EMTALA: Claim for Failure to Stabilize Patient May Proceed to Trial, Court Rules

December 20, 2017 | Risk Management News

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​A United States district court in Maryland has denied a hospital's motion for summary judgment in litigation alleging failure to stabilize in violation of the Emergency Medical Treatment and Labor Act (EMTALA). The court cited ambiguities in documentation in the hospital record of the time that a patient was admitted from the emergency room (ER) to the hospital, as well as lack of documentation regarding the patient's clinical status at the time and the hospital's failure to establish that the care provided to the patient was sufficient to stabilize him without performing surgery sooner. However, the court granted summary judgment to the hospital on the plaintiff's EMTALA claim for failure to screen.

The patient was injured in an auto collision, suffering exsanguination, mangled limbs, open fractures, severe pain, and pulseless extremities. Emergency medical services took him to the ED of a level II trauma center, where he arrived at 1:33 a.m. Within four minutes, a physician assistant screened him and documented his condition as the highest level of trauma. Blood transfusions were administered. The on-call trauma surgeon arrived in the ER 20 minutes after the patient, described the patient as being in "severe distress," and diagnosed "severe hypovolemic shock and massive bleeding from the arteries and extremities," "massive soft tissue injury," "vascular injury," and "multiple open fractures." Hospital records indicate that the patient was scheduled "to go immediately to the operating room (OR) for vascular and orthopedic repair," but the surgical specialists were documented as "no show in the ER" and "extremely tardy in the OR."  The patient was admitted to the intensive care unit at 4:13 a.m., but the records also indicated that at 4:15 a.m. he was taken to the OR with surgery scheduled for 4:24 a.m. The on-call orthopedic and vascular surgeons arrived at 4:35 a.m. and surgery began at 5:13 a.m. Documentation in the hospital record stated that by then, "his lower extremities had become ischemic, gangrenous, and ultimately necrotic due to oxygen deprivation." Ultimately, the patient required amputation of his...

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