The Emergency Medical Treatment and Labor Act (EMTALA) was passed to end “dumping” of individuals who came to an emergency department (ED) for care but did not have insurance to pay for those services.
As a result of this legislation, EMTALA requires an ED to perform an appropriate medical screening examination when any individual presents in the ED, and if an emergency medical condition exists, provide treatment to stabilize that condition.
EMTALA also includes criteria under which the patient may be transferred to another facility.
In the following case out of the U.S. District Court of Puerto Rico, the question of whether the ED in the Caribbean Medical Center (CMC) met its obligations under EMTALA is assessed.
Specifics of the Case
A 79-year-old male patient had a history of hyperlipidemia, peripheral vascular disease, gastritis, and diabetes. He was also a chronic cigarette smoker and had a history of alcohol use.
One day, the patient developed severe abdominal and chest pain, and his wife called 911 to take him to the hospital. When the ambulance arrived, the paramedics assessed him and documented that he had abdominal pain and an irregular heart rate. The documentation was given to the hospital personnel.
When evaluated a second time, the patient was taken by ambulance to the ED. A nurse triaged him at approximately 7:40 p.m. The nurse documented that the patient’s chief complaint was acute abdominal pain, pain in the thorax with “severe intensity,” and the areas of pain involved “the right and left chest and the upper and lower abdomen.”
The patient’s condition was classified as an emergency, and he was seen by a physician at about 7:49 p.m. The doctor’s diagnosis was “epigastric tenderness.” He ordered an array of laboratory tests and prescribed various medications for the patient.
At about 8:50 p.m., the patient was found unresponsive and without a pulse. Attempts to resuscitate him failed, and he was declared dead at 9:35 p.m. The final diagnosis was acute cardiac arrest.
The patient’s family filed a case against the facility, the physician who treated him in the ED, and various insurance companies, alleging the facility violated the EMTALA by not providing adequate medical screening, which led to the patient’s death. They also alleged the facility was professionally negligent in the patient’s care.
The family alleged the facility didn’t initiate nor follow its diagnosis and treatment protocols for chest pain and/or acute coronary syndrome. The protocols required an EKG be ordered within 10 minutes of a patient’s arrival and certain medications be administered (e.g., anticoagulant, antiplatelet therapy).
CMC and one of the insurance companies filed a Motion to Dismiss the case against them. Their basis for the motion was that the family failed to state a claim under EMTALA and that their case was not filed within the statute of limitations for their state professional negligence claims.
The patient’s family filed a Motion in Opposition to the Motion to Dismiss claiming their case was not time barred because they provided written notice of their claims.
The Court’s Decision
In its Memorandum and Order, the court reviewed and analyzed applicable case law and the EMTALA.
It opined that when a plaintiff claims an EMTALA screening violation occurred, the individual does not need to prove that he or she was suffering from an emergency medical condition.
Rather, the failure to provide an appropriate screening is a “sufficient” basis to find liability if other elements of the cause of action are met.
The court said the facility’s internal procedures “set the parameters” for an appropriate screening. The court also held that CMC was a hospital covered by the EMTALA.
Because CMC and the insurance company did not contest any of the plaintiff’s material facts (e.g., no EKG within 10 minutes of arrival, the patient’s condition was an emergency), the court denied their Motion to Dismiss as it related to the EMTALA claim.
The defendants’ claim that the plaintiffs did not file their state professional negligence claims on time also was denied.
This matter, the court said, “calls for a credibility matter.”
The court denied the Motion to Dismiss but instructed the defendants that once discovery was completed, they could revisit their argument about the state negligence claims, through a Motion for Summary Judgment.
Your Role As a Nurse in the ED
This court decision emphasizes the importance of the EMTALA in ensuring that anyone who presents in an ED is appropriately screened and treated to stabilize the patient’s condition.
ED nurses are often the first staff members to come in contact with someone who arrives at the ED. That is why it’s essential that you follow the policies and procedures in place in your facility that comply with the EMTALA.
Moreover, as in this case, your accurate, clear, and complete documentation concerning your triage decision and your patient care is crucial in the decision as to whether the patient’s condition is an emergency under the EMTALA.
Another aspect of your role is that of patient advocacy. In this case, it appears that no staff member vocalized the fact that the hospital protocol for a patient with these symptoms was not being initiated.
Because patient advocacy is a legal and ethical responsibility, it’s critical to raise your concerns to whomever is identified in the facility policy and procedure when mandates are not followed.
Take these courses related to ED care and documentation:
A Valid, Reliable Triage System Can Help You Better Assess ED Patients’ Acuity
(1 contact hr)
This module provides nurses with an understanding of the history, types and methods of ED triage, with an emphasis on the five-level triage systems.
Document It Right: A Nurse’s Guide to Charting
(5.2 contact hrs)
Professional nurses are vital partners with other healthcare professionals, and nursing documentation is an essential part of comprehensive patient care. Although documentation has always been an important part of nursing practice, the increasingly complex healthcare environment, litigious society and the diversity of settings in which patients receive care require that nurses pay more attention to documentation. This continuing education module outlines the importance of documentation, different formats and settings for documentation, and what nurses must document, including information about difficult situations.
Emergency Care Is a Patient’s Right — Insured or Not
(1 contact hr)
In 1986, Congress enacted the Emergency Medical Treatment & Labor Act (EMTALA) to ensure public access to emergency services regardless of ability to pay. Some states have their own EMTALA-like statutes. Healthcare professionals who work in clinical areas in which EMTALA applies need to be aware of its fundamental requirements to provide patients with the care they are entitled to under law. Supervisors in such areas need to ensure that their staff members are properly educated about EMTALA and that policies are in place to address EMTALA.