James v. Sunrise Hospital, 86 F.3d 885, 1996 U.S. App. LEXIS 14537 (9th. Cir. 1996)

The patient was admitted to the hospital with renal failure. A synthetic graft was inserted into her arm. The next day, she complained of pain and numbness in her forearm around the graft site, and these symptoms continued to spread. Her hand became blue and hospital staff noted a weak pulse in that arm. Regardless of these obvious symptoms, the hospital discharged the patient without caring for her veins. Her hand eventually had to be amputated as a result.

The Ninth Circuit considered the District Court’s dismissal of the failure to stabilize claim for failure to state a claim, and analyzed whether EMTALA was applicable to inpatients. The plaintiff argued that her claim was brought solely under subsection (c) of the relevant statute, concerning “transfers” of a patient who is “at a hospital” with an “emergency condition,” as opposed to subsection (b), which applies when an individual “comes to a hospital and the hospital determines that the individual has an emergency medical condition.” The court engaged in statutory interpretation and determined that subsection (c), restricting transfers of unstabilized patients, applies only to an individual who “comes to the emergency room” for a medical screening and is found to have an emergency medical condition. The court acknowledged that the issue was close and difficult, but found that Congress only intended to restrict transfers of individuals who were not stabilized after the hospital has actual notice of an emergency medical condition. Although the plaintiff argued that this simply encouraged hospitals to do a “so bad a job that it never even spots emergencies,” the court found that the screening provisions and state malpractice laws adequately protected patients from such a concern.

Notes: One of the earlier cases engaging in detailed statutory interpretation of the interplay between the three operative provisions of the statute. This case does highlight some of the ambiguity in the drafting of the statute; for instance, the screening requirement applies to a person who “comes to an emergency room”; the stabilization requirement applies to an individual who “comes to a hospital”; and the transfer provision applies to an individual “at a hospital.” It is unclear from the plain text if all three of these provisions were intended to be read in concert, but the courts have construed them so, finding that the transfer provision applies to individuals who are not properly stabilized after they have received an appropriate medical screening examination that has revealed an emergency medical condition.