William Romine went to the emergency room at St. Joseph-Mount Sterling hospital in Mount Sterling, Kentucky, after cutting his hand with a pair of scissors while trying to unclog a bottle of Gorilla Glue. . Romine was not immediately seen at St. Joseph-Mount Sterling because no beds were available. Unsatisfied with having to wait, he left to go to another hospital in Winchester, Kentucky. During the trip to the second hospital, Romine decided to return back to St. Joseph-Mount Sterling, where he was again told there were no available beds. A short while later Romine received treatment to temporarily stop the bleeding. St. Joseph-Mount Sterling determined that it was unable to treat the injury and Romine was airlifted to another hospital where his bleeding was stopped by the placement of sutures.
After receiving follow-up care from an orthopedic specialist, Romine filed an action in the Eastern District of Kentucky claiming that St. Joseph-Mount Sterling violated EMTALA by failing to provide him with an appropriate medical screening and by failing to stabilize his injury.
Following the close of discovery, St. Joseph-Mount Sterling filed a motion for summary judgment. On November 27, 2012, the court granted the motion citing a number of reasons.
First, the court found that because Romine had not provided expert testimony, he could not show that any alleged screening violation actually caused or exacerbated his injuries. Romine argued that the Centers for Medicare and Medicaid Services (“CMS”) sent a preliminary determination letter to St. Joseph-Mount Sterling indicating that CMS planned to terminate St. Joseph-Mount Sterling’s participation in the Medicare program because its failure to provide appropriate medical screening and triage to Romine was enough to establish an EMTALA violation. The court rejected Romine’s argument, finding that CMS’ preliminary determination letter was not conclusive of an EMTALA violation because it was disputed by St. Joseph-Mount Sterling and resolved through a plan of correction prior to the instigation of a formal enforcement action. The court continued by stating that even if the CMS letter was accepted as proof of an EMTALA violation, it did not establish the requisite causal link between the violation and the alleged injury.
Second, the court found that even if Romine had submitted appropriate expert testimony to establish the causal connection between the alleged inappropriate medical screening and his injury, he could not succeed on his EMTALA claim because he could not show that St. Joseph-Mount Sterling acted with an improper motive. Relying on precedent in the Sixth Circuit, the court found that Romine was required to provide proof that the inadequate screening was motivated by his lack of resources, lack of insurance, or some other bias. The court found that Romine failed in this regard because he had insurance and presented the court with no other basis for bias.
Last, Romine’s failure to stabilize claim only involved his first visit to St. Joseph-Mt. Sterling. Romine’s complaint did not involve his second trip to St. Joseph-Mount Sterling or the efforts to stabilize him before the transfer to the University of Kentucky. Reviewing Romine’s complaint regarding his first visit to St. Joseph-Mount Sterling the court rejected Romine’s failure to stabilize claim finding that hospital staff did not screen him during his first visit much less make requisite finding that Romine was suffering from an emergency medical condition. The duty to stabilize is only triggered following an emergency medical condition determination. Without a duty to stabilize, the court ruled that “no rational juror could find for Romine on a stabilization claim . . . .”
This case should serve as a reminder for all facilities covered by EMTALA that claims under EMTALA may be brought even when the injury to the patient is relatively minor. Facilities should ensure their EMTALA policies are updated and the impacted staff is adequately trained.