The patient presented at 5 pm with chest pains and shortness of breath. EKG and a blood draw were initiated within 20 minutes. A chest x-ray was performed in another 30 minutes. After several hours, the patient was seen by the ED physician, and then a cardiologist examined the patient. He offered the patient a “clot buster” or stent. He went to surgery for the stent about 11:30 pm.
Later, the patient discovered that standards recommended that the process should be 90 minutes or less from time of presentation and sued the “name brand” clinic and hospital for an EMTALA violation for failure to promptly assess and stabilize his condition.
The US Court of Appeals for the Third Circuit ruled that the hospital had followed its applicable policies and procedures and that they did not discriminate against the patient, so EMTALA does not apply. The patient was not represented by counsel. The court noted that the patient’s complaint might state a cause of action for malpractice, but EMTALA lawsuits are not federal malpractice cases.
So, if your hospital would handle chest pains and shortness of breath in this time frame, would you get the same legal outcome? Probably not.
First of all, your policies and procedures probably are different. Secondly, if you handle even one similar patient differently, you are potentially providing “disparate care” and EMTALA would be violated.
More importantly, however, is the fact the CMS does not use the same approach as the Courts. CMS looks at quality and standards of care and has access to information the courts never see in your peer review and quality documents. My opinion is that that CMS would have cited this hospital had they received a complaint (and that in turn could have changed the court case dramatically).
The patient made two mistakes: going to this hospital and not getting a lawyer to file a complaint with CMS.