Nolen v. Boca Raton Cmty. Hosp., 373 F.3d 1151, 2004 U.S. App. LEXIS 12038 (11th Cir. 2004)

The patient, a pediatric nurse, was twenty-two weeks pregnant with triplets. She arrived at the emergency room complaining of cramping and mucous discharge. The ER nurse took vital signs, noted a medical history, conducted fetal monitoring, and examined the patient’s abdomen. A physician then examined the patient roughly an hour and ten minutes after presenting. The physician performed an examination of the patient’s cervix, finding the cervix to be neither dilated nor thinner, and took a culture of her vagina. An ultrasound was also performed to evaluated the heartbeats of the three infants. The physician saw that the patient had two episodic contractions roughly thirty minutes apart, but found this inconclusive. The physician discharged the patient to home with instructions to keep her regularly scheduled appointment. After leaving the hospital, her condition worsened and she experiencing increased cramping. The next day, her perinatologist determined that the patient was in preterm labor, but also determined that she could not have been the night before at the hospital. She was sent back to the hospital to suppress labor. Efforts to do so were unsuccessful. One infant was born stillborn and the other two died shortly after being born.

The plaintiff brought a failure to screen claim against the hospital, that was dismissed by way of summary judgment. On appeal, the plaintiff argued that the hospital did not have a written screening procedure, which was a per se violation of EMTALA, and also did not follow the procedures that were in place. The court rejected this argument, finding that a “written” screening procedure was not required under the explicit terms of the statute. Further, the hospital proffered sufficient evidence to show that the patient was screened precisely as any other patient would have been, thus cutting off liability under EMTALA. The court went so far as to state that the patient “received superior care”; in fact, it cited evidence that 94% of the patients who came to the hospital for a labor check actually received less care.

Notes: A good case for hospitals in that it held that a formal written screening policy is not required under the statute. This can become an issue, especially given the myriad symptoms that patients who present to an emergency may be experiencing. So long as the hospital has some standard procedure or protocol of which the ER staff is aware and that is designed to recognize symptoms of an emergency medical condition, and it is followed uniformly, there can be no liability under EMTALA.