By Wolters Kluwer Editorial Staff
A Pennsylvania district court dismissed with prejudice a patient’s Emergency Medical Treatment & Labor Act (EMTALA) (42 U.S.C. §1395dd) claims against a hospital and its doctors for failure to screen and failure to stabilize, reasoning that the allegations did not touch the crux of an EMTALA claim—the events occurring within the emergency room. However, the court denied the hospital and its doctor’s motion to dismiss the patient’s negligence claim and request for punitive damages ( Hollinger v. Reading Health System, July 14, 2016, Stengel, F.).
Background. Emergency medical services transported a patient to Reading Hospital and Medical Center on September 9, 2013, after he was found unresponsive and incontinent of stool on the porch of the building from which he had been evicted. While he was in the emergency room, he continued to suffer seizures, and a doctor noted that he was also experiencing confusion and loss of consciousness. Following testing, including a CT scan showing atrophy indicative of small strokes, the patient was admitted as an inpatient at the hospital and assigned to an attending physician.
The next day, a neurologist examined the patient and concluded that the seizures were most likely due to alcohol withdrawal. The hospital’s alcohol withdrawal protocol was not initiated until September 14, when the patient was given an increased dose of Ativan. Several more days of examination and observation showed that the patient continued to be agitated, disoriented, combative and confused. On September 20, the patient slapped a nurse across the face with an open hand and, not fully ambulatory at the time, fell over. Hospital security requested that the patient be evaluated for discharge to facilitate his transfer into police custody.
After reevaluation by a psychiatrist, the hospital discharged the patient. The physician’s discharge summary described that the patient’s deliriums as “resolved” and noted that he was capable of making a decision regarding his discharge. The discharge summary made no reference to the patient’s mobility issues or the physical therapy that he was undergoing. The discharge instructions advised the patient to follow up with a primary care physician and highlighted a recommended change in his Ativan treatment. The patient did not leave the hospital with medication to control his seizures or his agitation. After his discharge, police escorted the patient from the hospital in a wheelchair to a prison and charged with aggravated assault. Shortly after patient’s arrival at the prison, he began to suffer grand mal seizures again.
EMTALA. The patient based his failure to screen claim and failure to stabilize on the “screening” that the psychiatrist and the discharging doctor had performed shortly before his discharge, eleven days after being admitted. The court noted that the legislative history and statutory language are clear that EMTALA’s screening and stabilization requirement is limited to the emergency room. The court noted that despite the patient’s characterization of the case as one of “patient dumping,” there was no factual basis for this characterization. The court noted that the patient made no allegations whatsoever challenging the care he received in the emergency room. The court noted that the patient has not alleged that his admission from the emergency room into the hospital was subterfuge to avoid EMTALA obligations nor do his allegations indirectly support such a contention.
Other claims. The court dismissed without prejudice the patient’s claims under Title III of the Americans with Disabilities Act (ADA) ( 42 U.S.C. §12182(a)) and section 504 of the Rehabilitation Act ( 29 U.S.C. §701 et seq.). However, the court allowed negligence claims to proceed, because the complaint presented sufficient factual allegations to establish a plausible claim for negligence. The court noted that that the dismissal of the patient’s medical malpractice claim against hospital and its doctors on the basis of Mental Health Procedure Act would be premature. The court also found that the patient had sufficiently stated a claim for punitive damages against the hospital and its doctors. Though the facts may later prove at most that the hospital and its doctors were merely negligent, discovery is necessary to make this determination and dismissal would be premature.