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In a significant win for plaintiffs bringing claims under the federal Emergency Medical Treatment and Assisted Labor Act — a law designed to prohibit hospitals from engaging in a practice known as “patient dumping” — a federal judge has ruled that such a plaintiff need not show that she was indigent or uninsured to invoke the law. The 22-page opinion in Love v. Rancocas Hospital by U.S. District Judge Joseph E. Irenas of the District of New Jersey marks the first time that any judge within the courts of the 3rd U.S. Circuit Court of Appeals has addressed EMTALA’s requirements. The ruling is a victory for attorney Richard S. Seidel of Kline & Specter who filed the suit on behalf of Daisy Love, a woman who claims that she suffered a debilitating stroke after she was sent home from an emergency room despite the fact that her high blood pressure had not been stabilized. In its motion for summary judgment, Rancocas Hospital did not dispute that Love may have had an emergency medical condition, nor that she was discharged before she was stabilized. But the hospital’s lawyer, Jennifer Parsons of Stahl & Delaurentis in Voorhees, N.J., argued that Love’s EMTALA claim should be dismissed because there was no evidence that she received any “disparate or discriminatory care.” Parsons urged Irenas to follow decisions from the 4th and 5th circuits, which concluded that EMTALA’s protections apply only to those patients who are unable to pay for their medical care. As a result, she argued, Love, who was covered by Medicare, could not invoke the law. But Irenas found that the federal circuits are split, and that “the better view is represented by those courts which hold that EMTALA applies regardless of the patient’s ability to pay or whether the patient has health insurance.” Irenas cited the 6th Circuit’s 1990 decision in Cleland v. Bronson Health Care Group in which the court focused only on the text of the EMTALA statute and held that it applies to all patients. In so ruling, the 6th Circuit rejected the views of the 4th and 5th circuits, finding that those courts had improperly looked to the law’s legislative history in holding that Congress intended the statute to ensure that indigent and uninsured patients receive the same emergency care as those with medical insurance. Instead, the Cleland court held that since the text of the statute is unambiguous, it controls, and there is no need to consult the legislative history. The Cleland court said it recognized that its ruling “leads to a result considerably broader than one might think Congress should have intended, or perhaps than any or all individual members of Congress were cognizant of. However, it is not our place to require statutes to conform with our notions of efficacy or rationality.” Irenas noted that the 9th Circuit adopted the Cleland court’s rationale in its 2002 decision in Bryant v. Adventist Health System, which held that EMTALA “protects all individuals, not just those who are uninsured or indigent.” Although the U.S. Supreme Court has never squarely addressed the question, Irenas found that in its 1999 decision in Roberts v. Galen of Virginia Inc., the high court held that no showing of improper motive is required to establish a violation of EMTALA’s stabilization requirement. The Roberts ruling, Irenas said, “gives further support for the conclusion that EMTALA applies regardless of whether the patient is uninsured or indigent.” Irenas concluded that, as a matter of statutory construction, it would be improper to look to legislative history. “This court declines to import limitations on EMTALA’s applicability from other sources where the language of EMTALA clearly states that all people are covered under the statute,” Irenas wrote. Under the law of the 3rd Circuit, Irenas said, “it is axiomatic that statutory interpretation begins with the language of the statute itself … and if the statutory language is unambiguous, the plain meaning of the words ordinarily is regarded as conclusive.” To establish a violation of EMTALA’s stabilization provision, Irenas found that the plaintiff must prove three things: � The patient had an emergency medical condition; � The hospital actually knew of that condition; � The patient was not stabilized before being transferred. Rejecting one of the hospital’s arguments, Irenas found that the plaintiff “need not demonstrate that she received disparate or discriminatory care.” Love’s claim survived summary judgment, Irenas said, because there are “substantial issues of material fact as to whether the hospital violated EMTALA in releasing her before her medical condition was stabilized.” EMTALA, Irenas noted, defines an “emergency medical condition” as “a medical condition manifesting itself by acute symptoms of sufficient severity … such that the absence of immediate medical attention could reasonably be expected to result in (i) placing the health of the individual … in serious jeopardy, (ii) serious impairment to bodily functions, or (iii) serious dysfunction of any bodily organ or part.” On the basis of that definition, Irenas found that Love “has clearly raised an issue of material fact as to whether she suffered from an emergency medical condition, given the evidence of her high and unstable blood pressure readings, syncope and repeated falls, which are classic symptoms of possible stroke.” Irenas found that EMTALA requires a hospital to provide “for such further medical examination and such treatment as may be required to stabilize the medical condition,” and prohibits a hospital from discharging a person with an emergency medical condition before the patient is stabilized. Love has a valid claim, Irenas found, because she has “raised a genuine issue of material fact as to whether she received the treatment necessary to stabilize her condition and whether she was stable when she was discharged from the emergency department.” Irenas noted that expert reports submitted by Love’s lawyer “identify specific steps that the emergency department failed to take to stabilize plaintiff’s blood pressure.” He also noted that one of the doctors who treated her at Rancocas Hospital had “admitted at his deposition” that her blood pressure readings showed that her condition was not stable, and that hospital records show that Love’s blood pressure had “spiked” shortly after the doctor discharged her, but before an ambulance had arrived to take her home. Those facts, Irenas said, pointed to a genuine dispute on the issue of whether Love’s condition was stable when she left the hospital several hours after her formal discharge. “The fact that the emergency department ordered an ambulance to take plaintiff home also raises questions as to the stability of her condition at the time she was discharged,” Irenas wrote. But in his final paragraphs, Irenas made clear that his ruling was limited to a rejection of the hospital’s summary judgment motion on the EMTALA claim and had no bearing on her separate medical malpractice claim. “Plaintiff’s claim that the emergency department failed to diagnose or misdiagnosed her condition does not fall under EMTALA, as it is in the province of state medical malpractice law,” Irenas wrote. “This court makes no comment as to (1) what damages, if any, would be available should plaintiff prevail on the merits of her EMTALA claim, or (2) what proof would be necessary to establish a valid damage claim,” Irenas wrote.

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