Chapter 10: Emergency Care Flashcards
What was the common law rule regarding a hospital’s duty to provide emergency care?
Options:
A) Hospitals had a duty to treat all emergency patients
B) Only public hospitals had a duty to provide emergency care
C) A hospital had no duty to admit or serve all who presented for treatment
D) Hospitals were required to stabilize but not treat emergency patients
C) A hospital had no duty to admit or serve all who presented for treatment.
The Emergency Medical Treatment and Labor Act (EMTALA) applies to:
Options:
A) Only public hospitals
B) Only hospitals with more than 100 beds
C) Virtually all hospitals that participate in Medicare
D) Only hospitals with dedicated emergency departments
C) Virtually all hospitals that participate in Medicare.
Under EMTALA, what is a hospital required to provide to any person who comes to the emergency department?
Options:
A) Full treatment regardless of ability to pay
B) An appropriate medical screening examination to determine if an emergency exists
C) Transfer to the nearest public hospital
D) Care only if the patient has insurance
B) An appropriate medical screening examination to determine if an emergency exists.
What is considered an “appropriate medical screening examination” under EMTALA?
Options:
A) Any examination performed by a licensed physician
B) A screening that meets the hospital’s own standard procedures for patients with similar symptoms
C) A complete physical examination by a board-certified emergency physician
D) Only examinations that correctly diagnose the patient’s condition
B) A screening that meets the hospital’s own standard procedures for patients with similar symptoms.
According to the Summers v. Baptist Medical Center Arkadelphia case, which statement is MOST accurate about EMTALA violations?
Options:
A) Any misdiagnosis automatically constitutes an EMTALA violation
B) A screening examination can be “appropriate” under EMTALA even if it negligently fails to detect an emergency condition
C) Only intentional discrimination can constitute an EMTALA violation
D) Only patients without insurance can claim EMTALA violations
B) A screening examination can be “appropriate” under EMTALA even if it negligently fails to detect an emergency condition.
Under EMTALA, a patient with an emergency medical condition must be:
Options:
A) Treated regardless of cost
B) Stabilized before transfer or discharge, with limited exceptions
C) Transferred to a public hospital
D) Treated only if the hospital has the specific specialty service required
B) Stabilized before transfer or discharge, with limited exceptions.
In the context of EMTALA, a patient is considered “stabilized” when:
Options:
A) The patient is admitted to the hospital
B) The patient’s condition is completely resolved
C) No material deterioration is likely to result from transfer or discharge
D) A specialist has examined the patient
C) No material deterioration is likely to result from transfer or discharge.
According to the court in Moses v. Providence Hospital, what did the hospital fail to do?
Options:
A) Admit the patient
B) Stabilize the patient’s emergency condition before discharge
C) Screen the patient appropriately
D) Transfer the patient to another facility
B) Stabilize the patient’s emergency condition before discharge.
Which of the following is NOT a valid reason for transferring an unstabilized emergency patient under EMTALA?
Options:
A) The patient requests the transfer
B) The hospital lacks the capability to treat the emergency
C) The patient cannot pay for services
D) The benefits of treatment at another facility outweigh the risks of transfer
C) The patient cannot pay for services.
Under EMTALA regulations, what is the definition of “comes to the emergency department”?
Options:
A) The patient must physically enter the emergency room
B) The patient must be on hospital property requesting examination or treatment
C) The patient must arrive by ambulance
D) The patient must be registered as an emergency patient
B) The patient must be on hospital property requesting examination or treatment.
In the Arrington v. Wong case, what was the key issue?
Options:
A) Whether EMTALA applies to patients in ambulances
B) Whether emergency physicians must be board certified
C) Whether specialty consultation is required for all emergencies
D) Whether hospitals must have a dedicated emergency department
A) Whether EMTALA applies to patients in ambulances.
What is the significance of the Beller v. Health and Hospital Corp. case regarding EMTALA?
Options:
A) It established that hospitals must provide care regardless of insurance status
B) It clarified that a hospital-owned ambulance operating under community-wide EMS protocols may not trigger EMTALA obligations
C) It determined that all ambulances are considered hospital property
D) It required hospitals to maintain dedicated emergency departments
B) It clarified that a hospital-owned ambulance operating under community-wide EMS protocols may not trigger EMTALA obligations.
What is the primary purpose of Good Samaritan laws?
Options:
A) To require physicians to stop at accident scenes
B) To encourage physicians and others to provide emergency care by limiting liability
C) To establish standards for emergency departments
D) To require hospitals to provide charity care
B) To encourage physicians and others to provide emergency care by limiting liability.
Which statement is MOST accurate about the duty to render emergency aid?
Options:
A) All citizens have a legal duty to help persons in distress
B) Only physicians have a legal duty to provide emergency care
C) No one generally has a common law duty to aid another person, even in an emergency
D) Only hospital employees have a duty to provide emergency care
C) No one generally has a common law duty to aid another person, even in an emergency.
According to the text, staffing the emergency department with which of the following is MOST problematic?
Options:
A) Board-certified emergency physicians
B) Physicians rotating from various specialties
C) Unsupervised first-year residents or physicians not trained in emergency medicine
D) Contract physician groups
C) Unsupervised first-year residents or physicians not trained in emergency medicine.
What is the definition of an “emergency medical condition” under EMTALA?
Options:
A) Any condition requiring hospital admission
B) A medical condition with acute symptoms of sufficient severity that absence of immediate attention could reasonably be expected to result in serious jeopardy to health
C) Any condition diagnosed by an emergency physician
D) Any condition with symptoms lasting more than 24 hours
B) A medical condition with acute symptoms of sufficient severity that absence of immediate attention could reasonably be expected to result in serious jeopardy to health.
In the Baber v. Hospital Corporation of America case, why was the hospital not found liable under EMTALA?
Options:
A) The patient was treated in the psychiatric department, not the emergency department
B) The hospital properly screened and stabilized the patient
C) The patient voluntarily left against medical advice
D) The patient had insurance coverage
A) The patient was treated in the psychiatric department, not the emergency department.
Which of the following is true about EMTALA liability?
Options:
A) Only the hospital, not individual physicians, can be held liable
B) A patient must prove the hospital had an improper motive such as discrimination
C) Violations can result in civil monetary penalties and exclusion from Medicare
D) Only emergency physicians can be held personally liable
C) Violations can result in civil monetary penalties and exclusion from Medicare.
Under EMTALA, hospital property is defined as:
Options:
A) Only the main hospital building
B) The main hospital buildings and surrounding areas within 250 yards
C) Only areas designated for patient care
D) Any facility with the hospital’s name on it
B) The main hospital buildings and surrounding areas within 250 yards.
According to EMTALA, a hospital-owned ambulance is considered:
Options:
A) Always part of hospital property regardless of location
B) Hospital property only when on the hospital campus
C) Not hospital property in any circumstance
D) Hospital property unless operating under community-wide EMS protocols
D) Hospital property unless operating under community-wide EMS protocols.
What did the court in Childs v. Weis determine?
Options:
A) All hospitals must maintain emergency departments
B) The hospital was liable for turning away a woman in labor
C) A doctor had no duty to treat a patient with whom he had no preexisting relationship
D) Private hospitals must provide the same care as public hospitals
C) A doctor had no duty to treat a patient with whom he had no preexisting relationship.
How does EMTALA address the issue of “patient dumping”?
Options:
A) By requiring hospitals to provide complete treatment for all conditions
B) By prohibiting hospitals from transferring unstabilized emergency patients based on inability to pay
C) By requiring insurance companies to pay for emergency care
D) By mandating charity care programs at all hospitals
B) By prohibiting hospitals from transferring unstabilized emergency patients based on inability to pay.
Which of the following transfers would likely violate EMTALA?
Options:
A) Transferring a stabilized patient to a rehabilitation facility
B) Transferring an unstabilized patient to a hospital with specialized capabilities needed by the patient
C) Transferring an unstabilized patient because they are uninsured
D) Transferring a patient who requests transfer against medical advice
C) Transferring an unstabilized patient because they are uninsured.
In the Thompson v. Sun City Community Hospital case, what was the court’s finding?
Options:
A) The hospital had no duty to treat emergency patients
B) Transferring for financial reasons was permissible
C) Transferring a patient with an emergency condition for financial reasons was a breach of duty
D) The patient had no emergency condition
C) Transferring a patient with an emergency condition for financial reasons was a breach of duty.
To comply with EMTALA during a patient transfer, a hospital must do all of the following EXCEPT:
Options:
A) Provide treatment to minimize the risks of transfer
B) Obtain consent from the receiving hospital
C) Guarantee that the patient’s insurance will cover the transfer
D) Send medical records with the patient
C) Guarantee that the patient’s insurance will cover the transfer.
Regarding physician on-call requirements under EMTALA:
Options:
A) Every hospital must have every specialty on call 24/7
B) Hospitals must maintain a list of on-call physicians but have flexibility in how the on-call system is organized
C) Only emergency physicians need to be on call
D) Specialists are exempt from on-call requirements
B) Hospitals must maintain a list of on-call physicians but have flexibility in how the on-call system is organized.
In the Roberts v. Galen of Virginia case, what did the Supreme Court decide about EMTALA?
Options:
A) A patient must prove the hospital had an improper motive for transfer
B) Patients need not prove an improper motive to establish an EMTALA violation
C) Only uninsured patients can bring EMTALA claims
D) EMTALA does not apply to psychiatric emergencies
B) Patients need not prove an improper motive to establish an EMTALA violation.
Which of the following is NOT typically covered by Good Samaritan laws?
Options:
A) A physician helping at a roadside accident
B) A nurse providing aid at a shopping mall
C) A physician treating a patient in a hospital emergency room during normal duty hours
D) A medical student assisting at the scene of a natural disaster
C) A physician treating a patient in a hospital emergency room during normal duty hours.
According to the text, what is one of the key problems facing emergency departments today?
Options:
A) Too many emergency departments
B) Declining number of emergency departments while visits increase
C) Too many emergency medicine specialists
D) Excessive regulation of emergency services
B) Declining number of emergency departments while visits increase.
Which of the following patients is MOST likely to have a valid EMTALA claim?
Options:
A) A patient who was appropriately screened, found to have no emergency, and discharged
B) A patient who was misdiagnosed through negligence despite receiving the hospital’s standard screening process
C) A patient with an obvious emergency condition who was transferred to another hospital without stabilization because of lack of insurance
D) A patient who received treatment but feels it was inadequate compared to what insured patients receive
C) A patient with an obvious emergency condition who was transferred to another hospital without stabilization because of lack of insurance.
How do Good Samaritan statutes typically define the standard of care for covered individuals?
Options:
A) The same standard as hospital-based care
B) No liability except for gross negligence or willful misconduct
C) Complete immunity regardless of the care provided
D) Strict liability for any negative outcomes
B) No liability except for gross negligence or willful misconduct.
Under EMTALA, if a hospital lacks the capability to stabilize a particular emergency condition:
Options:
A) It is exempt from EMTALA requirements
B) It must still provide an appropriate screening examination and arrange appropriate transfer
C) It can simply refer the patient elsewhere
D) It must call 911 for the patient
B) It must still provide an appropriate screening examination and arrange appropriate transfer.
In Guerrero v. Copper Queen Hospital, what principle did the court establish?
Options:
A) Only public hospitals must provide emergency care
B) A licensed private hospital with an emergency department must provide care regardless of ability to pay
C) Hospitals can always transfer patients to public facilities
D) Emergency care is only required for life-threatening conditions
B) A licensed private hospital with an emergency department must provide care regardless of ability to pay.
In the context of emergency care, what does the term “patient dumping” refer to?
Options:
A) Discharging patients too quickly
B) Transferring patients to specialized facilities
C) Refusing to treat or transferring patients unable to pay for medical care
D) Moving patients between different hospital departments
C) Refusing to treat or transferring patients unable to pay for medical care.
What is the primary difference between state Good Samaritan laws and EMTALA?
Options:
A) Good Samaritan laws encourage voluntary aid by limiting liability, while EMTALA mandates hospital emergency care
B) Good Samaritan laws apply only to physicians, while EMTALA applies to all healthcare providers
C) Good Samaritan laws are federal, while EMTALA is state-based
D) Good Samaritan laws provide complete immunity, while EMTALA offers limited protection
A) Good Samaritan laws encourage voluntary aid by limiting liability, while EMTALA mandates hospital emergency care.
Under EMTALA, what is meant by “comes to the emergency department”?
Options:
A) Only patients who enter the emergency room
B) Patients who call the hospital for advice
C) Patients on hospital property requesting examination or treatment
D) Only patients who arrive by ambulance
C) Patients on hospital property requesting examination or treatment.
Which statement is MOST accurate regarding a physician’s duty to respond to emergencies outside the hospital?
Options:
A) All physicians have a legal duty to respond to any emergency
B) Physicians have the same duty as any other citizen under common law
C) Physicians must always provide care at accident scenes
D) Physicians are legally required to identify themselves as doctors at emergency scenes
B) Physicians have the same duty as any other citizen under common law.
Which case established that a hospital can be liable for failing to have proper staffing policies in its emergency department?
Options:
A) Childs v. Weis
B) Guerrero v. Copper Queen Hospital
C) Fjerstad v. Knutson
D) Baber v. Hospital Corporation of America
C) Fjerstad v. Knutson.
Apply the IRAC method to analyze a case where a hospital emergency department performed a standard screening exam but failed to detect a patient’s spinal fracture, resulting in paralysis.
- Issue: Whether the hospital violated EMTALA by failing to detect the spinal fracture
- Rule: EMTALA requires an “appropriate medical screening examination” consistent with the hospital’s capabilities and standard procedures
- Analysis: Under Summers, a negligent screening that follows standard procedures does not violate EMTALA; the law addresses disparate treatment, not medical malpractice
- Conclusion: Likely no EMTALA violation if the hospital followed its standard screening process, though the hospital might face state malpractice liability
Compare and contrast EMTALA requirements and state medical malpractice laws regarding emergency care.
- EMTALA focuses on access and prohibits “patient dumping” regardless of payment ability
- Malpractice laws address quality of care and negligence standards
- EMTALA requires screening and stabilization; malpractice requires adherence to standard of care
- EMTALA violations include civil penalties and Medicare exclusion; malpractice includes compensatory damages
- EMTALA is a federal statute; malpractice governed by state law
- EMTALA doesn’t require correct diagnosis; malpractice often involves misdiagnosis
- EMTALA applies only to Medicare-participating hospitals; malpractice applies to all providers
Explain the significance of the “comes to the emergency department” definition in EMTALA and how courts have interpreted it.
- Defines when EMTALA obligations begin
- Includes patients on hospital property requesting treatment
- Expanded beyond physical ED to include 250-yard radius of main buildings
- Arrington: May include patients in ambulances en route to hospital
- Beller: Hospital-owned ambulance under EMS protocols may not trigger EMTALA
- Baber: Does not include patients elsewhere in hospital not requesting emergency care
- Courts have generally interpreted broadly to fulfill anti-dumping purpose
- Ambiguities resolved in favor of patient protection
- Definition keeps evolving through regulatory updates and court decisions
Discuss the evolution of the common law duty to provide emergency care and how EMTALA changed the legal landscape.
- Traditional common law: No duty to treat patients without prior relationship
- Childs v. Weis exemplified harsh traditional rule
- Judicial decisions gradually established limited duty for emergency care
- Williams and Guerrero cases recognized duty for hospitals with EDs
- EMTALA (1985) created affirmative federal obligation regardless of payment ability
- Shifted from physician-centered to institution-centered responsibility
- Established universal screening requirement regardless of payment source
- Created stabilization requirement before transfer/discharge
- Added significant penalties for violations
- Focus moved from moral obligation to legal requirement
Analyze how EMTALA’s requirements for patient transfers balance patient needs with hospital capabilities.
- Transfer allowed only after stabilization within hospital capabilities
- Exceptions: patient request or medical benefits outweigh risks
- Required elements: treatment to minimize risks; receiving hospital consent
- Medical records must accompany patient
- Qualified personnel and equipment required during transfer
- Sending hospital maintains responsibility until transfer complete
- Receiving hospitals with specialized capabilities must accept transfers
- Balance recognizes not all hospitals can treat all conditions
- Protects patients while acknowledging resource limitations
- Prevents transfers based solely on financial considerations
Describe the key issues in Moses v. Providence Hospital regarding EMTALA and behavioral health patients.
- Extended EMTALA’s stabilization requirement to psychiatric conditions
- Hospital discharged patient despite psychiatrist determining he was not stable
- Patient killed his wife days after discharge
- Court found psychiatric emergency conditions covered under EMTALA
- Stabilization duty not limited to physical conditions
- Hospital admission does not end EMTALA obligations
- Recognized difficulty in predicting dangerousness in psychiatric patients
- Established that psychiatric emergency requires same level of care as physical emergency
- Highlighted hospital’s duty to consider safety risks to others
- Demonstrated EMTALA applies throughout hospital stay until stabilized
Explain the limitations of Good Samaritan laws and why they differ from state to state.
- Vary widely in who is protected (some only cover healthcare professionals)
- Different standards for immunity (gross negligence vs. ordinary negligence)
- May not apply to pre-existing duty situations
- Some only apply outside hospital settings
- May not cover in-hospital emergencies (Colby v. Schwartz)
- Questionable effectiveness in encouraging aid
- State-specific requirements for immunity
- Limited applicability to emergency department care
- Few cases testing their effectiveness
- Differences reflect varying state policy priorities regarding liability protection
Discuss the liability considerations when staffing hospital emergency departments.
- ED coverage by on-call physicians alone increases liability risk
- Specialists in other disciplines may lack emergency medicine expertise
- Unsupervised residents or physician assistants create liability exposure
- Hospital liable for credentialing physicians without emergency training
- Corporate negligence applies to ED staffing decisions
- Hospital policies must ensure competent ED coverage
- Required protocols for specialty consultation and transfer
- Joint liability possible with contracted physician groups
- Hospital cannot abdicate oversight responsibility
- Adequate supervision and communication systems essential
Explain what constitutes an “appropriate medical screening examination” under EMTALA according to key court decisions.
- Not defined in statute but clarified through court decisions
- Summers: Hospital’s own standard procedures for similar symptoms
- Not necessarily a correct diagnosis or complete workup
- Must be non-discriminatory (same for all patients regardless of payment)
- Includes ancillary services routinely available to the ED
- Purpose is to determine existence of emergency medical condition
- May vary based on presenting symptoms and facility capabilities
- Disparate impact on patient must be shown for violation
- Medical negligence alone not sufficient for EMTALA violation
- Consistent application of screening protocols is key
Common law duty to aid strangers
Under traditional common law, individuals (including physicians and hospitals) have no legal duty to aid strangers in emergency situations, even if they could easily do so without risk to themselves. This rule has been modified over time by judicial decisions and statutes.
Emergency Medical Treatment and Labor Act (EMTALA)
Federal law passed in 1985 requiring Medicare-participating hospitals with EDs to:
1) Provide appropriate medical screening to anyone seeking emergency care
2) Stabilize emergency medical conditions before discharge/transfer
3) Transfer patients only when medically appropriate
Prevent “patient dumping” based on inability to pay
Appropriate medical screening (under EMTALA)
EMTALA requires hospitals to perform screening consistent with their capabilities to determine if an emergency exists. Courts generally hold that an “appropriate” screening means patients must receive the same screening as others with similar symptoms (uniform treatment), not necessarily a non-negligent screening.
Emergency medical condition (under EMTALA)
Defined by EMTALA as a condition with acute symptoms of sufficient severity where absence of immediate medical attention could reasonably be expected to:
1) Place health in serious jeopardy
2) Cause serious impairment to bodily functions, or
3) Cause serious dysfunction of any bodily organ/part
For pregnant women, includes situations where delivery is imminent or transfer poses risks
“Comes to the emergency department” under EMTALA
Refers to when EMTALA obligations are triggered. Includes:
1) Patients physically in the ED
2) Patients elsewhere on hospital property (within 250 yards of main buildings)
3) Patients in hospital-owned ambulances (with exceptions for community EMS protocols)
Courts have widely interpreted this provision
Stabilization requirement under EMTALA
Hospitals must provide treatment to stabilize emergency conditions before discharge/transfer. A condition is “stabilized” when “no material deterioration is likely to result from or occur during” release. If transfer is necessary, the hospital must:
- Minimize transfer risks
- Find a willing and capable receiving facility
- Send medical records
- Use qualified personnel/equipment for transfer
Good Samaritan statutes
State laws that protect individuals (often specifically healthcare providers) from liability for ordinary negligence when rendering emergency aid in good faith. Key features:
- Vary by state in coverage and scope
- Generally do not protect against gross negligence
- May not apply when there’s a pre-existing duty to treat
- Usually don’t apply to in-hospital emergencies (with exceptions)
Childs v. Weis (1966)
Pregnant woman with bleeding and labor pains went to ED where nurse called doctor, who instructed her to contact her own physician. Baby was born in car en route to another facility and died. Court held:
- No doctor-patient relationship existed
- Doctor had no duty to treat without established relationship
- Illustrates traditional common-law rule (now largely modified)
Williams v. Hospital Authority of Hall County
Georgia court held that a public, tax-supported hospital with an ED was obligated to provide emergency care to an accident victim with a fracture. Court rejected hospital’s argument that it had absolute right to refuse service, calling such refusal “repugnant.”
Guerrero v. Copper Queen Hospital
Arizona court ruled that a licensed private hospital with an ED must provide emergency care regardless of a patient’s ability to pay, extending duty to treat beyond just public hospitals.
Summers v. Baptist Medical Center Arkadelphia
Patient fell while deer hunting and was examined in ED, where doctor diagnosed muscle spasms. Patient was actually suffering from broken vertebra, sternum, and rib. Court held EMTALA requires uniform screening for all patients, not necessarily non-negligent screening. A negligent examination may be a state malpractice issue but not an EMTALA violation if uniformly applied.
Gatewood v. Washington Healthcare Corp.
Court held that EMTALA “is not intended to duplicate preexisting legal protections, but rather to create a new cause of action, generally unavailable under state tort law, for what amounts to failure to treat.” Reinforced that EMTALA is not a federal medical malpractice statute.
Arrington v. Wong (2001)
Patient suffering heart attack was being transported by ambulance to Queens Hospital. After learning patient’s doctor practiced elsewhere, Queens Hospital physician suggested diversion to another facility where patient died. Court held:
- A hospital may not divert patients without valid treatment-related reason
- Patient “comes to the emergency department” even before physically arriving
- Extended EMTALA’s reach to patients in non-hospital ambulances off hospital property
Roberts v. Galen of Virginia
U.S. Supreme Court case establishing that EMTALA violations do not require proof of an improper motive (such as economic discrimination). EMTALA requires appropriate screening and stabilization regardless of the hospital’s motives.
Moses v. Providence Hospital
Patient with psychiatric symptoms was discharged despite psychiatrist’s earlier determination that he was not “medically stable from a psychiatric standpoint.” Ten days later, he murdered his wife. Court held:
1) EMTALA requires more than just admitting a patient; hospital must treat to stabilize
2) Stabilization means ensuring “no material deterioration is likely” upon discharge
3) Whether patient had an emergency condition was a factual issue for jury to decide
Important for behavioral health patients under EMTALA
Beller v. Health and Hospital Corp
Pregnant woman with prolapsed umbilical cord was transported in Wishard hospital-owned ambulance operating under community EMS protocols to another facility. Court held:
- Patient had not “come to the emergency department” of Wishard
- Ambulance operating under community EMS protocols was not under hospital operation
- 2003 EMTALA regulation clarifying this point applied retroactively as it merely clarified existing law
Pretermit
Legal term meaning to disregard, overlook, or intentionally omit consideration of an issue.
Per curiam
Latin for “by the court”; a decision issued by all or a majority of judges deciding a case where individual authorship is not specified.
Corporate practice of medicine (CPM)
A doctrine prohibiting corporations from practicing medicine through employed physicians. Intended to prevent commercialization and exploitation of medicine. Key points:
- Developed for for-profit corporations
- Many states have abolished or created exceptions
- Generally considered less relevant for non-profit hospitals
- Creative arrangements often bypass restrictions where they exist
Proximity of EDs to hospital property under EMTALA
EMTALA regulations define hospital campus as:
- Main hospital buildings
- Areas within 250 yards of main buildings
- Other areas determined to be part of campus by Medicare regional office
This determines where EMTALA obligations apply
Hospital duty to exercise reasonable care in emergency situations
Once care begins, hospitals and providers must exercise reasonable care, which includes:
- Appropriate triage
- Maintaining adequate records and providing discharge instructions
- Having qualified staff available
- Following hospital policies and professional standards
- Transferring patients when appropriate (with proper information)
