- EMTALA and Healthlaw Resources For Healthcare Professionals, Hospitals, and Their Attorneys
Oct 27, 2016

MedLaw E-Bulletin March 4, 2006

In this issue:

1. California Court Dodges 250-Yard Rule
2. New Mailing System
3. I Need Your Help
4. Coming Soon...

MedLaw E-Bulletin March 4, 2006
Stephen A. Frew JD, Publisher

In this issue:

1. California Court Dodges 250-Yard Rule
2. New Mailing System
3. I Need Your Help
4. Coming Soon...

-------------------------1 ------------------------------
California Court Dodges 250-Yard Rule

A federal court in California found a plaintiff who fell and
was injured in the parking lot of a medical center had no
claim under the Emergency Medical Treatment and Labor Act
(EMTALA) against the hospital.

In reaching the conclusion, there is no indication that
the Court considered the CMS Regulation that added parking
lots and similar locations within 250 yards of the hospital
to the definition of having presented to the hospital for
EMTALA purposes.

The court explained its decision under the interpretation
that EMTALA is a statute aimed at prohibiting patient
dumping and once the plaintiff was taken to the medical
center she received treatment and was not “dumped” in any
way, the court said.

The court further held that EMTALA contains no requirement
that a medical center use its own personnel to transport
a patient injured on its premises to the emergency

Published accounts indicate Plaintiff Maria Addiego was
taken by her daughter to the California Pacific Medical
Center (CPMC) for an appointment. As plaintiff exited her
car in CPMC’s parking garage, she fell and broke her hip.

Although they were located about thirty yards from CPMC’s
emergency department, the parking attendant instead called
the security department who refused plaintiff’s request for
immediate medical attention from the emergency department.
Instead, security called 911. After plaintiff had been
lying on the ground for nearly an hour, an ambulance came
and transported plaintiff thirty yards to CPMC’s emergency

Plaintiff sued CPMC alleging the delay made her injuries
worse and claiming premises liability and personal injury.
Plaintiff also filed a separate action adding the City and
County of San Francisco as a defendant and alleging that
CPMC violated EMTALA by refusing to transport her to the
emergency department, and instead requiring that the San
Francisco Fire Department do so.

The situation is strikingly similar to the incident at
Ravenswood Hospital in Chicago where a hospital ED refused
to assist a teenager who had been shot and lay just a short
distance from the ED entrance. Chicago Fire EMS did not
respond because it was an incident at a hospital and
interpret ted the call as a transfer request. Chicago police,
reportedly frustrated by the stand-off between the hospital
and EMS, deviated from departmental rules and moved the
child to the hospital ED just yards away. The child,
however, died from loss of blood attributed to the delay
in care.

In response to this Chicago event, CMS added a definition in
its Out-Patient Prospective Payment regulations defining the
area of 250 yards around the hospital, including access
areas and hospital parking areas, to be "presenting to the
hospital" for EMTALA compliance rules. The rules also
require the hospital to provide a response to the patient
in addition to calling 9-1-1.

While the decision is likely to influence litigation cases
arising in the Northern District of California, it is
unlikely to influence CMS enforcement of the 250 yard
requirements of the OPPS regulation under EMTALA.

Never-the-less, one wonders whether the court was provided
information on the 250-yard rule and ignored it, or whether
the attorneys' for the patient failed to present the rule
that was specifically intended to prevent incidents like the
one described. In either case, someone screwed up.

The patient is fortunate that they fell in California, and
not northern Michigan, or they might have frozen to death
awaiting the delayed EMS response while hospital personnel
ignored a seriously injured patient within view of the
ED entrance.

Addiego v. City and County of San Francisco, No. C 05-04819
CRB (N.D. Cal. Feb. 17, 2006).

----------------------- 2 --------------------------

New Mailing System Aimed At Avoiding Email Blockades

The new email server sending this message was added to
fight the fact that almost 80% of our ebulletins were
being blocked by service providers without the awareness
of our subscribers.

Because of this, you may wish to check out the news section
of the website at for past issues of the
ebulletin to make sure you have gotten all of the
information we have sent out. In particular the last two
ebulletins contained important information and resources.

You should also consider downloading our desktop alert
tool. This tiny icon on your lower toolbar will alert
you each time a new item is posted on the website, and
that includes new ebulletins. You can also use it to
monitor RSS feeds from all of your favorite websites so
you do not have to keep checking for new material.

The tool is ZERO$, and we highly recommend it.

Or, there are links at the bottom of the
page to complimentary RSS feedreaders that can also keep
track of any RSS feed, including

---------------------- 3 ----------------------
I Need Your Help...

Because of the 80% blockade rate for email generally,
many of our subscribers are NOT aware of our conversion
to the new system. If someone you know thinks that they
are subscribed, but did NOT get this ebulletin, please
direct them to the website to sign-up on the new system.
You can forward this ebulletin to them if you wish, but
please put a note at the top so they know where the
message came from and do not accuse us of unsolicited
commercial e>m/a/i/l.

------------------------ 4 ------------------------------

Coming Soon ....

Last fall, you helped out and let me know what topics and
locations you favored for an EMTALA seminar. Now that we
have the E-Bulletin back up and functioning, I will now
turn my attention back to setting up one or more programs
for later this year. I will send out another announcement
as soon as the dates and locations are selected...then
more info will follow as arrangements are completed.

I wish you the best,

Stephen A. Frew JD
PO Box 15665
Loves Park, IL 61132
P: 608-658-5035
F: 815-654-2162

Stephen A. Frew JD, Publisher
PO Box 15665
Loves Park
Illinois 61132
United States