By Gregory Kane, J.D., M.B.A.
Summary judgment was granted to a hospital defending an (EMTALA complaint against an emergency room patient who did not have an emergency medical condition and was stabilized before being discharged.
A California hospital was granted summary judgment in an Emergency Medical Treatment and Active Labor Act (EMTALA) complaint from a former emergency room patient because that patient had not had an emergency medical condition and the hospital not only stabilized her condition but took into account additional risks and factors including mental health prior to discharging her (Crawford v. Kaiser Foundation Hospitals, July 21, 2020, Beeler, L.).
Background. On March 24, the patient went to Kaiser’s emergency department complaining of difficulty breathing. The treating physician examined her and ordered extensive testing noting that her allergy to Albuterol and prior splenectomy posed a risk of bacterial infection. She was diagnosed with community-acquired pneumonia and asthma. She was prescribed certain medications and it was noted that her symptoms were exacerbated by anxiety, but the doctor concluded she was not suffering from an emergency condition and she was discharged. At that time the patient’s vital signs were unremarkable, she was ambulatory and her condition had improved. She had also asked to go home.
The patient returned to the emergency room on March 25, complaining of shortness of breath. She had not taken some of the prescribed medication. Within half an hour of her arrival she was cleared as stable and within medical probability that she would not deteriorate is she were transferred or discharged. Due to the short time elapse between visits, however, the treating physician referred the patient for an inpatient consultation with a Kaiser hospitalist who made the clinical decision to monitor the patient overnight. The patient received the same treatment she would have received had she been admitted as an inpatient. Around midnight that night, the patient was examined and based on the record and examinations, a hospital physician determined that the patient did not show emergency conditions or needed immediate medical attention. The patient had an in-person consultation with a hospitalist the next morning and based on her history, imaging studies, test results and current vital signs, the hospitalist diagnosed the patient with community-acquired pneumonia and asthma. It was determined that the pneumonia was already improving with her symptoms exacerbated by anxiety and asthma. It was also determined that her condition was mild enough to treat with home care and follow-up visits and she was discharged. A social-worker consultation was also ordered to address the patients complaints about her care which related to her frustrations with the insurance and healthcare system Medi-Cal, which the patient described as racist and fraudulent.
Several hours after her discharge, the patient called for an ambulance and asked to be taken to a different hospital for shortness of breath. She was admitted as an inpatient for two nights and administered tests and given the same diagnosis and medications she had received at Kaiser.
The patient returned to the Kaiser emergency room on March 30 complaining of shortness of breath, but would not allow a nurse to draw blood, had not filled her prescriptions, demonstrated no shortness of breath, was combative with the hospital personnel, and left after refusing to sign "Against Medical Advice" paperwork.
The patient filed a complaint against Kaiser for violation of EMTALA for failing to stabilize her before discharging her. Kaiser’s motion to dismiss for failure to state a claim was denied as the patient had plausibly pled her claim. Kaiser moved for summary judgment prior to the close of discovery. The patient was appointed pro bono counsel and granted the patient’s motion to postpone the due date for her opposition. The pro bono counsel withdrew due to conflict with the patient and the parties relationship during discovery was contentious. Kaiser renewed its summary judgment motion after discovery closed. The patient did not file on opposition but did move for an additional 90 days of extended discovery. As discovery was extensive, her motion was denied. The patient was twice referred to the court’s resources for litigants representing themselves and advices of the court’s standards for summary judgment but the patient did not file an opposition or statement of non-opposition.
Kaiser’s expert witness opined that the patient had been stable after Kaiser provided her with the evaluation and assessment and testing and treatment she received prior to her discharge. He believes that Kaiser appropriately screened and stabilized her pneumonia and that the patient’s outcome would have not been different or improved by a longer period of time at the hospital.
Summary judgment. EMTALA imposes (1) a duty to screen a patient for an emergency medical condition and, if found, (2) a duty to stabilize the patient before transferring or discharging the patient. The record showed that the patient did not have an emergency medical condition and, even had she had one, Kaiser stabilized her prior to discharge. Summary judgement was granted.
The case is No. 19-cv-01573-LB.
Attorneys: Muneerah Crawford, pro se. John Stewart Simonson (Hayes Scott Bonino Ellingson Guslani Simonson & Clause LLP) for Kaiser Foundation Hospitals.
Companies: Kaiser Foundation Hospitals
MainStory: TopStory CaseDecisions EMTALANews CaliforniaNews
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