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A federal judge has allowed the estate of a woman who died of hemopericardium in Lankenau Medical Center’s emergency room to proceed with a claim against the hospital for failure to screen under the federal Emergency Medical Treatment and Active Labor Act, finding that the hospital could not adequately articulate its own screening procedure as a defense.

The EMTALA requires hospitals to provide “appropriate medical screening” to any individual who presents for emergency treatment.

In Blake v. Main Line Hospitals, U.S. Chief Judge Petrese B. Tucker of the Eastern District of Pennsylvania denied the hospital’s motion for summary judgment because it failed to offer any evidence outlining its standard screening procedure.

Instead, Tucker said, the defense relied on doctors’ and nurses’ depositions, medical records and expert reports to support its argument that it did not deviate from its standard screening procedures.

“It is well settled … that a court should consider the hospital’s screening procedures when considering a screening claim under the EMTALA,” Tucker said, citing the U.S. Court of Appeals for the Eighth Circuit’s 1996 ruling in Summers v. Baptist Medical Center Arkadelphia. “Defendants’ failure to proffer the hospital’s standard screening procedures, while simultaneously arguing that plaintiff has not established that defendants’ actions did not conform to these standards, therefore ‘puts the cart before the horse.’”

In Blake, according to Tucker, plaintiffs-decedent Arlene Blake, 47, awoke around 12:30 a.m. on Aug. 11, 2011, with chest pain and called 911.

After emergency medical technicians arrived, Blake was given nitroglycerin sprays at 1:54 a.m., 2:08 a.m. and 2:12 a.m., each time with no change, according to Tucker.

When Blake’s blood pressure began to decline, she was transported from her home by ambulance to Lankenau Medical Center’s emergency department, arriving at about 2:09 a.m., Tucker said.

According to the emergency nurses’ clinical report, Blake was triaged by a nurse, Matthew Geitl, at 2:22 a.m., at which time she was alert and not in acute pain, according to Tucker.

Blake had described her chest pain as being on her left side and radiating to her back, Tucker said. Geitl drew blood labs and an electrocardiogram was taken at around 2:26 a.m.

At 2:58 a.m., another nurse, Cynthia Faust, noted that Blake looked uncomfortable and, at 2:59 a.m., noted that Blake was ready for evaluation, according to Tucker.

At 4:15 a.m., Faust recorded that Blake was still waiting for an evaluation, according to Tucker, who said there was some discrepancy regarding when the emergency room physician, Dr. Seema Rathi, first saw Blake.

While the emergency nurses’ clinical report first mentions a physician being present at 5:40 a.m., Tucker said, Rathi testified at deposition that she had reviewed Blake’s EKG at some point before that and that Blake was then evaluated by nurses, who were under orders to interrupt Rathi with other patients if Blake’s status changed.

According to Tucker, Rathi further testified at deposition that between 4:15 a.m., when the nurses’ clinical report noted Blake was waiting to be seen, and 5:40 a.m., when a code was called after Blake began having what appeared to be a seizure, she had evaluated Blake, ordered medications and informed a member of the hospital staff that Blake would most likely need to be admitted to the hospital.

But Rathi later stated in her testimony at deposition that it may have been as late as 5:30 a.m. when she first saw Blake, according to Tucker.

Faust testified at deposition that she notified Rathi at some point that Blake needed something for pain, and that later, as she was about to give Blake the ordered aspirin and nitroglycerin, she saw Rathi leaving Blake’s room, according to Tucker.

Faust testified at deposition that Rathi told her she thought the source of Blake’s pain was her gallbladder and that the hospital was going to admit her in order to rule out chest pain, according to Tucker.

Faust testified that about 10 minutes later, immediately after she began giving Blake the nitroglycerin, Blake said she didn’t feel right and began to have what appeared to be a seizure, according to Tucker.

When no pulse was detected, Blake was given CPR, as well as code medications, and was intubated, according to Tucker, but was pronounced dead about 40 minutes later, at approximately 6:20 a.m.

Tucker said Blake’s autopsy “allegedly stated” that the cause of death was hemopericardium from a ruptured aortic dissection.

Gregory Blake, the administrator of Arlene Blake’s estate, subsequently filed suit against Main Line Health System and Main Line Hospitals Inc., of which Lankenau Medical Center is a subsidiary, alleging the hospital failed to screen Arlene Blake for the condition Rathi perceived her to have, an aortic dissection, according to Tucker.

The defendants, however, argued that they provided the proper screening under the EMTALA because Blake was “‘triaged, monitored, assessed and treated in accordance with the normal and customary practice of the emergency department,’” Tucker said.

But Tucker, noting that the EMTALA does not define “‘appropriate medical screening’” and that federal courts have interpreted the law as requiring hospitals to provide uniform screening to patients with substantially similar complaints, said she had to deny the defendants’ motion for summary judgment because “one of the foundational factual determinations in assessing an EMTALA screening claim remains unresolved: what the hospital’s standard screening procedures are.”

Tucker said that while the defendants relied heavily on Rathi’s testimony, “Rathi’s own medical judgment … does not shed light on the hospital’s standard screening procedures.”

“In fact, at numerous points within her deposition, Rathi seems to be unaware of whether any standard hospital screening procedures even exist,” Tucker said, adding that Faust also seemed to have “an unclear understanding” of the hospital’s screening procedures.

“Because all determinations regarding plaintiff’s EMTALA screening claim flow from the factual issue of what the hospital’s standard screening procedures are, including whether these procedures were followed in the instant case, there remains a genuine issue of material fact,” Tucker said.

Counsel for the plaintiff, Thomas A. Lynam III of Villari Lentz & Lynam in Philadelphia, could not be reached for comment at press time.

Counsel for the defense, Donna N. Kramer of Post & Schell in Philadelphia, declined comment.

Zack Needles can be contacted at 215-557-2493 or zneedles@alm.com. Follow him on Twitter @ZNeedlesTLI.

(Copies of the 13-page opinion in Blake v. Main Line Hospitals, PICS No. 14-0567, are available from Pennsylvania Law Weekly. Please call the Pennsylvania Instant Case Service at 800-276-PICS to order or for information.) •