The U.S. Court of Appeals for the First Circuit recently determined that a woman en route to a hospital in a private ambulance, suffering from emergency symptoms of an ectopic pregnancy, could not be turned away by the hospital’s emergency department under the Emergency Medical Treatment and Active Labor Act (EMTALA), broadening the common understanding of what it means to “come to” a hospital under EMTALA. Prior to this decision, it was commonly believed that a person had to physically arrive on a hospital’s grounds before the hospital was restricted under EMTALA from declining to treat that individual.

The decision (Morales v. Sociedad Espanola de Auxilio Mutuo y Beneficia, 1st Cir., No. 07-1951, 04/18/08) addressed for the first time what it means to “come to” a hospital’s emergency department under EMTALA. The court determined 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 her imminent arrival.”

EMTALA applies to any hospital that participates in Medicare. Under EMTALA, “if any individual . . . comes to the emergency department [of a covered hospital] and a request is made on the individual’s behalf for examination or treatment for a medical condition, the hospital must provide for an appropriate medical screening examination.” 42 U.S.C. § 1395dd(a). If the screening examination discloses that the individual suffers from an emergency medical condition, the hospital must provide necessary stabilization. 42 U.S.C. § 1395dd(b)(1). EMTALA’s definition of what it means to “come to” a hospital states that the hospital may turn away a patient who is in an ambulance not owned by the hospital and not yet on the hospital’s grounds if the hospital is in “diversionary status,” meaning that it “does not have the staff or facilities to accept any additional emergency patients.” 42 C.F.R. § 489.24(b)(4) (2003). However, the court noted that the hospital in question never claimed to be in diversionary status when it turned away the plaintiff. Instead, it cut off communications with the ambulance after learning of the plaintiff’s uninsured status.

The court determined that the meaning of “comes to” in EMTALA was ambiguous; it therefore looked to statutory intent. The court noted that EMTALA was enacted in response to widespread reports that hospitals were “dumping” or refusing to treat indigent patients. The court further noted that the purpose of the act was to ensure that all individuals experiencing a medical emergency would be treated fairly, regardless of their socioeconomic status. It then held: “An interpretation of the statute concluding that an individual en route to the hospital, under the plaintiff’s version of the facts, has ‘come[] to’ the emergency department fits most squarely with this intent. This reading comports with EMTALA’s primary goal and hinders efforts to turn away prospective patients because of their economic status.” The court concluded its decision by inviting HHS to resolve the ambiguity of the act by more clearly defining what it means to “come to” a hospital.

Based upon this case, hospitals participating in Medicare should review their policies to ensure that they are compliant with this interpretation of EMTALA. Hospitals should specifically take the First Circuit’s interpretation of EMTALA into careful consideration when determining how to respond to a request for care from an uninsured individual en route in a private ambulance.

For further information, please contact Lora Zimmer or your regular Hinshaw attorney.

This alert has been prepared by Hinshaw & Culbertson LLP to provide information on recent legal developments of interest to our readers. It is not intended to provide legal advice for a specific situation or to create an attorney-client relationship.