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Emergency Medical Treatment And Active Labor Act (EMTALA) Hospital's by vev19514

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									          Legal information for nurses Legal Eagle Eye Newsletter for the Nursing Profession home page.



 Emergency Medical Treatment And Active Labor
 Act (EMTALA): Hospital’s Standard Emergency
 Procedures For Chest Pain Not Followed, But
 Court Finds It Did Not Aggravate Patient’s MI.
T     he US District Court for the District of
      Puerto Rico was willing to agree with
the patient that the hospital did not com-
                                                   The EMTALA was passed
                                                                                       Alcohol/Drug Intoxication No Excuse
                                                                                         It was noted in the E.R the patient
                                                                                    smelled of alcohol and was intoxicated
                                                 by the US Congress in 1986
pletely follow its own standard procedures                                          when he came in.
for medical screening and stabilization of       to do away with hospitals               However, the hospital offered the
an emergency-room patient presenting with        dumping indigent and unin-         court no explanation how that would in
complaints of chest pain.                        sured patients from private        general or in this case excuse the hospital
     The patient came in to the emergency        to public hospitals.               from fully following its standard screening
room between 7:10 and 7:26 p.m. A CBC,                                              and stabilization procedures for a patient
                                                   However, at this time the
EKG, CPK and arterial blood gases were                                              with chest pains who was presumptively
done and he was given one sublingual             EMTALA extends to all who          having an MI.
dose of nitroglycerin.                           present themselves at hos-              But there is more to it than that for a
     According to the court record, he was       pitals that have emergency         patient to have a valid civil case against a
also given Zantac, Vistaril and Haldol in the    rooms and participate in           hospital for violation of the EMTALA.
emergency room.                                  Medicare, not just indigent             Cause-And-Effect Must Be Proven
     The patient was admitted to a medical/                                              Belatedly the patient did receive all of
surgical unit. At 7:30 and 8:00 a.m. the next
                                                 or uninsured persons.              the accepted screening and care appropri-
morning he was given repeat EKG’s that              First, a hospital must per-     ate for an MI patient, on a hospital medical/
were suggestive he had had a myocardial          form an appropriate medical        surgical unit and then in the ICU.
infarction. A cardiologist came in for a         screening of any individual             According to the court, in a civil law-
consultation at 8:15 a.m.                        who arrives at the emer-           suit for damages the patient has the burden
     He was transferred to the intensive                                            of proof, even when there is a violation of
                                                 gency room requesting treat-
care unit at 8:00 p.m. that evening and                                             the EMTALA, to prove that care being de-
heparin anticoagulant therapy was begun.         ment, to determine if the in-      layed or denied caused or aggravated harm
He remained in the ICU for seven more            dividual has an emergency          to the patient.
days and was transferred to another hospi-       condition.                              In this case the patient was unable to
tal for heart surgery.                             Second, the hospital must        present that proof, the court ruled, and so
         The EMTALA Was Violated                                                    the court dismissed his lawsuit.
                                                 stabilize a patient who is at
     In the lawsuit the patient said his care                                           Expert Witness Testimony Required
in the emergency room was insufficient.          the hospital and has an                 As in other medical litigation, proving
Serial cardiac enzyme tests were not done,       emergency medical condi-           medical cause-and-effect in an EMTALA
a cardiologist was not called in and he was      tion (whether or not the           case requires expert medical testimony, the
not given aspirin, heparin and TPA.              emergency presented first in       court stated.
     He also claimed he should have been         the emergency room).                    In this case the patient’s lawyers sub-
transferred to another hospital that would                                          mitted a physician’s report comparing the
have given appropriate care for a patient
                                                   Third, the hospital can          emergency-room care that was given with
having an acute MI.                              transfer the individual to an-     the hospital’s standard emergency-room
       The court agreed with the patient on      other hospital only when           procedures for patients with chest pain.
   these points. The Emergency Medical           certain conditions are met if           However the physician stated no opin-
       Treatment and Active Labor Act            the person still has an emer-      ion on cause-and-effect. In fact, the court
  (EMTALA) says that every hospital that                                            believed the physician lacked the profes-
                                                 gency medical condition that
 participates in Medicare and has an emer-                                          sional qualifications to give an opinion as a
gency room must follow the hospital’s own        has not been stabilized.           specialist in cardiology, which legally was a
                                                    UNITED STATES DISTRICT COURT,
 screening and stabilization protocols with                                         fatal flaw in the patient’s lawsuit. Torres
                                                         PUERTO RICO, 2000.
 each and every patient presenting with the                                         Otero v. Hospital General Menonita, 115 F.
same signs and symptoms. The court ruled                                            Supp. 2d 253 (D. Puerto Rico, 2000).
        that was not done in this case.

 Legal Eagle Eye Newsletter for the Nursing Profession                                    January, 2001           Page 7
         Legal information for nurses Legal Eagle Eye Newsletter for the Nursing Profession home page.

								
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