Vickers v. Nash, 78 F.3d 139, 1996 U.S. App. LEXIS 4421 (4th Cir. 1996)

The plaintiff’s decedent presented to the hospital emergency department with lacerations and contusions which were treated. An x-ray of the cervical spine was performed and negative. Four days later the patient died with the cause of death identified as cerebral herniation and epidural hematoma caused by a skull fracture. The plaintiff contended that decedent received different treatment than other patients in the defendant hospital’s emergency department than did “other patients presenting in this same medical condition. However, the court focused on the distinction between an appropriate initial screening examination and the correctness of the treatment that follows from that screening, requiring dismissal of plaintiff’s EMTALA claim. The court noted that upholding plaintiff’s EMTALA claims would “eviscerate any distinction between EMTALA actions and state law actions for negligent treatment and misdiagnosis,” and that accepting plaintiff’s arguments would permit every claim of misdiagnosis to be recast as an EMTALA claim, directly contravening the intent of the statute. The court noted that EMTALA imposes only a “limited duty” on hospitals with emergency rooms to provide emergency care to all individuals who request service, in the form of an appropriate screening examination and noted that issues related to diagnosis are strictly the province of state law-based medical malpractice claims. The court further stated that only disparate screening examinations for individuals perceived to have the same condition is the cornerstone of an EMTALA claim and that treatment decisions based on medical judgment fall outside EMTALA. The court reached the conclusion that no EMTALA claim was stated despite the “mechanical incantation” that decedent had not been evaluated in the same manner as other similarly situated plaintiffs.

Notes: Another good case for hospital-defendants. In line with Summers, i.e. no violation occurs if patient is screened for “perceived” symptoms. This case makes a clear distinction between “screening” and subsequent “treatment.”