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Christopher Sercye, a fifteen year old Chicago teen, was playing a game of basketball when he was shot by gang members.  The inner-city basketball court, where the incident occurred, was located one block from the Ravenswood Hospital Medical Center.  Christopher was able to walk most of the way to the Hospital but collapsed just outside the Hospital grounds, within 30 feet from the emergency department entrance.   Christopher’s friends sought help from inside the Emergency Department.  To their dismay, emergency personnel refused to go to Christopher as it was against the hospital’s policy for staff to leave the hospital grounds.  Instead, staff members called 911 for an ambulance to bring Christopher to them.  After waiting nearly twenty-five minutes, a police officer brought a wheelchair to Christopher; wheeled him onto the hospital grounds and into the ED.  Christopher died an hour later. 

       Last month, the family of Christopher Sercye received $12.5 million from the hospital in settlement of their claims.  The Sercye family had filed suit against the hospital, alleging wrongful death, medical negligence and a violation of a federal statute, the Emergency Medical Treatment and Active Labor Act (“EMTALA”).  The Centers for Medicare and Medicaid Services (“CMS”), a division of the Department of Health and Human Services, fined the Hospital $40,000 for violating EMTALA.  Interestingly, the Hospital may not have technically violated EMTALA and whether the Hospital staff had a duty to go to Christopher is still up for debate. 

EMTALA was enacted under the Clinton Administration to prevent emergency departments from refusing to provide emergency services or transferring an unstable patient because they don't have insurance or are unable to pay.  Congress enacted EMTALA to protect the poor and yet the Act applies to all individuals who enter an emergency room in search of healthcare.  Any hospital that has an emergency department and participates in the Medicare program is subject to the Act.  Under EMTALA, an individual who comes to a hospital seeking emergency care must receive a medical screening examination.  A violation of EMALTA results when the hospital’s medical screening examination was inappropriate or the hospital failed to properly stabilize the individual.

EMTALA is enforced by individuals who sue under the Act, and by CMS.  In the matter of Christopher Sercye, CMS threatened to suspend Ravenswood Hospital’s Medicare funding unless the Hospital revised its policy of not allowing staff to leave hospital grounds.  Ultimately, the hospital’s policy was found to be legitimate based on the hospital’s location since the inner city area was unsafe for its employees.  In the end, CMS only fined the Hospital $40,000; a nominal fee compared to the threatened suspension of Medicare reimbursement.  However, in light of the fact that the hospital may not have technically violated EMTALA with regards to its treatment of Christopher Sercye, it may seem unreasonable on the part of CMS.

The issue which this case raises is whether Christopher Sercye actually came to the hospital in search of medical treatment as the statute requires?

Initially, courts were strictly interpreting the meaning of “comes to” for purposes of enforcing the EMALTA.   A Texas court held that by merely walking through the ED while in route to another area of the hospital, it was not the same as the patient “coming to” the ED in search of treatment as the statute requires.  Another court has held that a patient already in the hospital’s ambulance en route to the ED had not yet “come to” the emergency department for purposes of enforcing the EMTALA.  In response to the courts strict interpretations in these cases, the CMS clarified the phrase by defining “comes to” to mean “the individual is on the hospital property.”  The CMS defined “hospital property” to include hospital ambulances, sidewalks, the parking lot, driveway or any other department within the hospital.

Despite this broad definition of “comes to,” Christopher Sercye was not on hospital property when emergency staff refused to treat him. Technically then, no violation of EMALTA occurred.  Regardless, CMS fined the hospital.  The message seems to be: CMS will use common sense and their base decisions on the spirit of the law when interpreting EMTALA.  As this case demonstrates, EMTALA may apply to a hospital’s periphery and not just the actual emergency room.  EMTALA was enacted to save lives--not to lose them based on technicalities.   

Ravenswood Hospital’s policy of not permitting staff members to leave hospital grounds was revised after Christopher Sercye’s death.  But with dozens of sick and wounded patients already in the ED, how far must a physician or any other member of the hospital staff go to render care to someone outside the hospital? 

Many states, such as Illinois, have Good Samaritan Laws, which would offer protection to medical personnel who render assistance to an injured person not yet inside the hospital grounds.  Such laws encourage medical staff to leave the hospital grounds when an emergency situation arises near the hospital.  However, each emergency situation that occurs off-site will require an individualized assessment by the medical staff; what medical equipment will be necessary to aid the injured person; who should be sent out to treat the patient; will the staff be in danger if they leave the grounds; and will other patients already inside the emergency department suffer?

Staff members should be aware of the hospital’s regulations regarding the treatment of patients outside the hospital grounds, as well as the requirements of the EMTALA, but above all, medical staff must use common sense and remember that human lives are at stake-their own, their co-workers and their patients.


EMTALA

by Attorney Frank E. Reardon

July 2003