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.
How Much is Your Injury Claim Worth?
Find out now with a FREE case review from an attorney…
Visitor Questions on Treatment Denial
Neurologist not treating ADHD? My brother has ADHD and his doctor won’t treat him, she says because of his behavior. Which makes no sense, since he acts well behaved in her office. Whatever happens at home is the job of the parents to deal with, right? My brother is twelve years old, but he is going through his rebellious... Read More >>
Unwarranted delay in treatment resulted in several root canals… I would like to know if I have a malpractice case for unwarranted delay in treatment and what would you recommend as the ramification (ex. no case, get a lawyer, file a complaint, small claim court, etc.?) My kid had been seeing this general dentist for few years and we regularly met with him once... Read More >>
Turned away by urgent care? I went to urgent care tonight (02/04/2015) and was sent away by a triage rep. I went in there because my scalp is sore and I think I may have been bitten by a spider. I have a couple of bumps on my scalp and a couple of tender spot on my scalp. It was... Read More >>
Was my husband a victim of patient abandonment? My husband was discharged from his pain management doctor because he could not get time off work to come in to leave a urine specimen. He was given only 24 hrs notice to comply or risk being discharged. He has had to take time off of work due to another unrelated issue and could not... Read More >>
Surgery was cancelled the day before due to insurance issues? My son is 2 and has been diagnosed with chordee, hypospadia, and inguinal hernia. The day before the surgery I was told by the billing department at Johns Hopkins that since our insurance is not accepted there, they will have to cancel the surgery. They then referred me to another practice, but I am now... Read More >>
Physical therapist stopped treatment while I had unfilled prescriptions? I have multiple orthopedic conditions and surgeries. After several years of being treated by a physical therapist, he began double booking my appointments and ignoring me. I had outstanding prescriptions from different doctors for treatment. He abruptly discontinued service, left a voicemail on my phone while I was at work, did not provide a referral,... Read More >>
Insurance denials of EMTALA claims? We have several emergency claims that are denied on a regular basis by Aetna, Blue Cross, Blue Shield, United Healthcare, Care 1st (to name a few). The insurers constantly deny payment due to “No Authorization for Treatment” or “Non Medical Necessity,” or they process it to the patient’s deductible and expect us to write off... Read More >>
Denied at Vision Center due to racial discrimination? I was visiting Las Vegas for the 4th of July, when I returned home to Kalamazoo, MI my eye was killing me. It was extremely sensitive to light, very painful, and I had a ton of pressure behind my right eye. I live alone, so I created a patch out of paper towel, covered it... Read More >>
Doctor refusing to treat because I won’t take meds with serious side effects? I called my doctor’s office asking for an appointment to see her, because I had an infection that was not clearing up. She was aware of the infection and had given me antibiotics previously. She refused to set up an appointment for treatment, and told her nurse to tell me that she couldn’t do anything... Read More >>
Neglect and mismanagement of severe pain related to ovarian cyst… I went to my local ER with intense pelvic and lower back pain. My pain was an 8-9 out of 10, and I have never been to an ER for pain management. I am not a “frequent flyer.” After an evaluation by an RN, then the MD, I was to receive some fentanyl IVP for... Read More >>
ER doctor refused to remove pieces of glass from my foot… I went to the emergency room for foot pain. They took an x-ray and found I had a couple pieces of tiny glass in my right foot. The doctor told me to find another podiatrist because they were booked up for three months. She told me all I need was a small scraping around the... Read More >>
Can a hospital outpatient clinic refuse to treat a patient? This happened in Ohio. I went to First Care which is an affiliation with the local hospital because my wife had bells palsy. She just wanted to get a check up on her eye and she was complaining of her ears bothering her. They were advised that this is all we wanted them to do... Read More >>
Nurse ignores pain reports in patient with hematoma… I recently had scrotal hernia surgery with mesh implant. On day 2 after the surgery I felt something was wrong. I contacted the doctor and told him the pain was increasing, along with bruising and swelling. On day 4 I called the doc’s office and spoke with the nurse. I told her the symptoms I... Read More >>
Is the doctor liable for not ordering an MRI for 20 months? On July 10, 2009 I had an auto accident with an 18 wheeler in Nashville TN. I had to go to the ER. The hospital did a CT scan on my head because I had a knot on my skull. The ER report said I needed an MRI because the CT scan showed some problems... Read More >>
Doctor Refused My Surgery Due to Smoking? After injuring my foot and going to the emergency room, the physician on duty said I fractured my heel. He said he was going to put my foot in a cast and see how it healed. He sent me home and said to call for a follow up visit in a couple of weeks. On... Read More >>