Bryan v. Rectors and Visitors of the Univ. of VA, 95 F.3d 349, 1996 U.S. App. LEXIS 24139 (4th Cir. 1996)

The patient was admitted to the emergency room and the family instructed the hospital to take all necessary measures to keep her alive. The hospital, allegedly against the family’s wishes, entered a do not resuscitate order. The patient eventually suffered a heart attack and expired eight days after the order was entered.

The plaintiffs alleged because the patient “came to” the emergency room with an emergency medical condition, the hospital had an obligation under EMTALA to stabilize her condition, even after she was admitted as an inpatient, and the hospital failed to offer stabilizing treatment by letting the patient expire. The court disagreed with this theory, and stated the following: “It seems manifest to us that the stabilization requirement was intended to regulate the hospital’s care of the patient only in the immediate aftermath of the act of admitting her for emergency treatment and while it considered whether it would undertake longer-term full treatment or instead transfer the patient to a hospital that could and would undertake that treatment. It cannot plausibly be interpreted to regulate medical and ethical decisions outside that narrow context.” Id. at 353 (emphasis added). Because the patient had received stabilizing treatment for twelve days following her admission, the court found that no EMTALA violation could be alleged and dismissed the claim by way of a 12(b)(6) motion.

Note: One of the original cases to establish that EMTALA does not apply to inpatient hospital care, even if that patient “comes to” the hospital through the emergency room first. CMS issued regulations consistent with this opinion in 2012.