First Circuit Holds That Diversion Of Nonhospital-Owned Ambulance Can Violate EMTALA

The United States Court of Appeals for the First Circuit has

held that a hospital can violate the Emergency Medical

Treatment and Active Labor Act (EMTALA) when it diverts a

nonhospital-owned ambulance en route to the facility to another

hospital without being on formal diversionary status. Although

the United States Court of Appeals for the Ninth Circuit issued

a similar ruling in 2001, both decisions appear to conflict

with the plain meaning of the EMTALA regulations, which states

that a nonhospital-owned ambulance does not become subject to

EMTALA until it arrives on hospital property.

Background

EMTALA requires a hospital to provide (1) a medical

screening examination to determine whether a patient has an

emergency medical condition; and (2) any necessary treatment

within its capacity required to stabilize that condition for

any patient who "comes to the emergency department."

In its April 18, 2008 decision in Carolina Morales v.

Sociedad Espanola de Auxilio Mutuo y Beneficencia

(Morales), the First Circuit held that "an

individual can come to' the emergency department for EMTALA

purposes, without physically arriving on the hospital's

grounds, as long as the individual is en route to the hospital

and the emergency department has been notified of her imminent

arrival." While the plain meaning of EMTALA regulations

indicates that EMTALA applies to hospital-owned ambulances off

hospital property under certain circumstances, the case is

noteworthy because it is only the second decision to apply this

rule to a nonhospital-owned ambulance.

Facts

The Morales case involved a plaintiff in Puerto

Rico who was experiencing severe abdominal pain and vomiting

for two days after being diagnosed with a non-viable ectopic

pregnancy. Her coworkers called an ambulance, which began to

transport her to the hospital where her obstetrician regularly

practiced. While en route, the paramedics called ahead to the

emergency department and notified the medical director of the

patient's condition, her forthcoming arrival, and need for

treatment. In a subsequent conversation with the ambulance

crew, the medical director inquired as to whether the patient

had medical coverage and, upon receiving no assurance that this

was the case, abruptly terminated the call. The paramedics

interpreted this as a refusal to treat the patient and

transported her to another hospital.

The patient ultimately sued the hospital alleging, among

other matters, that the medical director's...