The following are quotations from decided cases which describe the historical underpinnings of EMTALA.
From Cleland v. Bronson Health Care Group, Inc., 917 F.2d 266, 271 (6th Cir. 1990):
From Gatewood v. Washington Healthcare Corp., 290 U.S. App. D.C. 31, 933 F.2d 1037 (D.C. Cir. 1991):
From Arrington v. Wong, 19 F. Supp. 2d 1151 (D.Hi. 1998):
The effects of patient dumping on the availability and quality of emergency services for indigent and uninsured patients are well documented. See Karen I. Treiger, Note: Preventing Patient Dumping: Sharpening the COBRA's Fangs, 61 N.Y.U. L. Rev. 1186, 1190 (1986) (cited by appellants).10
10 Treiger discusses three recent studies analyzing patient dumping. See Karen I. Treiger, Note: Preventing Patient Dumping: Sharpening the COBRA's Fangs, 61 N.Y.U. L. Rev. at 1190-1191. One study reports that eighty-seven percent of hospitals transferring patients cited the lack of insurance as the sole reason for the transfer. Id. at 1190 (citing Schiff,
From Hardy v. New York City Health and Hospitals Corp., 164 F.3d 789 (2d Cir. 1999):
EMTALA, which applies to all hospitals that participate in the federal Medicare program, imposes two primary obligations on those hospitals. First, when an individual shows up for treatment at a hospital's emergency room, "the hospital must provide for an appropriate medical screening examination . . . to determine whether or not an emergency medical condition" exists. 42 U.S.C. § 1395dd(a). Second, if the screening examination indicates that an emergency medical condition does exist, the hospital ordinarily must "stabilize the medical condition" before transferring or discharging the patient. Id. § 1395dd(b)(1)(A).
EMTALA is not a substitute for state law on medical malpractice. See Power, 42 F.3d at 856. It "was not intended to guarantee proper diagnosis or to provide a federal remedy for misdiagnosis or medical negligence." Id. Instead, EMTALA was enacted to fill a lacuna in traditional state tort law by imposing on hospitals a legal duty (that the common law did not recognize) to provide emergency care to all. See Brooks v. Maryland Gen. Hosp., Inc., 996 F.2d 708, 714-15 (4th Cir. 1993); Bryan, 95 F.3d at 351 ("[EMTALA's] core purpose is to get patients into the system who might otherwise go untreated and be left without a remedy because traditional medical malpractice law affords no claim for failure to treat."); Gatewood v. Washington Heathcare Corp., 933 F.2d 1037, 1041 (D.C. Cir. 1991) (finding EMTALA creates "a new cause of action, generally unavailable under state tort law, for what amounts to failure to treat").
The legislative history of EMTALA demonstrates that "Congress never intended to displace state malpractice law." Brooks, 996 F.2d at 714. This intent to supplement, but not supplant, state tort law is evident in EMTALA's limited preemption provision. See 42 U.S.C. § 1395dd(f); see also Brooks, 996 F.2d at 715. EMTALA provides: "The provisions of this section do not preempt any State or local law requirement, except to the extent that the requirement directly conflicts with a requirement of this section." 42 U.S.C. § 1395dd(f).
EMTALA's deference to state law is also apparent in its express adoption of state law as to the damages recoverable. Id. § 1395dd(d)(2)(A); Brooks, 996 F.2d at 715. EMTALA provides that a plaintiff, in a civil action against a hospital, may "obtain those damages available for personal injury under the law of the State in which the hospital is located, and such equitable relief as is appropriate." 42 U.S.C. § 1395dd(d)(2)(A).
Significantly, EMTALA's legislative history demonstrates that Congress questioned "the potential impact" of EMTALA on "the current medical malpractice crisis"; Congress also expressed concern that an unbridled EMTALA could unduly burden hospitals and thereby "result in a decrease in available emergency care" rather than the intended increase in such care. H.R. Rep. No. 241, 99th Cong., 1st Sess. 27 (1986), reprinted in 1986 U.S.C.C.A.N. 42, 728. New York's notice-of-claim law, by promoting timely settlement of claims and protecting municipal hospitals from unnecessary or excessive litigation expenses, helps to alleviate these concerns.
In determining whether federal law preempts a state statute, "our sole task is to ascertain the intent of Congress." California Fed. Sav. & Loan Ass'n v. Guerra, 479 U.S. 272, 280 (1987); see Burgio and Campofelice, Inc. v. New York State Dep't of Labor, 107 F.3d 1000, 1008 (2d Cir. 1997). When Congress expressly defines a statute's preemptive reach, and the definition provides "a reliable indicium" of congressional intent as to what should be left to state authority, there is a "reasonable inference" that Congress did not intend to preempt matters beyond that reach. Freightliner Corp. v. Myrick, 514 U.S. 280, 288 (1995) (discussing Cipollone v. Liggett Group, Inc., 505 U.S. 504, 517 (1992)); see also Toy Mfrs. of Am., Inc. v. Blumenthal, 986 F.2d 615, 623 (2d Cir. 1993). This is based on the familiar principle of expressio unius est exclusio alterius, the mention of one thing implies the exclusion of the other. See Cipollone, 505 U.S. at 517.
EMTALA specifically envisions that some procedural matters are better left to state discretion: "The provisions of this section do not preempt any State or local law requirement, except to the extent that the requirement directly conflicts with a requirement of this section." 42 U.S.C. § 1395dd(f) (emphasis added). As the Fourth Circuit has recognized, "EMTALA is quite clear that it is not intended to preempt state tort law except where absolutely necessary." Bryan, 95 F.3d at 352. We need only determine whether New York's notice-of-claim requirement "directly conflicts" with EMTALA.
From Reynolds v. Mainegeneral Health, 218 F.3d 78 (1st Cir. 2000):