| Hospital Refuses Treatment to an Indigent Patient With Severe Stomach Pains Unless She Paid $50 Ruptured Appendix and Lawsuit Follow Hospital Must Screen and Stabilize the Patient Before Transfer |
Emergency departments of hospital have special responsibility toward their patients because there patients are seeking treatment of an urgent nature, and often lack insurance or personal resources to foot the bill. Can the hospital insist upon payment prior to rendering services? Can it send the patient, in medical distress, to another hospital, possibly a public hospital? What precisely are the responsibilities of a hospital emergency room?
Facts: On March 19, 1988, plaintiff and her mother went to Enid Memorial Hospital's emergency room after plaintiff complained of severe stomach pains. Plaintiff was thirteen years old at the time. Upon arrival, plaintiff's mother was asked to fill out a standard form. One of the questions related to insurance. Plaintiff's mother informed the duty nurse that she had no insurance "except welfare."
The sequence of events after this point is greatly disputed. Plaintiff contends her mother requested a medical exam but was told no one would see her daughter unless she made a $50.00 payment, which she could not do. Conversely, defendant asserts the nurse told plaintiff's mother that welfare did not ordinarily cover emergency room visits, and therefore she would be billed at some time in the future. It is undisputed that plaintiff and her mother left the hospital without receiving any treatment.
The next day, plaintiff's appendix ruptured. An emergency operation was performed at a different Enid hospital. Plaintiff allegedly suffered greater postoperative pain than she would have if the appendix had been removed earlier. Further, the procedure itself was more complex. She also alleges she may be unable to have children as a result of the rupture.
Plaintiff brought suit claiming damages for personal injury. After the jury returned a verdict in favor of the hospital, plaintiff appealed. The central issue decided by the U.S. Court of Appeals was that the defendant (the hospital in this case) has the burden of proof to show that the request for screening was withdrawn. The case was returned for retrial.
Court Decision: The statute concerning examination and treatment for emergency medical conditions and women in active labor states:
In the case of a hospital that has a hospital emergency department, if any individual (whether or not eligible for benefits) comes to the emergency department 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 within the capability of the hospital's emergency department to determine whether or not an emergency medical condition exists or to determine if the individual is in active labor.
This law was enacted as a response to the nationwide problem of "dumping" indigent patients who have no health insurance. A civil enforcement provision allows those harmed to bring suit against the violating hospital. Any individual who suffers personal harm as a direct result of a participating hospital's violation of a requirement of this section may, in a civil action against the participating hospital, obtain those damages available for personal injury under the law of the state in which the hospital is located, and such equitable relief as is appropriate.
The language of the statute is very explicit. Hospitals must provide a medical screening to any person requesting treatment to determine whether an emergency medical condition exists. If treatment is required, the hospital must stabilize the patient's condition prior to any transfer. However, a hospital has satisfied its obligations under the statute if the patient refuses to consent to treatment.
Here, there is a factual dispute whether plaintiff withdrew her initial request for treatment. It is this alleged withdrawal, rather than a failure to consent, that is at issue. Plaintiff argues that pursuant to the explicit language of the statute, the burden of proof rests with defendant to show the request was withdrawn. We agree.
Stevison v. Enid Health Systems, Inc. 920 F. 2d 710; 1990 U.S. App.
