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Court decides if EMTALA should apply to inpatients
A 2003 Centers for Medicare & Medicaid Services (CMS) regulation that interpreted the Emergency Medical Treatment and Labor Act (EMTALA) does not apply to inpatients does not have the "force and effect of law," according to a recent decision by a U.S. District Court in Puerto Rico.
The court ruled that a mother could continue with her suit alleging that Hospital San Pablo del Este (HSPE) transferred her newborn child without providing stabilizing care while the infant was in a profoundly unstable condition. The judicial finding that the regulation only is an interpretation has the potential to bring up the issue on appeal in this or other cases, and perhaps ultimately return EMTALA to the Supreme Court for further clarification, says Stephen A. Frew, JD, a web site publisher and risk management specialist (www.medlaw.com) in Madison, WI.
The mother gave birth by cesarean at the HSPE, and the infant originally was taken to the hospital's newborn unit, according to a summary of the case. The child developed emergency conditions, including upper gastrointestinal bleeding, and was vomiting blood, the court opinion stated. The following day, the physician at HSPE ordered the infant transferred to Hospital Interamericano de Medicina Avanzada, where the child was described on arrival as being "critically ill." Medical records showed that the infant left HSPE "totally unstable" and with active upper gastrointestinal bleeding, the court noted. The child died two days later.
The hospital moved to dismiss the case on the grounds that under the 2003 CMS regulations, it was not bound by the stabilization and transfer rules of EMTALA because the infant was an inpatient. The court ruled that the 1998 Lopez-Soto v. Jose Hawayek case had previously held that EMTALA did apply in almost identical circumstances and emphasized that EMTALA's clear language is not limited to hospital emergency departments. The Lopez-Soto case is the only significant court of appeals case to interpret the Supreme Court ruling on EMTALA in the 1999 Roberts v. Galen case.
The judge refused to throw out the case because of the CMS interpretation not being binding on the court, and the judge stated that it would not apply in any case because the interpretation was issued after the child's death. The court noted that retroactive applications are not favored by law.
The decision allows the mother to proceed to trial, but she still must prove her allegations and that the conduct did violate EMTALA. Further appeal of the ruling is not likely to be allowed until a final verdict has been rendered in the case, Frew said.
"The original Roberts court clearly felt that EMTALA was not affected by what door the patient entered or what the patient's status in the hospital was, and applied it to an inpatient discharge situation," he notes. "The interpretation that EMTALA sections are to be read separately is also critical to the building debate over whether the CMS interpretation that 'EMTALA does not apply to inpatients' alters the requirements for hospitals with specialized capabilities to accept transfers under EMTALA."
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