifications to address confusion regarding the 2001 definition"
7.4.1.2. “reiterations and clarifying changes are needed to ensure uniform and consistent application of policy and to avoid any misunderstanding of EMTALA requirements by individuals, physicians, or hospital employees.”
7.4.2. DHHS Final Rule: “proposal to clarify that EMTALA does not apply to a hospital-owned ambulance when the ambulance is operating under community wide protocols that require it to transport an individual to a hospital other than the hospital that owns the ambulance.”
7.5. Appeals Court's Take:
7.5.1. Intent of DHHS should factor into court's analysis of whether the amendment was a change in law or a clarification.
7.5.1.1. Court deferred to DHHS's intent that the 2003 amendment was a clarification
7.5.1.1.1. 2003 amendment clarifies what "operated by" a hospital means
7.5.2. Plaintiff focused on ambulance ownership, and neglects to take into account the qualifier of "operated by"
7.5.2.1. Ambulance can be owned by a hospital, but not operated by said hospital, as is the case with Wishard Memorial Hospital
7.5.2.1.1. As such, Plaintiff would not have "come to the emergency room" of Wishard Memorial Hospital, given that the ambulance is question was owned by Wishard but was not operated by the Hospital
8. Conclusion
8.1. Court found no inconsistency between 2001 and 2003 EMTALA definitions
8.1.1. Both definitions hold that plaintiff would have "come to the emergency room" if they were in an ambulance owned and operated by the hospital
8.1.1.1. Wishard ambulance was operating under EMS protocol
8.1.1.2. Welch and baby Beller, Plaintiffs, had not come to the Wishard emergency department under EMTALA
8.2. Plaintiff's claim of EMTALA violation and negligence does not hold
8.2.1. Wishard did not violate EMTALA nor act negligently in failing to stabilize Joshua Beller and transferring him to another facility
8.2.1.1. Wishard's actions were not the proximate cause of Josua Beller's injuries