Romine v. St. Joseph Health Sys. (Summary)

EMTALA

Romine v. St. Joseph Health Sys., No. 12-6587 (6th Cir. Oct. 24, 2013)

The United States Court of Appeals for the Sixth Circuit affirmed a lower court’s decision to grant a hospital’s motion for summary judgment, finding that a patient had failed to provide sufficient evidence to establish a causal relationship between the hospital’s alleged violation of the Emergency Medical Treatment and Active Labor Act (“EMTALA”) and his injury.

The patient had lacerated his hand and went to the hospital’s emergency department.  While at the emergency department, the patient was informed by the receptionist there were no beds available, while the patient waited and insisted that all he needed was an examination.  After waiting about ten to 12 minutes, the patient went back home, only to have to return to the hospital emergency department because of his profuse bleeding.  The same receptionist told the patient that he would have to wait.  A nurse then noticed the patient’s significant injury and took him into the emergency room for treatment.  While the staff managed to temporarily stop the bleeding, they decided that the patient would need to be airlifted to another hospital for more treatment.  At this new hospital, the patient got the treatment he needed, but was instructed not to use the injured hand for one month, during which time he was unable to work.

The court found that the patient had not provided adequate evidence of causation for his EMTALA suit because he failed to provide expert testimony to prove that his harm, missing one month of work, resulted from the hospital’s delay in treating him.  The court noted that in cases such as this, a layperson cannot distinguish between whether the harm was caused by the initial injury or the delay in treatment and, accordingly, expert testimony is required.  Furthermore, the court held that the patient failed to provide evidence that the hospital acted with an “improper motive” – which is an essential element of an EMTALA claim in that jurisdiction – because he made no allegations that he received a different standard of care than other patients.

The court also rejected the patient’s argument that CMS’s preliminary determination letter, which found that the hospital had violated EMTALA, was binding in this case.  Notably, said the court, the CMS preliminary determination letter makes no findings about whether the violation caused a patient’s harm or whether the hospital had improper motive.  In addition, because the preliminary decision is preliminary and has not been adjudicated within the agency, it is not the sort of agency decision that would be entitled to preclusive effect in later lawsuits.