Eberhardt v. City of Los Angeles, 62 F.3d 1253, 1995 U.S. App. LEXIS 23052 (9th Cir. 1995)

Neighbors of a 23 year old called the police to report that the patient was suffering from a heroin overdose. When paramedics arrived, the patient was found orientated and with generally normal vital signs. Oxygen was applied and Narcan was administered to reverse the effects of opioid drugs. The patient was transferred to a hospital. The patient told the triage nurse that he had snorted cocaine and smoked heroin. The physician who evaluated the patient found that the Narcan had helped alleviate the patient’s symptoms. The physician recalled the patient stating that he wanted his life to end and that he was upset that he received care. The patient was advised to seek long-term methadone treatment at another hospital. The patient, shortly thereafter, pulled out his IV and left the emergency room. Thirty hours later, the patient, armed with a machete, began breaking windows of a private residence, and was shot and killed by police officers.

The plaintiff alleged that the hospital and the individual physicians violated the failure to stabilize provisions of EMTALA by discharging the patient in an unstable mental condition. First, the court held that a private claim could not be brought under EMTALA against the individual physicians involved, as the statute only authorized claims against hospitals.

Second, the court found that EMTALA only required a screening examination to detect “acute and severe symptoms that alert the physician of the need for immediate medical attention to prevent serious bodily injury.” Id. at 1257. The plaintiff had not shown that the patient’s suicidal condition was manifested by severe and acute symptoms. However, the patient had signed his own discharge papers and agreed to seek methadone treatment. The court found that there was nothing substandard about the screening evaluation in terms of deviation from a standard policy, and thus a screening claim could not be sustained.

Finally, the court found that there could no failure to stabilize claim because the hospital did not have actual knowledge of the alleged emergency medical condition, i.e. the suicidal tendency.

Notes: Certainly an odd case factually, but  the Court applied standard EMTALA principles to resolve the issue. There was no evidence that the hospital deviated from its standard screening. The court did not address the effect of the patient effectively discharging himself by walking out of the hospital.