[EMTALA.COM logo - COBRA, Patient Dumping Act]


2002 cases
Dollard v. Allen
(D. Wyoming)
EMTALA held not to apply to a new medical condition arising in an inpatient. See our analysis.
2002 cases
St. Anthony Hospital v. DHHS
10th Circuit
Upholds administrative sanctions taken against a hospital by CMS for "reverse dumping", refusal by a hospital with specialized capabilities to accept a patient for whom a transfer had been requested. Elaborates factors that the courts will consider when determining whether a hospital "has the capacity to treat the individual" as provided in the EMTALA statute. Adopts a liberal definition of "specialized capabilities or facilities", agreeing with an adminstrative law judge that "Congress intended th[is] term to encompass those capabilities and facilities which enable a hospital to offer specialized care that is not offered by hospitals that are less well-endowed," i.e., the transferring hospital. Upholds finding of liability against the hospital based on the decision of a specialist (not a hospital employee) declining to accept the transfer of the patient. Even if the specialist is not a hospital agent for purposes of accepting or rejecting the patient, the ER physician clearly is, and the decision will be imputed to him.
2001 cases
Arrington v. Wong (PDF)
(9th Circuit)
A hospital which is in contact with an ambulance not owned by the hospital may not direct the ambulance to take the patient to another facility unless the E.R. is in diversionary status. (The Court here disregards the principle of exclusio alterius. It also relies on the April 2000 amendments to 42 CFR 489.24, despite the fact that they did not become effective until January 2001.)
Brenord v. Catholic Medical Center
Plaintiffs did not establish that the hospital provided a MSE different from that which is normally given and thus did not establish a violation of EMTALA. There is no violation of the requirement that stabilizing treatment be given if the hospital did not in fact determine that the patient had an emergency medical condition.
Jackson v. East Bay Hospital (PDF)
9th Circuit
Hospital not liable for failure to diagnose the physical cause of an emergency medical condition (drug toxicity) when it did provide stabilizing treatment of the symptoms (psychiatric manifestations) and concluded that he was stable.

Notes that the weight of authority is that "an examination does not have to be 'medically adequate' to satisfy EMTALA's requirements".

2000 cases
Reynolds v. Mainegeneral Health
(1st Circuit)
Order of summary judgment in favor of defendant hospital upheld. A medical condition which might arise after the patient is admitted does not consitute a current "emergency medical condition" at the time of initial presentation, invoking the obligation to conduct further testing and to institute treatment.
Bloomer v. Norman General Hospital
(10th Circuit)
Summary Judgment should be entered in favor of defendant Hospital. Following Repp v. Anadarko and Urban v. King, the plaintiff must show that the hospital did not follow its own procedures and (for failure to treat claims) that it failed to provide treatment in light of actual knowledge of an emergency medical condition. The complaint did not allege either. The fact that the patient received different treatment at different presentations does not raise an inference of differential care, since medical decisions may be justifiably different at each presentation.
Drew v. New Liberty Hospital District (PDF)
The court rejects the claim of sovereign immunity by the hospital, a political subdivision of the state. The state's immunity provisions are pre-empted by EMTALA, since they are not state-created "requirements".
1999 cases
Roberts v. Galen of Virginia
U.S. Supreme Court
525 US 249 (1999)
The Supreme Court's first pronouncement on EMTALA. See our commentary. The ACLU has posted a copy of its brief filed in this case. The web site for counsel for plaintiff, Joe Mattingly of Lebanon, Kentucky, provides access to other information about the case, courtesy of Mr. Mattingly's sister.
Cherukuri v. Shalala
175 F.3d 446 (6th Cir. 1999)
Overturns administrative fine against a physician for allegedly failing to stabilize trauma patients with head injuries and abdominal injuries by performining abdominal surgery before transfer from a tiny rural hospital. Detailed consideration of the term "stabilize" and the need for room for the exercise of clinical judgment in factual situations. Under the statutory language, if the physician believes that the transfer is not likely to cause a material deterioration in the patient's condition, no certification and no agreement to accept the patient is necessary. A surgeon is not required to force an anesthetist to administer anesthesia when he is unwilling to do so for medical reasons. The court decries the failure of any effective appellate review by the administrative review board.

We have also posted a major portion of the Department Appeals Board ruling.

Hardy v. New York City Health and Hospitals Corp.
164 F.3d 789 (2d Cir. 1999)
State notice-of-claim requirement applies to EMTALA claim. The requirement does not pose a direct conflict with EMTALA and thus is not pre-empted.
1998 cases
Arrington v. Wong, M.D.
D. Hawaii 1998
EMTALA not implicated in a diversion case. Radio contact with ambulance personnel does not establish "coming to the ER".

(See the 9th Circuit decision, under "2001 cases" below.)

Bohannon v. Durham County Hospital
M.D.N.C. 1998
Claim: failure to read and interpret x-rays before discharging the patient. Held: sufficient facts alleged to raise a jury question.
Fisher v New York Hospitals
E.D.N.Y. 1998
Failure to diagnose/inadequate screening does not raise EMTALA violation. No liability on the part of the examining ER physician.
Lebron v. Ashford Presbyterian
D.P.R. 1998
No claim under EMTALA against the ER physician.
Lopez-Soto v. Hawayek
D.P.R. 1998
On rehearing. Claim: delay in performing C-section. No EMTALA implication for an inpatient. Held: patient did not "come to the ER" seeking treatment, but rather appeared as instructed by her physician for admission and delivery.
Urban v. King, M.D.
D.Kan. 1998
No claim against an indvidual physician under EMTALA.

(The EMTALA claim is of tangential significance only in the procedural morass presented by this case at this level. The previous opinion addressed EMTALA directly, but was not involved on appeal.)

1997 cases
Adams v. Grace Hospital, 962 F.Supp. 101 (E.D.Mich. 1997) Follows Cleland - proof of an improper motive for transfer must be shown
Barris v. County of Los Angeles, 70 Cal.Rptr.2d 281 (1997) Cases under EMTALA are subject to California's cap on damages
Jackson v. East Bay Hospital, 980 F.Supp. 1341 (1997) Cases under EMTALA are not subject to California's cap on damages.
C.M. v. Tomball Regional Hospital, 961 S.W.2d 236 (Tex.Civ.App. 1997)  
Casey v. Amarillo Hospital District, 947 S.W.2d 301 (Tex.App. 1997) Not necessary to show proof of improper motive for transfer
Diaz v. CCHC-Golden Glades, Limited, 696 So.2d 1346 (Fla.App. 1997) Hospital owned by Commonwealth of Puerto Rico is immune from liability under EMTALA. See also Vargas.
Scott v Hutchinson Hospital, 959 F.Supp. 1351 (1997) EMTALA does not apply when a patient has been admitted to the ICU and is later transferred to another facility.
Kenning v St. Paul Fire & Marine Insurance Company, 990 F.Supp. 1104 (D. Ark. 1997) No violation of EMTALA - patient was stable at time of transfer
1996 cases

Vargas v Del Puerto Hospital
98 F3d 1202 (9th Cir 1996)

No civil liability can be premised solely on a doctor's failure to provide a proper written certification in compliance with EMTALA requirements, when the undisputed facts showed that the transfer itself was proper.

Bryan v Rectors and Visitors of the University of Virginia
95 F3d 349 (4th Cir 1996)

See commentary

Vickers v Nash General Hospital
78 F3d 139 (4th Cir 1996)

Failure to make the proper diagnosis does not implicate EMTALA.

Summers v Baptist Medical Center Arkadelphia
91 F3d 1132 (8th Cir 1996)

See commentary

Cunningham v Fredonia Regional Hospital
98 F3d 1349 (10th Cir 1996)

The court approves giving medication in the emergency room without a physician's examination, at the order of the patient's family doctor, because that approach was specifically sanctioned under the hospital's written policy. (NOTE: We would caution against reliance on this decision, as the situation described can be problematic in considering the EMTALA requirement of a medical screening examination.)

James v Sunrise Hospital
86 F3d 885 (9th Cir 1996)

Section 1395dd(c) prohibits transfer if the patient "has an emergency medical condition". The court holds that this section is invoked only if the physician in fact makes a determination that an emergency medical condition exists, even though there is a variation in the language of that section from that contained in subsections (a) and (b).

Dickey v Baptist Memorial Hospital
Northern District of Mississippi, December 1996

The two-year statute of limitations under EMTALA is not subject to a discovery rule.

(EMTALA issue not appealed. Case reversed on state grounds, 1998.)