Morgan v. N. Miss. Med. Ctr., Inc., 403 F. Supp. 2d 1115, 2005 U.S. Dist. LEXIS 31512 (S.D. Ala. 2005)

This is a very detailed District Court opinion that grappled with the issue of whether admitting an individual as an inpatient eliminates liability under the statute. (See a more detailed description of this issue here). The decedent fell from a tree stand located in a hunting camp and suffered severe injuries, including fractured ribs, vertebrae, dislocated shoulder, and a pulmonary contusion. The decedent was rushed to the hospital/defendant’s emergency room. The decedent was uninsured, and, upon arrival, the hospital notified the decedent’s spouse that she would need to make arrangements for payment. The hospital admitted the patient, but discharged him nine days later, with the allegation being that certain critical tests were not performed. Shortly after being transferred home by ambulance, the decedent passed away from complications related to the fall.

The plaintiff alleged both screening and stabilization claims against the hospital. With respect to the screening claim, the plaintiff alleged that the hospital failed to perform an MRI of the decedent’s spine. In reviewing the claims on a motion to dismiss, the court found that the complaint was devoid of any allegation pertaining to disparate treatment or deviation from standard protocol. The court noted that this claim was merely a “negligence claim in disguise.” However, even if the plaintiff had alleged disparate treatment, the court found that the allegation pertained to the plaintiff’s entire hospital admission, and that there was no authority to support the circumstance “in which EMTALA’s screening duty has been extended to an inpatient some eight days post-admission to the hospital.” Id. at 1127.

In the more interesting part of the court’s opinion, the court analyzed the stabilization claim and whether the decedent’s admission cut off EMTALA liability for the hospital. The court noted that there were varying views on the issue among the different circuits: the Fourth Circuit in Bryan limits the application of EMTALA to “the immediate aftermath” of the patient’s admission; the Sixth Circuit in Thornton permits a stabilization claim even if the patient is admitted for several days, so long as the patient “is found to suffer from an emergency medical condition in the emergency room”; finally, the Ninth Circuit in Bryant finds that the stabilization requirement ends upon admission, so long as there is no evidence that the admission was designed merely to avoid EMTALA liability. Siding with the Ninth Circuit, the court cleverly noted that “[i]f the Fourth Circuit’s construction of the temporal limits of § 1395dd(b) is too draconian, and if the Sixth Circuit’s is too permissive, then, much like Goldilocks in the famed fairy tale, the Ninth Circuit’s approach may be just right.” Id. at 1129. This is known as a “subterfuge” theory of admission.

Interestingly, the court actually found that the complaint alleged a subterfuge claim. The complaint alleged that the hospital was immediately pressing for financial information and then immediately made plans to discharge the patient when it was determined that there would be no source of payment. The court found that these allegations “could reasonably support a conclusion that the Hospital’s admission of Mr. Morgan was a mere facade, a charade undertaken for risk management purposes even though the Hospital had no intention of stabilizing his injuries before transferring him.” Id. at 1130.

Notes: This is an interesting case that performs a thorough analysis of the inpatient situation under EMTALA and settles in the center of the divided Circuit Courts. It is also one of the few cases where a subterfuge theory had been found to be supportable.