hospital buildingThe Emergency Medical Treatment and Active Labor Act (EMTALA), despite being enacted more than 30 years ago, has produced a case examining the applicability of malpractice damages limitations that bears watching.

In Scott v. Ruston Louisiana Hospital Company, the court examined whether state medical malpractice caps are applicable to an EMTALA case. A young patient came to Northern Louisiana Medical Center’s emergency room for treatment. The physician ordered an MRI around 9 a.m. However, the MRI was not performed until after 3 p.m. The delay was alleged to be the result of a hospital policy “that requires that emergency room requests for MRIs be summarily denied and delayed until reimbursement from the insurance company has been certified.” The parents of the patient alleged that if the MRI had been timely performed, the patient’s hematoma would have been identified and treated in enough time to prevent the permanent paralysis that later developed, or that the severity of the patient’s symptoms would have been reduced.

EMTALA regulates the procedural aspects of the provision of emergency medical services and establishes a private cause of action for a violation of its terms. However, EMTALA does not address the substantive quality of care provided to a patient. Any person who suffers harm as a direct result of a participating hospital’s violation of EMTALA may, in a civil action, obtain those damages available for personal injury under the laws of the state in which the hospital is located, and obtain such equitable relief as is appropriate.

In this case, the plaintiffs’ complaint specifically alleged that their EMTALA claims were not subject to the state’s medical malpractice damages limitations. The court found that there was no conflict between the malpractice statute’s damages caps and EMTALA, as EMTALA expressly defers to state law on the question of damages. The court held, similarly to most federal courts confronting the question of damages limitations, “that EMTALA’s incorporation of state law extends to caps on damages for medical malpractice claims so long as the challenged conduct falls within the particular state’s definition of malpractice.” Under this line of reasoning, whether the malpractice damages limitations are applicable depends on whether the allegations in the complaint state a malpractice claim under the state’s malpractice law. Thus, medical malpractice damages limitations will be applicable if the allegations come within the scope of applicable state malpractice laws, which will be determined on a case-by-case basis.

The court, however, has granted a motion for an interlocutory appeal to the Fifth Circuit on the issue of the medical malpractice damages limitations, to resolve the issue inasmuch as there was a prior Eastern District of Louisiana case that held that the state medical malpractice claims caps were not applicable to an EMTALA case. In Jeff v. Universal Health Services, the court found that (1) EMTALA creates a distinct federal cause of action based on a strict liability standard rather than a negligence standard; (2) EMTALA claims are not analogous to a medical malpractice claim; and (3) EMTALA’s failure to incorporate a state’s procedural limitations for malpractice actions “supports the conclusion that EMTALA does not incorporate a state’s medical malpractice damages caps.”

The case bears watching, as it may significantly increase the risks associated with EMTALA violations should the Fifth Circuit decide that the limitations are inapplicable.