Lewellen v. Schneck Medical Center

Brief Fact Summary. Plaintiff Lewellen was in a drunk driving accident and was taken to the hospital.  Doctors there performed only a cursory examination of him and did not properly review his x-rays and despite his complaints of great lower back pain, discharged him after one hour.  He was immediately taken to jail overnight where his condition worsened until a jail officer took pity on him and arranged for him to go back to the hospital.  Overnight a burst fracture in his spine damaged spinal nerves leaving him permanently neurologically disabled.

Synopsis of Rule of Law. Under the Emergency Medical Treatment and Active Labor Act (“EMTALAâ€), federally-funded hospitals must meet two requirements:  (1) A hospital must provide for an appropriate medical screening examination to determine whether an emergency medical condition exists, and (2) If such a condition exists, the patient may not be discharged until he has received a stabilizing treatment.  EMTALA was passed to combat the problem of patient dumping (the practice of transferring or discharging indigent or non-insured patients while their emergency conditions worsen).

Facts.  Plaintiff Lewellen was in a serious drunk driving accident and was taken to the Defendant Schneck Medical Center emergency room.  Dr. John Reisert examined him and noted that he was complaining of lower back pain.  Reisert ordered x-rays of his lumbar and cervical spine to determine whether there was a facture.  The quality of the x-rays were poor and there was a dispute in the records whether the poor quality was because Lewellen was in significant pain and unable to turn on his side or whether he was being uncooperative.  Before the last of Lewellen’s x-rays had even printed off (and before the doctor had a chance to review them) and only an hour after coming to the hospital, Lewellen was discharged.  He insisted he was in great pain and should be treated, not discharged, but nevertheless he was told to leave.  Thereafter a police officer took him immediately to jail.  While in jail, he had a burst fracture in his spine that was damaging his spinal nerves.  Later that night, jail officer McPherson noticed Lewellen crying in pain and saw that he had urinated all over himself.  The McPherson called defendant’s emergency room where a nurse told him that someone had reviewed the x-ray and found an abnormality, but despite the abnormality, Lewellen should not come back to the hospital.  Upset with this response, McPherson implored the jail commander to get medical help for Lewellen.  This was done and an ambulance was called to pick him up.  Lewellen arrived back at Schneck hospital and a CT scan revealed that during the night in jail, a fragment of bone from the burst fracture had displaced and was impinging on his spinal column, resulting in permanent neurological defects.  Thereafter, he could not urinate or defecate on his own and suffered from sexual dysfunction.  Lewellen sued the hospital under the Emergency Medical Treatment and Active Labor Act (“EMTALAâ€).  Defendant moved for summary judgment.

Issue. Whether a jury could find that the hospital’s treatment and examination of Lewellen did not satisfy EMTALA’s “appropriate medical screening†requirement.

Held. Yes.  There are two requirements for certain federally-funded hospitals under EMTALA.  (1) A hospital must provide for an appropriate medical screening examination to determine whether an emergency medical condition exists, and (2) If such a condition exists, the patient may not be discharged until he has received a stabilizing treatment.  If either requirement is not met a patient may sue the hospital.  A hospital does not satisfy the first requirement if the examination is so cursory that it is not “designed to identify acute and severe symptoms that alert the physician to the need for immediate medical attention to prevent serious bodily injury.â€Â  The court held that a reasonable jury could conclude that the screen performed was too cursory and thus did not satisfy EMTALA.  Specifically, Lewellen was discharged as the x-rays were printing off, so a jury could conclude that the doctor did look at them or looked at them too casually to catch what other physicians said was obvious: the burst fracture in his spine.  Moreover, Lewellen still had a bleeding gash in his arm with dirt and grass in it when he arrived at the jail.  Accordingly, the court denied defendant’s motion for summary judgment.

Discussion. EMTALA was passed to combat the problem of patient dumping, that is, the practice of transferring or discharging indigent or non-insured patients while their emergency conditions worsen.  It is not a national medical malpractice statute.  Accordingly, a hospital that conducts an appropriate medical screening according to the first requirement, yet in that process fails to detect or misdiagnoses an emergency medical condition—even if negligent and liable under the common law—is not liable under EMTALA.