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American Academy of Emergency Medicine

Federal Appeals Court Rules on EMTALA Screening

Submitted by Kathi Ream

On January 29, the U.S. Court of Appeals for the Eighth Circuit ruled that an individual who presented to a hospital emergency room with a puncture wound to his foot that subsequently became infected, received an appropriate medical screening examination under EMTALA, even if he were improperly or negligently treated. (Hunt v. Lincoln County Memorial Hospital, 8th Cir., No. 02-1151, 1/29/03) The Appeals court found that Hunt could not sue Lincoln County Memorial Hospital (LCMH) under EMTALA on what was essentially a medical malpractice claim. The Appeals Court found that Hunt was examined and received proper instructions on how to care for the wound and that this was "appropriate for EMTALA purposes."

The underlying incident occurred in August 1998 when Hunt stepped on a nail, suffered a puncture wound to his right foot, and was taken by his mother to the LCMH ED. He was examined by two nurses, was asked whether his tetanus shot was current, was advised to keep his foot elevated and the wound clean, and was released. Later that month, his foot became swollen and sore and he was diagnosed at a different hospital with osteomyelitis and cellulitis in his right foot, resulting from infections caused by the nail. He claimed that the infection would not have occurred had the staff at LCMH performed an appropriate medical screening examination and provided the necessary antibiotic treatment.

The Court found that although EMTALA sets forth the examination and treatment requirements for hospitals dealing with patients with emergency medical conditions, it does not establish "a general federal cause of action for medical malpractice in emergency rooms. . . . It does not guarantee proper diagnosis or provide a federal remedy for medical negligence . . . rather, the EMTALA focuses on uniform treatment of patients presented in hospital emergency departments."

The Court goes on to say that "Essentially, Hunt's claim is not that he received non-uniform treatment, but that he received incorrect treatment. Based on the injury to his foot and the status of his immunizations, the staff at LCMH gave Hunt instructions for caring for his injury, and this treatment was 'appropriate' for EMTALA purposes. . . . While Hunt may or may not have a state law medical malpractice claim, he does not have a valid federal EMTALA claim against LCMH or Welch [the doctor on call]," the court concluded.

Text of the court's decision is available at
http://www.ca8.uscourts.gov/opns/opFrame.html