The screening requirement in EMTALA reads as follows:
(a) Medical screening requirement:
In the case of a hospital that has a hospital emergency department, if any individual (whether or not eligible for benefits under this sub-chapter) comes to the emergency department and a request is made on the individual’s behalf for examination or treatment for a medical condition, the hospital must provide for an appropriate medical screening examination within the capability of the hospital’s emergency department, including ancillary services routinely available to the emergency department to determine whether an emergency medical condition exists.
42 U.S.C. § 1395dd(a) (emphasis added). While a plain reading of this paragraph and an interpretation of the phrase “appropriate medical screening examination” could lead one to conclude that EMTALA was intended to impose a standard on hospital emergency departments that is co-extensive or similar to the standard of care imposed by state malpractice law, courts have almost uniformly rejected this approach.
In considering the issue, the Eight Circuit Court of Appeals in Summers v. Baptist Medical Center Arkadelphia, 91 F.3d 1132 (8th Cir. 1995) made the following observation:
What is meant by the word “appropriate”? One possible meaning, perhaps
the most natural one, would be that medical screening examinations must be
correct, properly done, if not perfect, at least not negligent. It would be easy to
say, for example, simply as a matter of the English language, that a negligently
performed screening examination is not an appropriate one. So far as we can
determine, however, no court has interpreted the statute in such an expansive
fashion, and it is easy to understand why.
The court then concluded, in line with several other Circuit Courts, that “[p]atients are entitled under EMTALA, not to correct or non-negligent treatment in all circumstances, but to be treated as other similarly situated patients are treated, within the hospital’s capabilities. It is up to the hospital itself to determine what its screening procedures will be. Having done so, it must apply them alike to all patients.” As such, courts instead have interpreted the screening requirement to impose an obligation on hospitals only to apply their own established screening procedures “even-handedly” to all patients. See, e.g., Gatewood v. Washington Healthcare Corp., 933 F.2d 1037, 1041 (D.C.Cir. 1991); Holcomb v. Monahan, 30 F.3d 116, 117 (11th.Cir. 1994); Repp v. Anadarko Mun. Hosp., 43 F.3d 519, 522 (10th Cir. 1994); Correa v. Hospital San Francisco, 69 F.3d 1184, 1192 (1st.Cir. 1995); Vickers v. Nash General Hosp., Inc., 78 F.3d 139, 142 (4th.Cir. 1996); Cruz Vázquez v. Mennonite General Hosp., 717 F.3d 63, 69 (1st Cir. 2013).
Courts are clear that “EMTALA is not a substitute for state law malpractice actions, and was not intended to guarantee proper diagnosis or to provide a federal remedy for misdiagnosis or medical negligence.” See Vickers, 78 F.3d at 132, citing Power v. Arlington Hosp. Ass’n, 42 F.3d 851, 856 (4th Cir. 1994). The Circuit Courts are in agreement of the need to distinguish EMTALA claims from standard claims of negligence and misdiagnosis, as EMTALA was “not intended to duplicate preexisting legal protections, but rather to create a new cause of action, generally unavailable under state tort law, for what amounts to failure to treat.” Vickers, 78 F.3d at 142. As such, as noted by one court, “questions regarding whether a physician or other hospital personnel failed properly to diagnose or treat a patient’s condition are best resolved under existing and developing state negligence and medical malpractice theories of recovery.” Baber v. Hospital Corp., 977 F.2d 872, 880 (4th Cir. 1992).
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