Legal Eagle Eye Newsletter for the Nursing Profession (3)11 Aug 95


   Quick Summary: The EMTALA was enacted by Congress in 1986 to prevent "patient dumping," the transfer of a patient from one facility to another solely because of the patient’s indigency or lack of insurance.

   However, the EMTALA applies to all patients, whether or not they are indigent and even if they have insurance.

   Hospitals may be sued under the EMTALA if they provide a substandard emergency medical screening or make an inappropriate transfer of an emergency- room patient.

   Once an emergency-room patient is stabilized, a hospital’s responsibilites under the EMTALA end. If the patient is not stabilized, a patient may be transferred only if the patient consents, or if the physician certifies that the benefits of transfer outweigh the risks.

   A hospital may transfer a patient when it lacks the facilites to stabilize the patient’s condition.  UNITED STATES DISTRICT COURT, NORTHERN DISTRICT OF OHIO, 1994.


   A patient sued a hospital and the on-call emergency room physician claiming that he had been refused treatment because of his HIV+ status.

   The suit alleged violation of the Federal EMTALA, the Americans with Disabilities Act and the Federal Rehabilitation Act of 1973. The suit also alleged that the hospital and the physician had intentionally and negligently inflicted emotional distress upon the patient, in violation of the state law of Ohio.

   The patient and his companion were travelling through Ohio on their way from Maine to a vacation destination in Wisconsin. The patient took a floxin tablet, apparently his first experience with that medication. Within two hours he began to experience fever, headache, nausea, joint pain and redness of the skin. He phoned his physician in Maine and was told to go to the nearest emergency room.

   When he got to the emergency room, he was suffering from toxic epidermal necrolysis. The court record is somewhat confusing. The emergency room staff stated in court they concurred with the emergency room physician’s after-the-fact diagnosis of toxic epidermal necrolysis, but it was apparent they thought at the time the patient presented himself that he had experienced a sudden and pronounced advance from latent HIV+ status to full-blown AIDS.

   The diagnosis of toxic epidermal necrolysis was used by the hospital and emergency room physician in court as the reason for transferring the patient to a university teaching facility. The hospital and physician claimed they had diagnosed this condition in the emergency room, but did not know how or have the facilities to treat it, while the patient would claim this was just a pretext for trying to "dump" him upon another facility, due to his apparent manifestation of full-blown AIDS symptomatology.

   The U.S. District Court for the Northern District of Ohio attempted to sort things out by ruling that there was no violation of the EMTALA in this case. The patient was "stabilized" before his transfer to the teaching facility. Thus the hospital’s motive in effecting his transfer was not relevant to the purposes behind the EMTALA.

   Although the EMTALA was not violated, the court believed that the patient had stated probable cause for a violation of the Americans With Disabilities Act. This Act proscribes discrimination in public accommodations against persons with disabilities. The court was satisfied that a hospital was meant to be considered a "public accommodation," and that a person with HIV+ status is a "person with a disability" as defined by the Americans With Disabilities Act.. Howe vs. Hull, 874 F. Supp. 779 (N.D. Ohio, 1994).