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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