REARDON LAW OFFICE

Treating Patients Who Present For Emergency Care

by Attorney Frank E. Reardon

October 2003

Healthcare Law, Litigation & Public Policy   Medical Licensure & Discipline ♦ Employment Board of Registration

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In the summer of 2003, the family of Christopher Sercye received $12.5 million from a Chicago-area hospital.  The Sercye family had filed suit against Ravenswood Hospital, alleging wrongful death, medical negligence and a violation of a federal statute, the Emergency Medical Treatment and Active Labor Act (“EMTALA”).

Congress enacted EMTALA in the 1980s to keep hospitals from turning away emergency patients or transferring patients in unstable condition because they are unable to pay. Although EMTALA’s purpose is to protect the poor, 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. Penalties for infractions range from suspension of Medicare participation to fines up to $50,000 per violation.


Under EMTALA, anyone who comes to a hospital seeking emergency care must receive a medical screening examination. In addition, any patient transferred out of an ER must first be stabilized. A violation of EMALTA results when the hospital’s medical screening examination was inappropriate or the hospital failed to properly stabilize the individual.


In the case of Pamela Sercye-McCollum, et al. v. Ravenswood Medical Center, et al., Christopher Sercye, a 15-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.   


In addition to the Hospital's $12.5 million settlement, 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 legal duty to go to Christopher is still up for debate. 


EMTALA is enforced by individuals and hospitals with a private right of action against hospitals who violate EMTALA. 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 fined the Hospital $40,000; a far lesser penalty than the threatened suspension of Medicare reimbursement. 


The issue in the Christopher Sercye case centers on whether Christopher actually came to the hospital in search of medical treatment under the statute’s provisions. Originally, the Act required an individual to physically enter the Emergency Department. Before the new guidelines, a Texas court held that merely walking through the ED en route to another area of the hospital, was not the same as the patient “coming to” the ED in search of treatment as the statute requires. Another court 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.”  CMS now defines “hospital property” to include hospital ambulances, sidewalks, the parking lot, driveway or any other department within the hospital.  The new EMTALA rules published in 2003 also clarify and expand the definition of an Emergency Department under the statute. CMS now says an emergency department is any facility on-or-off the main campus that is either 1. licensed by the state as an emergency room or emergency department; 2., holds itself out as providing care for emergencies without requiring an appointment; or 3. a facility of the hospital that has provided at least one-third of its outpatient visits for treatment of emergency conditions on an urgent basis.


But the new EMTALA rule also reduces some of the hospital’s potential burden. On-call requirements for specialists are now more discretionary. For example physicians will be permitted to be on-call at more than one facility and to schedule elective procedures during on-call shifts.


Despite the broader 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 that CMS will use common sense and base their 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.