Harold Summers v. Baptist Medical Center Arkadelphia
91 F.3d 1132, 1996 U.S. App. LEXIS 19173, 1996 WL 434515 (1996)
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Rule of Law:
The Emergency Medical Treatment and Active Labor Act (EMTALA) does not create a federal cause of action for medical malpractice. To state a claim for an inappropriate medical screening under EMTALA, a plaintiff must show the hospital treated them with a disparate impact, meaning differently from other patients perceived to have the same condition, not merely that the screening was negligent or resulted in a faulty diagnosis.
Facts:
- On October 25, 1992, Harold Summers fell from a tree stand while deer hunting.
- An ambulance brought Summers to the emergency room at Baptist Medical Center Arkadelphia (Baptist).
- Summers informed the physician that he was experiencing severe chest pain and heard a 'popping noise' every time he breathed, in addition to back pain.
- The physician ordered x-rays of Summers's spine but not his chest, diagnosing him with muscle spasms.
- Summers's request for admission to the hospital was denied, even after he mentioned having insurance and cash; he was given pain injections and discharged.
- Two days later, at another hospital, a chest x-ray and CT scan revealed that Summers had a broken sternum, a broken rib, and a fresh vertebral fracture, which a neurosurgeon deemed a 'life threatening injury.'
- Baptist hospital personnel later acknowledged that a patient complaining of chest pain with snapping or popping noises would normally be given a chest x-ray.
Procedural Posture:
- Harold Summers sued Baptist Medical Center Arkadelphia in the U.S. District Court for the Eastern District of Arkansas, alleging violations of EMTALA.
- The District Court granted summary judgment in favor of Baptist, dismissing the complaint.
- Summers, as appellant, appealed to a three-judge panel of the U.S. Court of Appeals for the Eighth Circuit.
- The panel reversed the District Court's judgment and remanded the case for trial.
- The Eighth Circuit granted Baptist's suggestion for a rehearing en banc, which vacated the panel's opinion and judgment.
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Issue:
Does a hospital violate the Emergency Medical Treatment and Active Labor Act's (EMTALA) requirement to provide an 'appropriate medical screening' when its physician fails to diagnose a serious injury due to negligence, if the patient is treated consistently with other patients perceived by the physician to have the same, less serious condition?
Opinions:
Majority - Arnold, C.J.
No. A hospital does not violate EMTALA's screening requirement when a physician's misdiagnosis results from faulty screening, as long as the patient is not screened differently from other patients perceived to have the same condition. EMTALA was enacted to prevent the 'dumping' of uninsured or indigent patients and does not create a federal cause of action for medical negligence. To establish a violation, a plaintiff must show disparate treatment—that the hospital failed to apply its standard screening procedures uniformly to patients with the same perceived symptoms. Here, the physician did not perceive Summers to have symptoms requiring a chest x-ray; therefore, the failure to order one was, at most, negligence or a 'faulty screening,' not the disparate treatment that EMTALA prohibits.
Dissenting - Heaney, J.
Yes. A hospital's failure to follow its own established screening procedures for a patient's stated symptoms is sufficient to state a claim under EMTALA. The majority improperly assumes facts against Summers by concluding the doctor 'did not perceive' the symptoms, which is a factual question for a jury to decide. Since the hospital admitted its standard procedure for Summers's reported symptoms was to perform a chest x-ray, and it failed to do so, a jury could find that the hospital did not provide an 'appropriate medical screening' as required by the plain language of the statute.
Analysis:
This decision significantly narrows the scope of EMTALA's 'appropriate medical screening' provision by drawing a sharp line between it and state medical malpractice law. By focusing on the physician's subjective perception of a patient's condition, the court makes it much harder for plaintiffs to succeed on an EMTALA claim based on misdiagnosis alone. This ruling solidifies the 'disparate treatment' standard in the Eighth Circuit, requiring plaintiffs to produce evidence that they were treated differently than another patient who the hospital perceived as having the same condition, a much higher bar than showing a deviation from the standard of care.
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