Beller v. Health and Hosp. Corp. of Marion County Indiana, 703 F.3d 388 (7th Cir. 2012)

The patient, a 34 week-pregnant woman, called 911 after her water broke at home. The paramedic dispatched to the house diagnosed a prolapsed umbilical cord and attempted to relieve pressure on the cord. The ambulance that transferred the patient belonged to another hospital’s emergency room. However, due to the emergent nature, the patient was brought to the nearest hospital, which did not have obstetrics capacity. The physician who examined the patient there determined that she needed care at a hospital with appropriate facilities and transferred the patient by ambulance to another hospital. After arrival, the baby was delivered by cesarean section with severe brain damage.

The issue in the case was whether the patient had “come to the emergency room” of the hospital who’s ambulance first transferred the patient, and the issue required a determination to be made by the court as to which CMS regulations applied, the 2001 or 2003 versions. Under the 2001 regulations, the hospital’s “property” was defined by CMS to include an ambulance even if not on hospital property. In 2003, this definition was slightly altered to exempt ambulances operated under communitywide emergency medical service protocols and directed to transport an individual to a hospital other than the hospital that owns the ambulance. The court determined that the agency regulation from 2003 applied retroactively because, under past precedent, CMS was merely amending the definition of the term “comes to the hospital” to reflect the definition it had always intended, i.e. a clarification as opposed to a substantive change. In doing so, the court looked to the agency explanatory statements in the federal register and also considered that EMS protocols was not in effect at the time of the 2001 regulations. Because the plaintiff had not “come to the emergency department, due to the ambulances participation in EMS protocols, summary judgement on EMTALA claim in favor of the hospital was affirmed.”

Note: A case dealing with a lesser known aspect of EMTALA, and a good example of how careful reading of the statute in conjunction with the CMS regulations can have a substantial impact on the case outcome.