Medical Treatment Denial and Malpractice Lawsuits



Can you sue a doctor or hospital for refusing treatment? The answer is...it depends. State and federal laws vary widely on the issues of medical treatment denial. If you're considering legal action against a doctor or hospital for refusing to treat, you should consult with an experienced attorney. These cases are complex.

Refusal of medical treatment usually occurs in emergency rooms and urgent care clinics. A trained medical technician's or nurse's assessment of a medical condition, known as triage, determines the priority of an injured person's medical need. People with life threatening injuries may be seen immediately, while those with lesser injuries may have to wait.

For example, a patient with chest pains, which may indicate the onset of a heart attack, will receive immediate medical care. Those with head trauma, serious burns, or other life threatening injuries will also be high on the list. Someone with a sprained ankle, however, may have to wait for several hours before being seen.

There are times when a patient may be rightfully denied emergency medical care. Some of the most common reasons include:

  • The patient exhibits "drug seeking behavior." Most emergency room doctors and nurses are trained to identify those who likely have a drug problem.

  • The patient is deluded, believing she is seriously ill when there is no real illness.

  • The patient displays destructive or dangerous behavior while waiting to be seen.

If you don't fall under one of the above categories, you will still be able to see the emergency room doctor, even if you don't have a medical emergency (due to liability reasons). You may have to wait until every patient with a more serious condition is seen, even if they arrived at the E.R. hours after you did, which is a legitimate exercise of emergency care triage.

The Emergency Medical Treatment and Active Labor Act

The Federal Emergency Medical Treatment and Active Labor Act (EMTALA), is part of the Consolidated Omnibus Reconciliation Act (COBRA). EMTALA.com offers a summary of its provisions. The Act applies to all hospitals in the United States and its territories. It sets out the laws governing facilities that provide emergency medical care.

The EMTALA requires hospital E.R. staff to provide medical treatment to all people with real emergency medical conditions, regardless of the person's ability to pay (or provide medical insurance). Illegal denial of treatment may subject the medical provider to disciplinary action.

Under EMTALA, an emergency medical condition is defined as:

...one that manifests itself by acute symptoms of sufficient severity (including severe pain, psychiatric disturbance, and/or symptoms of substance abuse) such that the absence of immediate medical attention could reasonably be expected to result in the following:

  • placing the health of the individual (or unborn child) in serious jeopardy

  • the serious impairment of a bodily function

  • the serious dysfunction of any bodily function or part

  • the inadequate time to effect a safe transfer of a pregnant woman to another hospital before delivery, or, that the transfer may pose a threat to the health or safety of the woman or unborn child."

Under EMTALA, people with medical emergencies must be treated to the extent their condition is stabilized. Stabilized means the patient is placed in a position so that discharge from emergency care will not adversely affect or otherwise cause a "material deterioration" of the patient's condition.

This includes the time that passes during the patient's return home, or to another medical facility. For women, this includes waiting until a baby is delivered.

Under the Federal Civil Rights Act of 1964, and subsequent federal laws, hospital emergency rooms and registered clinics can't deny treatment to patients based on race, color, creed, age, or sexual preference, presuming the patient has a true medical emergency.

Once stabilized, the EMTALA permits the medical facility to legitimately deny the patient medical care. Denial of care can be based on a number of legitimate reasons (barring descrimination), including inability to pay for services, lack of insurance, type of illness, and other practical reasons.

What to do if you were denied emergency medical treatment...

If you were denied treatment for legitimate reasons at an emergency room or urgent care center, you may have no legal recourse. If, however, you learn from a credible medical provider your condition did require emergency care, and you were turned away from an E.R., you may have the basis of a medical malpractice claim.

Additionally, you may report the emergency provider's action to Medicare. They will investigate your claim, and if they find you were denied emergency medical care in violation of EMTALA, the facility may be subject to:

  • Termination of their lucrative Medicare provider agreement
  • Fines up to $50,000 per violation ($25,000 for a hospital with fewer than 100 beds)
  • Physician fines of $50,000 per violation, including on-call physicians

If you are wrongly denied treatment in an emergency room setting, ask to see the person responsible for operations. State that you are familiar with EMTALA regulations and you're sure refusing to treat you is a violation. Cite the reasons you were wrongfully denied treatment, such as not having insurance, or being unable to pay the costs of treatment.

You have no rights to any fines levied against the hospital for violation of EMTALA. However, if you can prove their treatment denial resulted in an unnecessary aggravation of a pre-existing condition, or was responsible for unnecessary physical pain and suffering, you may have the basis of a medical malpractice case.

If the hospital was fined or censured by the government for violating EMTALA, those violations will go a long way towards supporting a malpractice claim.

If you were refused medical treatment based on discrimination, as set out under the Federal Civil Rights Act, the violation can be reported to your state attorney general's office, or the local office of the United States Attorney.

Can private doctors refuse to treat patients?

The short answer is, yes. A private doctor isn't subject to the provisions of EMTALA, and can dismiss you as a patient at any time (barring discrimination), for just about any reason, without fear of credible legal reprisals. Doctors in private practice are basically small business owners. In a sense, a sign stating "No Shirt, No Shoes, No Service" can be applied to doctors, as well as to your local restaurateur.

A doctor can refuse to treat a patient because:

  • The doctor's practice is so busy she is unable to accept new patients.

  • The doctor doesn't have a working relationship with your health insurance company.

  • The doctor chooses not to treat patients with the illness or injury you suffer from.

  • You can't pay for the costs of treatment.

  • You or your spouse is a medical malpractice attorney.

Your doctor can refuse to continue treating you because:

  • You haven't paid your bill.

  • The doctor has stopped doing business with your health insurance provider.

  • You continue to exhibit drug seeking behavior.

  • You are a disruptive patient.

  • For reasons of conscience (including religious, contraceptive, or palliative care beliefs, or deciding not to prescribe narcotics for pain management).

  • The doctor learns you or your spouse is a medical malpractice attorney.

There is an exception...

You can't be discharged if it will result in your medical condition worsening before you find another doctor, or will result in another medical condition.

If your doctor says she has to stop treating you, you must try to find another doctor as soon as reasonably possible. Whether or not your doctor can discharge you as a patient after giving you adequate time to find another doctor, and you refused to do so, is a question for the courts.

If your doctor refuses to continue to provide treatment, and as a direct result your condition worsens, you may have the basis of a medical malpractice claim.

Get an Attorney

If you believe you were wrongfully denied medical treatment by a doctor or emergency care facility, and that denial caused you further injury, you must seek the advice and counsel of an experienced medical malpractice attorney.

Malpractice cases are complex, and can sometimes take years to resolve. Hospitals and doctors pay millions of dollars in malpractice insurance premiums. Any malpractice claim will be defended aggressively by "take no prisoners" attorneys working for the insurance company. Only an experienced attorney can handle a case like this and properly represent your interests.

If the treatment denial occurred in an emergency room setting, you should retain an attorney with experience in EMTALA violations. Most malpractice attorneys don't charge for an initial consultation. In almost all cases, you won't have to pay any legal fees or other costs until, and unless your attorney wins your case.

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