Bryant v. Adventist Health System/West, 289 F.3d 1162; 2002 U.S. App. LEXIS 9522 (9th 2002)

In Bryant, the patient, a seventeen year old, severely disabled boy, presented to the emergency room accompanied by his mother with complaints of coughing up blood and a fever for the prior four days. The physician ordered a chest x-ray and blood tests. The physician subsequently failed to recognize an abscess in the boy’s lung that was shown on the x-ray, and  misdiagnosed the boy with pneumonia and asthma only. The physician injected antibiotics and discharged the boy. The next day, a hospital employee called the boy’s mother and told them to return to the hospital immediately, as the abscess had been detected. Because there were no beds available in the intensive care unit, the boy was transferred to another facility. The boy was discharged and appeared to be improving, but later expired suddenly.

The family brought EMTALA claims against the hospital related to (1) the missed diagnosis of the lung abscess and (2) the boy’s four day hospital stay after he returned to the hospital and was diagnosed with the abscess and was later discharged. First, the court reiterated that “a hospital does not violate EMTALA if it fails to detect or if it misdiagnoses an emergency condition,” and thus the hospital could not be liable under the EMTALA screening requirement nor under the stabilization requirement, as the stabilization requirement does not take effect until the hospital is aware of the emergency medical condition. Secondly, the court found that the claim related to the stay at the hospital also was not actionable, as the hospital’s obligation under EMTALA ends when the individual is admitted for inpatient care.

Notes: A well-cited case for the concept that a misdiagnosis does not result in EMTALA liability. Also an excellent example of how EMTALA obligations end when an individual is admitted to inpatient care. See also 2012 CMS Regulations, clarifying inpatient exception.