The purpose of the screening requirement is for the hospital to determine whether an emergency medical condition exists; if so, the hospital then has further obligations under the stabilization requirement. The stabilization requirement in EMTALA reads as follows:
(b) Necessary stabilizing treatment for emergency medical conditions and labor.
(1) In general
If any individual (whether or not eligible for benefits under this subchapter) comes to a hospital and the hospital determines that the individual has an emergency medical condition, the hospital must provide either—
(A) within the staff and facilities available at the hospital, for such further medical examination and such treatment as may be required to stabilize the medical condition, or
(B) for transfer of the individual to another medical facility in accordance with subsection (c) of this section.
42 U.S.C. § 1395dd(b)(1)
Courts have generally established a three-factor test for determining whether a hospital is liable under this theory: the plaintiff must show that she (1) had an emergency medical condition; (2) the hospital actually knew of that condition; and (3) the patient was not stabilized before being transferred.” Baber v. Hosp. Corp. of Am., 977 F.2d 872, 883 (4th Cir. 1992); Torretti v. Main Line Hosps., Inc., 580 F.3d 168, 178 (3d Cir. Pa. 2009). The courts have specifically stated that the knowledge requirements imposes a “mens rea” element to the claim, requiring actual knowledge on the part of the hospital. See Eberhardt v. City of Los Angeles, 62 F.3d 1253, 1258 (9th Cir. 1995); Holcomb v. Monahan, 30 F.3d 116, 117 (11th Cir. 1994); Gatewood v. Washington Healthcare Corp., 933 F.2d 1037, 1041, 290 U.S. App. D.C. 31 (D.C. Cir. 1991); Cleland v. Bronson Health Care Group, Inc., 917 F.2d 266, 271 (6th Cir. 1990).
Further, EMTALA’s stabilization requirement “does not impose a standard of care prescribing how physicians must treat a critical patient’s condition while he remains in the hospital, but merely prescribes a precondition the hospital must satisfy before it may undertake to transfer the patient.” Álvarez Torres v. Ryder Mem. Hosp., Inc., 582 F.3d 47, 51-52 (1st Cir. 2009); Smith v. Albert Einstein Med. Ctr., 2009 U.S. Dist. LEXIS 71403 (E.D. Pa. 2009) (“Indeed, liability under this provision [relating to the stabilization requirement] can only arise in the context of a transfer or discharge.”)
There are several important definitions contained within the text of EMTALA that are applicable to the stabilization requirement.
The term “to stabilize” means, with respect to an emergency medical condition described in paragraph (1)(A), to provide such medical treatment of the condition as may be necessary to assure, within reasonable medical probability, that no material deterioration of the condition is likely to result from or occur during the transfer of the individual from a facility, or, with respect to an emergency medical condition described in paragraph (1)(B), to deliver (including the placenta). 42 U.S.C. § 1395dd(e)(3)(a)
Some courts have explicitly stated that whether a patient was “stabilized” is an issue that requires an expert opinion to establish. See, e.g. Smith v. Botsford Gen. Hosp., 419 F.3d 513, 519 (6th Cir.2005) (holding that the plaintiff required expert testimony to establish this element of the EMTALA claim when determining that the plaintiff’s action was one of professional negligence subject to Michigan’s cap on malpractice damages); Liles v. TH Healthcare, Ltd., 2014 U.S. Dist. LEXIS 62171, (E.D. Tex., 2014) (“Plaintiffs’ EMTALA claims would require the finder of fact to evaluate  if and how defendants’ conduct in attempting to transfer or discharge Mr. Liles contributed to such injuries or illness, and  whether or not the Defendants provided sufficient “stabilizing treatment” in connection with the alleged attempts to transfer or discharge Mr. Liles…This is clearly not a matter of common knowledge . . . within the experience of the layman.”)
The term “transfer” means the movement (including the discharge) of an individual outside a hospital’s facilities at the direction of any person employed by (or affiliated or associated, directly or indirectly, with) the hospital…42 U.S.C. § 1395dd(e)(4)
The definition can become important when, for instance, a patient is transferred to another department within the hospital, although not technically admitted to inpatient service, where EMTALA has no reach. For example, in Ceballos-Germosen v. Doctor’s Hosp. Ctr. Manati, 2014 U.S. Dist. LEXIS 167635, (D.P.R., 2014), the patient arrived at the emergency department and was coughing up blood. The patient was eventually transferred to the ICU, but the time of admission was in dispute. The court, however, noted that because the plaintiff failed “to demonstrate that [the hospital] bade [the patient] farewell” and because the evidence showed that “[the patient] never left [the hospital’s] facilities, i.e., because she was never transferred,” there could be no stabilization claim. Id at 15-16
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