Novel “Bad Faith Admission” EMTALA Theory Survives Motion to Dismiss

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The U.S. District Court for the Northern District of California recently denied Contra Costa Regional Medical Center’s (CCRMC) motion to dismiss regarding an alleged violation of the Emergency Medical Treatment and Labor Act (EMTALA) that resulted in the death of the plaintiff’s wife. In his second amended complaint, the plaintiff alleged that his wife arrived at CCRMC’s labor and delivery department in active labor, and CCRMC staff knew she had an emergency medical condition due to complications from delivery shortly thereafter. Nevertheless, the plaintiff alleges that CCRMC did not admit the patient to its postpartum floor until approximately 2 1/2 hours after delivery and detection of the emergency medical condition. According to the plaintiff, prior to and at the time of his wife’s admission to the postpartum floor, CCRMC knew that it did not have the staff and facility to stabilize her emergency medical condition. As a result, the plaintiff alleges that the admission was not in good faith, in violation of EMTALA.

The court determined that if CCRMC had admitted the plaintiff’s wife to provide treatment or, in good faith, to stabilize her emergency medical condition for transfer, EMTALA liability would cease to apply. However, if CCRMC admitted the patient with the intent to stabilize her when it did not have the resources to do so, and the admission was in bad faith, CCRMC may be held liable for an EMTALA violation. Therefore, the court denied CCRMC’s motion to dismiss, holding that whether or not the admission was in good faith is a question of fact for the jury.

Regardless of the outcome at trial, this ruling is significant for several reasons. First, the court rejected CCRMC’s argument that EMTALA liability is precluded when a patient is admitted. Rather, the court held that the EMTALA regulations establish only that if a hospital provides an appropriate screening examination and in good faith admits the patient to provide treatment to stabilize the patient for transfer, EMTALA liability is precluded. Likewise, the court rejected the plaintiff’s argument that a hospital has a duty to stabilize all individuals who come to the emergency department regardless of whether the hospital effectuates a transfer. In so holding, the court echoes what other courts have long stated—EMTALA does not establish a federal malpractice standard. Nevertheless, the court’s decision could have far-reaching implications for hospitals going forward because EMTALA traditionally has not been used to second guess a hospital’s intent to admit a patient through the emergency department.