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Claim made under federal anti-dumping statutes
News: A pregnant woman whose baby died after the mother was transferred to a second hospital by an ambulance that broke down during the transfer settled her case for $850,000. The woman and her husband made a claim under federal anti-dumping statutes.
Background: On Aug. 1, 1994, the patient, who was 32 weeks pregnant, woke up with a severe headache, sore jaw, and bloody tongue. She had two seizures. The patient called her obstetrician and went to W.W. Backus Hospital in Norwich, CT. After she arrived and underwent tests, her obstetrician had her transferred by ambulance to the University of Connecticut in Farmington. The trip 70-minute trip took 90 minutes because the ambulance broke down, and the patient and her husband had to wait for a second ambulance. The baby died on Aug. 5 due to injuries to major organs, the plaintiffs claimed.
The plaintiffs alleged that the baby should have been delivered at Backus in order to stabilize the mother's condition, eclampsia. The plaintiffs also claimed that the obstetrician and Backus violated federal anti-dumping laws, which would require them to pay double damages. These defendants denied the allegations, claiming that their actions were medically appropriate and did not violate the standard of care.
The ambulance company, which also was sued, contended that the ambulance broke down without warning and that the 20-minute delay caused by the wait for the second ambulance did not cause the infant's death.
What it means to you: Leilani Kicklighter, RN, ARM, MBA, assistant administrator of risk/safety management for the North Broward Hospital District in Fort Lauderdale, FL, initially questions whether the patient was in labor or suffering from one of the potential complications of pregnancy, eclampsia. Kicklighter notes that if the patient had been stabilized and transferred to a higher level of care at another facility because of the potential prematurity of the fetus and the eclampsia, with full disclosure by the physician of the risks and benefits, and if the transfer was not done based on insurance coverage or ability to pay, then it is unclear why the hospital was held responsible. Moreover, an ambulance company normally operates independently from the hospital; therefore, the hospital is not customarily held liable for the ambulance company's negligence, she adds.
More inservicing needed
Nevertheless, there was a settlement in this case, reinforcing the need to hold repeated inservices for both the emergency department staff and the OB staff regarding the appropriate assessment of pregnant patients, Kicklighter says.
"The Emergency Treatment and Active Labor Act [EMTALA] applies to all patients presenting to and requesting care from an emergency department, and to all patients in labor, regardless of ability to pay.
"First, the patient is evaluated and screened and receives full informed consent regarding the risks and benefits of a transfer. Then, if the organization does not provide the level of care or the specialty needed, a patient may be transferred to another organization, provided it is for care and not because of lack of ability to pay. All of these elements must be emphasized to physicians and other staff to assure compliance. Whenever there is a question of whether the EMTALA regulations are met, the risk manager should be called," she explains.
Enforce ambulance fleet management
Another issue that arises in this case is the ambulance company's fleet management program, specifically related to this vehicle, Kicklighter observes. She would want to know when the vehicle last underwent routine maintenance and what the routine daily vehicle inspection entailed.
"Often, when an organization such as an ambulance company is vehicle-dependent, there is a reluctance to enforce routine maintenance checks. That is because it often means the vehicle will be out of commission for at least a day, and that means lost business. While automobiles are quirky and can stall without warning, the risk manager must be sure there is an appropriate, broad fleet management program in place and that it is enforced with documentation to back- up compliance."