Summers v. Baptists Med. Ctr., 91 F.3d 1132, 1996 U.S. App. LEXIS 19173 (8th Cir. 1995)

The plaintiff in this case fell out of a tree and was taken to the hospital emergency department by ambulance. When he presented, the plaintiff had complaints of stomach, back, and chest pain. The physician who evaluated the plaintiff testified that the plaintiff did not complain of pain in the front of his chest, nor did he notice any popping or cracking sounds when he pressed on the plaintiff’s chest. Although several “routine tests” were performed, as well as x-rays of plaintiff’s thoracic and lumbar spine, the physician did not order a chest x-ray. Because no fractures were revealed by the spine x-rays, the plaintiff was discharged. The next day, the plaintiff was in such severe pain that he was again taken to the emergency room by ambulance. This time, he was given a chest x-ray which showed a fresh break of a thoracic vertebra, a broken sternum, and a broken rib.

The plaintiff filed a lawsuit arguing that he did not receive an appropriate screening evaluation under EMTALA due to the physician’s failure to order a chest x-ray, which would have revealed the breaks. The plaintiff argued that because the defendant admitted that a chest x-ray should have been ordered in light of the complaint of chest pain, a jury could find that the hospital violated EMTALA. The court ultimately concluded that there could be no EMTALA violation under these facts, as the plaintiff’s argument that the “failure to order a chest x-ray for a patient complaining of popping noises in his chest…is nothing more than an accusation of negligence.” Id. at 1138. In support of its position, the court noted that the “emergency-room physician is required by EMTALA to screen and treat the patient for those conditions the physicians perceives the patient to have.” Id. at 1139, citing Vickers, 78 F.3d at 144. Because the physician did not perceive the plaintiff to have pain in the front of his chest, “[i]n the medical judgment of the physician, [the plaintiff] did not need a chest x-ray,” and thus the alleged inadequate screening amounted to nothing more than “faulty screening” that is not actionable under EMTALA. As such, summary judgment was granted in favor of the hospital, despite the fact that the court assumed that the plaintiff made a complaint of chest pain and despite the fact that the hospital admitted that a chest x-ray would have been necessary had the physician perceived such a complaint.

Notes: This is a good case for defendant-hospitals and supports the argument that there is no EMTALA violation if the caregivers screen for “perceived” symptoms, even if this perception was erroneous and the result of a misdiagnosis.