Legal Eagle Eye Newsletter for the Nursing Profession (4)7 Apr 96
A detailed court ruling came in a case filed against a healthcare facility by the family of a deceased patient. The family claimed the deceased was denied appropriate medical screening and stabilizing treatment and inappropriately transferred to another facility in violation of the Emergency Medical Treatment and Active Labor Act.
In a preliminary hearing, the court threw out the familys allegations the deceased had not been adequately screened and stabilized in the facilitys emergency department. The court also ruled appropriate the facilitys decision to transfer the patient to a specialized facility for care. However, the court did fault the manner in which the transfer was effected.
The deceased sustained massive burns in an industrial accident. He was transported by ambulance to the local hospital, where he was promptly examined in the ER. IV fluids and oxygen started by EMTs in the field were continued, and morphine was given IV for pain. The physician decided the patient needed to go to a regional trauma center for specialized burn care.
Arrangements were made to transport the patient by ground ambulance, with a driver, paramedic and registered nurse. Serious respiratory problems developed en route. The on-board personnel stopped at the nearest hospital, where the patient could be intubated. A respiratory therapist joined the team on board the ambulance. By the time they reached the burn center, the patients condition, according to the court record, had "materially deteriorated." He expired without regaining consciousness. The family filed suit.
The EMTALA was not violated by the manner in which this patient was medically screened. According to the court, the EMTALA does not establish a national malpractice standard mandating how patients are to be screened in hospital emergency departments.
According to the court, the EMTALA requires that hospitals apply their standard screening procedures for identification of emergency medical conditions uniformly to all patients. As a legal standard, the EMTALA does not address the clinical adequacy of a screening examination, but only looks at whether the screening examination that was performed deviated from the hospitals evaluation procedures that would have been performed on any other patient with a similar condition.
The court concluded that when this patient left the emergency department he appeared stable enough to make the trip to the burn center. Under the EMTALA, if no material deterioration of the patients condition is likely, within reasonable medical probability, to result from or during transfer, the emergency department has fulfilled its legal duty with respect to stabilizing treatment, according to the court.
Even assuming the patient appears medically stable enough to be transferred to another facility more suited to provide the care needed by the patient, and the patient is not being "dumped" upon another facility for being uninsured, on public assistance or indigent, a healthcare facility is still responsible under the EMTALA for seeing that the transfer is brought about to an appropriate facility and in an appropriate manner.
There was no question that a specialized burn trauma center was an appropriate facility to which to transfer this patient.
However, the court faulted the first hospital for not opting to transport this patient by air ambulance for more rapid arrival, and for not selecting transport able to intubate him immediately if he experienced respiratory difficulties associated with severe burn trauma en route. Smith vs. Janes, 895 F. Supp. 875 (S.D. Miss., 1995).