Moses v. Providence Hospital and Med. Ctr., 561 F.3d 573, 2009 U.S. App. LEXIS 7049 (6th Cir. 2009)

The hospital admitted the patient, who was brought to the hospital by his wife, for psychotic and “threatening behavior,” as well as a variety of physical symptoms. The physician noted that the patient was acting inappropriately, but that he had no signs of trauma. After a day or so of evaluation, the physician determined that the patient needed to be transferred to the psychiatric unit of the hospital on suicide precautions. The patient, however, was never transferred, but was instead discharged home. Ten days after being discharged, the patient murdered his wife. The estate of the wife brought a claim under EMTALA against the hospital, among other claims.

First, the court considered whether the wife had standing under EMTALA to bring a claim, given that she was not the actual patient who received treatment. The court analyzed the relevant statutory language and legislative history and concluded that EMTALA’s civil enforcement provision is not limited to patients who are actually treated at the hospital.

Second, the court considered whether the obligation to screen the patient was satisfied after the patient was admitted to inpatient care and discharged six days later. The court found that the statute requires “more than the admission and further testing of a patient; it requires that actual care, or treatment, be provided as well.” Id. at 582. The court noted that the statute “forbids the patient’s release unless his condition has ‘been stabilized,’” and does not simply apply to care in the emergency room setting. Id.

Although the court considered the CMS regulations, which at the time provided that a hospital’s liability under EMTALA ceases once the patient is admitted to inpatient service in good faith, the court rejected the agency’s interpretation of the statute as contrary to the plain language. The court noted that the statute required that “treatment” be provided to stabilize the patient and that “the hospital may not transfer the individual” with an emergency medical condition unless that patient consents—even if the patient had been admitted. (The court, alternatively, concluded that the regulations would not apply retroactively to the patient’s admission prior to their promulgation.)

Third, the court concluded that there was an issue of fact as to whether an EMC existed. With respect to the patient’s status on admission, the court found that noting a possible “acute psychotic episode” and placing the patient on suicide precaution could be viewed to support a jury’s conclusion that the hospital had actual knowledge of an EMC. Further, with respect to his condition at discharge, the court also found that the plaintiff introduced evidence questioning the validity of the physicians’ diagnosis that the patient was stable and was not in acute distress.

Finally, the court, agreeing with its sister circuits on the issue, held that an EMTALA claim could not be brought against an individual physician.

Notes: This is a very important case. First, it is one of the only cases to address EMTALA from a standing perspective, as far as we know. Second, this case was the first to outright reject CMS’s reading of the statute with respect to inpatient status, and prompted the agency to reconsider its regulations, soliciting further opinion of the community on the issue (CMS eventually declined to reconsider its take on the issue). This opinion also reaffirms the now well-established tenet that an EMTALA claim may not be brought against an individual physician.