Health Law Daily Sixth Circuit sticks with ‘improper motive’ standard for EMTALA claims
Monday, March 12, 2018

Sixth Circuit sticks with ‘improper motive’ standard for EMTALA claims

By Dietrich Knauth

The Sixth Circuit affirmed the dismissal of Emergency Medical Treatment and Active Labor Act (EMTALA) claims related to a patient’s stroke and spinal injury, finding that its own precedent requires patients to show that an "improper motive" led to their substandard care. Although it affirmed the lower court’s dismissal of the case as proper, the Sixth Circuit panel also acknowledged that its precedent is out of step with the majority of other appellate courts to weigh in on the issue, suggesting that en banc review may be appropriate (Elmhirst v. McLaren Northern Michigan, March 9, 2018, Gilman, R.).

Background. The plaintiff had sued a northern Michigan hospital where she was treated for dizziness, headache, nausea and trouble sleeping. She alleged that the hospital released her from care without detecting symptoms of vertebral dissection, which she said she suffered as a result of a chiropractor using too much force on her neck. Her condition worsened after she was released from the hospital, and she later suffered a stroke which left her permanently disabled, according to the complaint. She claimed that the hospital violated EMTALA by failing to provide her with an appropriate medical screening, and failing to stabilize her medical condition before discharging her.

Improper motive. Both the district court and the Sixth Circuit found that that the complaint did not include any facts showing that the hospital’s failure to provide appropriate screening was the result of an "improper motive," as required by the Sixth Circuit’s in Cleland v. Bronson Health Care Group Inc. The plaintiff argued on appeal that the court should overturn the improper-motive requirement, which has been rejected by the Tenth, Fourth, First, Eight, and D.C. Circuits as lacking statutory support, lacking conceptual coherence, and making a claim unreasonably difficult to prove. The Supreme Court has also noted the circuit split, although it has not weighed in on the appropriate standard, according to the decision.

The appellate panel declined to overturn its decision, noting that it could not dismiss a previous ruling in the absence of an en banc review. However, the lopsidedness of the circuit split, including the consensus favoring an alternate approach suggested by the D.C. Circuit, and the fact that the controlling Sixth Circuit decision was the first attempt by an appellate court at the time to interpret EMTALA requirements all lent support to an en banc review, according to the Sixth Circuit panel.

The case is No. 17-1949.

Attorneys: Albert J. Dib (Jefferson Law Center) for Jamie Elmhirst. Michael Lee Van Erp (Johnson & Wyngaarden, PC) for McLaren Northern Michigan, Jointly and Severally d/b/a Northern Michigan Emergency Medicine Center.

Companies: McLaren Northern Michigan, Jointly and Severally d/b/a Northern Michigan Emergency Medicine Center

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