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Federal District Court Declines to Expand EMTALA to Cover Complications Following Scheduled Inpatient Surgery

on Wednesday, 4 April 2018 in Health Law Alert: Erin E. Busch, Editor

In Gilmore v. Holland, decided in February 2018, the U.S. District Court for the Middle District of Pennsylvania held that the Emergency Medical Treatment and Labor Act (“EMTALA”) does not apply to a patient who has been admitted for an inpatient procedure who develops post-surgery complications.

In his complaint, Mr. Gilmore alleged that he was admitted to the hospital as an inpatient for a scheduled, non-emergent ablation procedure to treat atrial fibrillation. He was not admitted for the purpose of treating an emergency medical condition. Following the ablation procedure and over the course of several days, Mr. Gilmore had severe back pain and loss of feeling and weakness in his legs. Nephrology and vascular consults were provided. On the day after the ablation surgery, Mr. Gilmore received a neurology consult, and the neurologist recommended an MRI, which occurred two days after the ablation procedure. Following the MRI, Mr. Gilmore underwent laminectomies for a C7-T2 subarachnoid hemorrhage and spinal cord compression. The surgery revealed significant spinal cord compression, evidence of clotted subarachnoid hemorrhage, and active bleeding into the compressed hematoma area.

Eight days after the ablation procedure, Mr. Gilmore was transferred to a rehabilitation facility, but was readmitted to the hospital four days later for altered mental status. Fifteen days after his readmission to the hospital, Mr. Gilmore was discharged to a rehabilitation facility. Since that time, Mr. Gilmore was hospitalized numerous times and requires ongoing nursing home and rehabilitative care. He remains paralyzed with neurological deficits and has not been able to return home.

Among other defendants, Mr. Gilmore sued the cardiologist, neurologist, and the hospital alleging numerous grounds, including professional negligence, vicarious liability, and violation of EMTALA. With respect to the EMTALA claim, Mr. Gilmore advanced a novel theory and alleged that, based on the neurology evaluation conducted at the hospital, he had new lower extremity paralysis which was a new emergency medical condition for purposes of EMTALA. He further alleged that when his post-surgery medical condition was identified while an inpatient, the hospital had an obligation under EMTALA to provide such further medical examination and treatment as may have been required to stabilize his condition.

In response, the hospital filed a motion to dismiss the complaint. The Court granted the motion and dismissed Mr. Gilmore’s complaint in its entirety without providing him an opportunity to amend his complaint, concluding that the complaint failed to state a claim under EMTALA. The Court held that the hospital’s obligations under EMTALA ended when Mr. Gilmore was admitted to inpatient care and that his treatment did not fall within the scope of EMTALA. Mr. Gilmore presented to the hospital for a cardiac ablation, a prescheduled procedure, and began experiencing neurological issues only after the scheduled procedure had been performed during his inpatient stay.

The Court’s holding should not be surprising, given the regulatory and Interpretive Guidelines language. The EMTALA regulation states: “[t]his section is not applicable to an inpatient who was admitted for elective (nonemergency) diagnosis or treatment.” 42 C.R.F. § 489.24(d)(2)(ii). As the EMTALA regulation goes on to point out, there is protection for patients under the Medicare Hospital Conditions of Participation; a hospital is required by the Conditions of Participation to provide care to its inpatients. See 42 C.F.R. § 489.24(d)(2)(iii). Under Tag A-2407/C-2407 of the Interpretive Guidelines, CMS states: “[i]ndividuals admitted to the hospital for elective medical services are not protected by EMTALA. The Hospital CoPs (Conditions of Participation) protect all classifications of inpatients, elective and emergent.” The same Tag further states: “EMTALA does not apply to hospital inpatients. The existing hospital CoPs protect individuals who are already patients of a hospital and who experience an EMC (emergency medical condition).”

While the Court’s decision was expected, it is nevertheless welcome to confirm the scope of EMTALA. As the Court pointed out, Congress did not intend for EMTALA to cover such individuals every time they come to the hospital for their appointments, even though they suffer from serious medical conditions that risk becoming emergent.

Joseph P. Loudon

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