Legal Advisor

from July/August 2021

by The Clinical Advisor

Preventing Shingles: Raising Awareness and Promoting Vaccination

CASE

Prisoner’s Visit to ED Cues Suit

Inmate with hand bite was discharged without antibiotics or radiograph.

ANN W. LATNER, JD

Mr S is an inmate at a local prison. During an altercation with another prisoner, Mr S was bitten on his left hand. The bureau of prisons sent him to a local emergency department (ED), where he was seen by Mr N, a nurse practitioner, and Dr D, the supervising physician.

The patient was described as agitated and complained about pain from the bite to his left pinkie. Mr N was instructed by Dr D to give the patient a tetanus vaccine and discharge him with a 3-day supply of antibiotics. As Mr N was cleaning and sterilizing the wound and bandaging the finger, the patient noted that he thought his finger was broken and requested an “x-ray.” Dr D, who was walking by, told Mr S that the hospital’s imaging machine was broken and a radiograph of the finger could not be performed.

Mr S’s wound was cleaned and dressed but not sutured to avoid infection. Despite Dr D’s orders, no antibiotics were noted on the ED discharge report, and the patient was returned to prison without the prescription.

In prison, Mr S continued to complain about pain in his finger, which he described as 10 on a pain scale of 1 to 10. Six weeks after his visit to the ED, Mr S’s finger was radiographed, which revealed a displaced dorsal rotated fracture through the distal shaft of the left fifth middle phalanx. The radiologist’s report also noted that “there is surrounding soft tissue swelling without joint space malalignment.” Mr S was taken to a hand specialist who noted that he had a “fracture through the middle phalanx with displacement and angulation.” The specialist recommended surgery; specifically, “left small finger P2 fixation with DIP arthrodesis.” Mr S underwent the surgery, but he remained angry about how he was treated initially by the hospital and staff. Dr D and Mr N were unaware of Mr S’s condition until they were notified by the hospital’s attorney that the hospital was being sued by Mr S, pro se (representing himself without an attorney). The basis of the claim was violation of the federal Emergency Medical Treatment and Active Labor

Patient claims hospital staff discharged him without properly screening and stabilizing him, violating EMTALA.

Cases presented are based on actual occurrences. Names of participants and details have been changed. Cases are informational only; no specific legal advice is intended. Persons pictured are not the actual individuals mentioned in the article.

Act, commonly referred to as EMTALA. Mr S claimed that the hospital and staff had discharged him without properly screening and stabilizing him.

The Court Decides

The hospital’s attorney filed a motion to dismiss, arguing that EMTALA was aimed at curbing patient dumping, and that wasn’t the case here. The court noted that “Although Congress was concerned that the indigent and uninsured tended to be the primary victims of patient dumping, EMTALA is not limited to these individuals. Rather, under EMTALA, any individual who suffers personal harm as a direct result of a hospital’s violation of the statute may bring a private civil action for damages.”

The court pointed out that EMTALA requires hospitals to provide medical screening and stabilizing treatment to individuals seeking emergency care in a nondiscriminatory manner. “A hospital has 2 primary obligations under EMTALA: 1) if an individual arrives at an emergency room, the hospital must provide appropriate medical screening to determine whether an emergency medical condition exists; and 2) if the hospital determines an individual has an emergency medical condition that has not been stabilized, it may not transfer the patient unless certain conditions are met.” Because Mr S had alleged both failure to screen and failure to stabilize claims, the court looked at each separately.

Regarding failure to screen, the court pointed out that EMTALA doesn’t define what constitutes an appropriate medical screening, and so the screening provision generally has been interpreted as requiring hospitals to screen all similar patients according to the same procedures. It is up to the hospital what the screening procedures will be, but they must be applied to all patients.

Mr S, who researched his case in the prison’s law library, found a personal injury case in which the person was treated at the same hospital for a remarkably similar injury. In that case, the patient was given a radiograph and the patient was sent to surgery, during which an orthopedic surgeon inserted a plate and 6 screws to repair the fracture.

The hospital’s attorney tried to argue that a single case was not enough to prove that the patient was treated differently than other patients. However, the court held that at this early stage in the case, this evidence was sufficient to move forward.

The court then looked at the claim of failure to stabilize. To establish this claim, the plaintiff must allege that he had an emergency medical condition, that the hospital actually knew of the condition, and that the patient was not stabilized before being transferred.

The hospital’s attorney tried to argue that Mr S did not have an emergency medical condition as defined by EMTALA. However, the court pointed out that it could not say as a matter of law that Mr S did not have an emergency medical condition, and this would be something for a jury to decide. The court ultimately concluded that Mr S had, in fact, presented a failure to stabilize claim and that the case could proceed.

The case is moving its way through the legal process.

Protecting Yourself

Regardless of the social standing of a patient, all patients must be screened and stabilized the same way. ■

EMTALA requires screening and treatment to individuals seeking emergency care in a nondiscriminatory manner.

Ann W. Latner, JD, a former criminal defense attorney, is a freelance medical writer in Port Washington, New York.

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