Reynolds v. Maine General Health, 218 F.3d 78, 2000 U.S. App. LEXIS 16950  (1st Cir. 2000)

The patient was involved in a head-on collision and suffered fractures in his legs. He was taken to the hospital’s emergency room, and was triaged by a nurse and physician. A history was obtained, and labs, x-rays, and an abdominal CT were ordered. General and orthopedic surgeons were consulted. It was determined that surgery was required, and the patient underwent repair of his right tibia and left foot fractures. He was admitted to the hospital for post-operative care, and was discharged five days after he presented. Five days after discharge, he died from a massive pulmonary embolism emanating from a DVT at the fracture site. The patient’s mother testified that a physician was told that there was a history of clotting in the patient’s family.

The claims were for failure to screen for DVT and for discharging before stabilizing the patient. The court affirmed the grant of summary judgment for the hospital on both counts. First, the court stated that “at issue in this case is the precise scope of a participating hospital’s duty to screen for risks or related conditions associated with or aggravated by an emergency medical condition.” The court engaged in a lengthy analysis of whether a “symptom,” for the purposes of EMTALA, included “any evidence or communication of information that an [EMC] may exist.” The court rejected this approach, finding that the patient was not experiencing any symptoms of DVT. The court also rejected the argument that the hospital had a new duty to screen once the patient was admitted to in-patient service following his surgery. The court found that “the fact that [the patient] was in the hospital receiving treatment is a prima facie showing that the purposes of [the screening requirement] was satisfied.” Second, the court rejected the stabilizing argument, finding that there was no evidence that an EMC existed at the time of discharge.

Notes: An important case for its reading of the term “symptoms” in the statute.