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EMTALA Trumps Malpractice Suit Requirements

March 15, 2012

In the recent case of Cox v. Cabell Huntington Hospital, the Federal District Court for the Southern District of West Virginia ruled that EMTALA will preempt any state laws that conflict with EMTALA’s intent.

In the Cox case, the patient went to the emergency department with a severe arm fracture and alleges that he was discharged without being adequately screened or stabilized as is required under EMTALA. The opinion contained no further information regarding whether Mr. Cox suffered any bad outcome after his treatment in the emergency department. The hospital argued that the patient’s lawsuit should be dismissed because it did not contain a “certificate of merit.” Under West Virginia law, all malpractice suits in West Virginia must contain a certificate of merit from a physician stating that the lawsuit has a reasonable basis. The patient responded that he did not file a state “malpractice” claim, but rather filed a private action for violation of the federal EMTALA statute.

The court noted that EMTALA requires that hospitals screen and stabilize patients with an emergency medical condition. Any person “who suffers personal harm as a direct result of a participating hospital’s violation of a requirement of this section” (42 U.S.C. § 1395dd(d)(2)(A)) is entitled to file a lawsuit against the hospital. The court also noted that “state and local laws that directly conflict with the requirements of EMTALA are preempted.”  42 U.S.C. § 1395dd(f).

The requirements for proving an EMTALA violation are entirely different from the requirements for proving a medical malpractice claim. The court noted with an EMTALA violation, the issue is “not whether the screening met the applicable standard of care, but whether it was the same as that provided to other patients in the same facility.”

Because the claim was solely for a violation of EMTALA and because EMTALA does not have any requirement that a plaintiff file a “certificate of merit”, the District Court held that the “certificate of merit” requirements in the state malpractice statute were preempted when alleging an EMTALA violation.

Note, however, that just because the patient is allowed to proceed with his lawsuit, he is not assured of winning his lawsuit. He must prove not only that the hospital provided disparate treatment to him – for example, discharging him with neurovascular deficits when other patients with fractures and neurovascular deficits are admitted – and must also prove that he suffered some injury because of the disparate treatment.

Finally, as the court also noted, EMTALA violations may sometimes be less difficult to prove. Treatment that meets the “standard of care” (and which therefore does not amount to medical malpractice) may still violate EMTALA if it is discriminatory in nature.




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