The US 1st Circuit Court of Appeals added its weight to the issue of refusing ambulance patients by radio and sided with the US 9th Circuit in ruling that a patient has "come to the hospital" when the ambulance carrying the patient makes a radio request to bring the patient to a hospital by radio.

The Court held that an individual can come to the emergency department for EMTALA purposes without physically arriving on the hospital's grounds as long as the individual is en route to the hospital and the emergency department has been notified of the individual's imminent arrival.

In this case, the patient was en route in a non-hospital-owned ambulance when the paramedics on board had called ahead to the emergency department and notified its director of the individual's condition, impending arrival, and need for treatment.

In the first of two radio contacts, the director allegedly told the paramedics to call back when they had more information about the patient's condition. In the second radio, the director allegedly "abruptly  terminated" the radio contact with the paramedics when they could not provide assurance that the individual had insurance coverage.

The paramedics interpreted the director's action as a refusal to treat the individual at the hospital's emergency department and took the patient to a different facility, where she received treatment.

The individual subsequently brought suit against the hospital and other defendants for violating EMTALA, but the District Court Judge dismissed the case upon a finding that the patient's circumstances did not create an EMTALA liability

The Court of Appeals reversed, in a 2-to-1 ruling, and followed the prior ruling of the Ninth Circuit in Arrington v. Wong, 273 F.3d 1066 (9th Cir. 2001), which had held that a hospital may not turn away an individual in a non-hospital-owned ambulance unless the hospital is on diversionary status.

The 1st Circuit stated that any other interpretation would create a "perverse incentive" for hospitals to evade the EMTALA rules by financially screening patients by radio before they reached the hospital.

The case was sent back to the District Court for trial.

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