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EMTALA

Burrows v. Schug, 526 U.S. 1166 (1999)

Also under Emergency services, Peer review

Outcome:  Very unfavorable

Issue

The issue in this case was whether physician peer review records should be discoverable in the federal courts.

AMA interest

The AMA believes that peer review data should be kept confidential.

Case summary

An eleven-month old child died while being transferred between hospitals.  Dr. Schug, an emergency room physician, had ordered the transfer.  The child’s parents sued Dr. Schug for common law malpractice and for violation of EMTALA.  Subsequently, his actions were reviewed by his hospital’s peer review committee.

Under California law, the peer review records are not discoverable.  However, the United States District Court held that, because part of the action was based on EMTALA, those records would be discoverable.  The Ninth Circuit, in an unpublished decision, affirmed the District Court order.  Dr. Schug petitioned to the United States Supreme Court for a writ of certiorari.  The Supreme Court denied the petition.

Litigation Center involvement

The Litigation Center, the California Medical Association, and various other organizations filed an amicus brief to the Supreme Court urging a grant of certiorari.

Cherukuri v. Shalala, 175 F.3d 446 (6th Cir. 1999)

Also under Emergency services

Outcome:     Very favorable

Issue

The issue in this case was whether a patient could be transferred out of a hospital emergency room, although bleeding and suffering a deteriorating medical condition, if the transfer was medically necessary, in light of the transferring hospital’s inability to provide the needed medical care.

AMA interest

The AMA believes that Dr. Cherukuri acted justifiably when he ordered the transfer, since his hospital lacked the facilities and personnel needed to provide the emergency care required for these patients.  Even though the patients were still bleeding when Dr. Cherukuri ordered the transfer, his decision was in their best medical interest.

Case summary

Dr. Cherukuri, the doctor in this case who had ordered the transfer, was accused of violating the Emergency Medical Treatment and Active Labor Act, 42 U.S.C. § 1395dd(b) (“EMTALA”), which prohibits the transfer of emergency room patients unless they are in a “stable” condition at the time of the transfer.  The United States Department of Health and Human Services fined him $100,000, which was the largest fine ever assessed against a physician for an EMTALA violation.  Dr. Cherukuri appealed to the United States Court of Appeals for the Sixth Circuit.

Ultimately, the Sixth Circuit found that Dr. Cherukuri had performed exemplarily under extreme emergency circumstances. It not only reversed the fine, but it admonished the Department of Health and Human Services Appeals Board for not having reviewed the case more carefully.

AMA involvement

The AMA filed an amicus brief on Dr. Cherukuri’s behalf.  After filing the brief, the AMA learned that Dr. Cherukuri had sustained a disability and could not afford an attorney to represent him on the appeal.  The AMA attorney therefore represented Dr. Cherukuri without charge.

Coleman v. Deno, 823 So.2d 303 (La. 2002)

Also under Abusive litigation against physicians and Tort Reform

Outcome:    Somewhat favorable

Issue

The issue in this case was the correctness of a finding that a treating physician was liable for intentional malpractice because of his discharge and order of transfer to another hospital, of a patient who presented in an emergency room complaining of swelling and pain in his arm.

AMA interest

The AMA strives to avoid the expansion of liability theories against physicians, which can lead to abusive litigation.

Case summary

Louis Coleman presented himself at Jo Ellen Smith Hospital (“JESH”) emergency room at 8:10 p.m., complaining of swelling and pain in his left arm.  Dr. Richard Deno examined Coleman and determined that he should receive in-patient intravenous antibiotic therapy.

Instead of admitting Coleman to JESH, though, Dr. Deno elected to transfer him to the emergency room at Charity Hospital of New Orleans (“CHNO”), which had superior and more immediately available services for treatment of Coleman’s arm.  Dr. Deno contacted the CHNO emergency room and was advised that they would accept Coleman for treatment.  Dr. Deno determined that Coleman was in good condition and did not require an ambulance.  He therefore ordered the transfer at 10:00 p.m. and discharged Coleman.  He did not order the antibiotic therapy, because it would have contaminated the blood cultures that CHNO would need to take. 

Coleman arrived at CHNO at 12:21 a.m.  At 8:00 a.m.,  CHNO administered intravenous antibiotics.  After further evaluation, the CHNO physicians determined that Coleman’s arm was irrevocably damaged and required amputation to save his life. 

Coleman sued JESH, CHNO, and various physicians who had treated him, including Dr. Deno.  The hospitals settled for nominal payments, and the claims against them were subsequently dismissed.  Following a trial, a jury found Dr. Deno liable.  He appealed.

The Louisiana Medical Malpractice Act limits damages against a negligent physician to $100,000.  However, the Court of Appeal held that Dr. Deno had intentionally discharged Coleman from JESH without providing appropriate treatment.  Therefore, the appellate court reasoned that his supposed error went beyond ordinary negligence, and the damage cap in the statute would not apply.  The Court of Appeal affirmed the jury award of $4.4 million against Dr. Deno.

The Louisiana Supreme Court reversed the appellate court’s finding of intentional wrongdoing but affirmed the finding of negligence.  The majority held that Dr. Deno was liable for medical malpractice and that the Medical Malpractice Act should limit the damages against him.  A dissenting opinion argued that the jury verdict was completely in error, that Dr. Deno had done nothing wrong, and that judgment should have been entered for him on all counts.

Litigation Center involvement

The Litigation Center joined a Louisiana State Medical Society amicus curiae brief in an attempt to curb such abusive litigation against physicians.

The amicus brief argued that Dr. Deno’s decisions were made for legitimate reasons, and that he should not have been found liable at all.  The main focus of the brief, however, was that the Court of Appeal had created a new cause of action, based on speculative evidence, that allows plaintiffs and their lawyers to avoid the statutory cap on damages in medical negligence suits.  The amicus brief cautioned that the Court of Appeal decision was unsound and would seriously undermine the Medical Malpractice Act. 

Louisiana Supreme Court brief