Six days after he fell and hurt himself while climbing a tree the boy’s parents took him to the hospital’s emergency department.  After the nurse obtained vital signs and a history the boy was seen by the physician.  The physician ordered a CT of the lower extremities and pelvis.  Lab tests the physician ordered showed an elevated white blood cell count.  The physician did not consider the lab test results clinically significant.  He believed the boy’s injury was only a contusion with hematoma and muscle strain and he ordered the child discharged home with his parents.

    The next day the parents took the child to another hospital.  His temp was 103.6, pulse 166 and respirations 32.  He was diagnosed with a MRSA infection and spent six weeks in the hospital.

    The US Court of Appeals for the Fifth Circuit (Texas) dismissed the boy’s parents’ lawsuit which claimed that the hospital violated the US Emergency Medical Treatment and Active Labor Act (EMTALA).  A corporate representative from the hospital testified that the hospital’s standard policy for the emergency department was that the physician bore sole responsibility for the required EMTALA medical screening examination.  

    The hospital’s standard procedure for the emergency department was that the nurses, nurse practitioners and physicians assistants took vital signs and assessed their patients.  Hospital policy required them to communicate their findings to the emergency physician and document the data they obtained, but hospital policy held the emergency physician ultimately responsible for the required EMTALA medical screening examination.