If you’ve been denied treatment by a hospital or doctor, you need to know about medical malpractice and your right to seek compensation.
Nearly 137 million people of all ages end up at a hospital emergency room every year. ¹
Federal law requires Medicare-approved hospitals to provide emergency medical treatment to anyone who needs it, even when the person doesn’t have health insurance.
Roughly 15 percent of American adults do not have health care coverage. Among adults with lower incomes, as many as one in four persons don’t have health insurance. ²
Here’s where we unpack what kind of care hospitals and doctors are obligated to provide, and what you can do about it if the denial of treatment has harmed you.
Federal Laws Regulate Emergency Treatment
Before the enactment of civil and patient’s rights laws, patients who couldn’t pay were often refused treatment or transferred (“dumped”) at public hospitals even when they were in no condition to be moved.
Today, hospitals with emergency departments that qualify for Medicare are mandated by state and federal laws to provide emergency care to all patients, regardless of their ability to pay.
The Emergency Medical Treatment and Active Labor Act
The Federal Emergency Medical Treatment and Active Labor Act (EMTALA), was signed into law in 1986.
Originally written as an “anti-dumping” act, the law required private hospitals with dedicated emergency departments to treat women in active labor and people with emergency medical conditions, regardless of the person’s ability to pay.
EMTALA defines an emergency medical condition as one that occurred suddenly, with symptoms such as severe pain, psychiatric disturbance, or symptoms of substance abuse, where lack of emergency care could result in:
- 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
- not enough time to safely transfer a pregnant woman to another hospital before delivery, or transfer could be risky for the woman or unborn child
Under EMTALA, the patient can’t be released or transferred to another hospital until their condition has been stabilized.
Once stabilized, the hospital can legally release the patient or refuse further care, so long as the refusal is not discriminatory, for example, because of a person’s race or religion.
EMTALA doesn’t cover every type of medical facility. Private doctor’s offices, stand-alone medical labs, and specialty hospitals that don’t have an emergency room, won’t be subject to EMTALA rules.
In recent years, updates to the regulations and federal court decisions have begun to include hospital-sponsored urgent care centers under the EMTALA.
Case Summary: EMTALA Applies to Urgent Care Center
Patricia Friedrich went to the South County Hospital Urgent Care/Walk-in Center complaining about severe pain and burning in her chest and arm.
Patricia had texted several coworkers indicating that she knew she was having heart attack symptoms and needed to get checked at the ER. Patricia texted that she saw “South County Walk-In Hospital” so pulled in there to be checked.
The medical provider on duty told her she was suffering from gastrointestinal reflux disease. She was given a “GI cocktail” and released with no plan for follow-up care.
The next day, Patricia was found unresponsive at home. She was taken by ambulance to the hospital where she was pronounced dead. She died from cardiovascular disease.
Patricia’s family sued the hospital and urgent care center, alleging the urgent care center was negligent for failing to medically screen and stabilize Patricia’s condition as required under EMTALA.
At trial, South County argued that its urgent care center is not the same as a hospital emergency department, so EMTALA does not apply. South County also argued that their website clearly states the walk-in location is not for health emergencies.
However, the judge ruled in favor of Patricia’s family, finding:
“Someone driving by the clinic with an emergency medical need—like Friedrich—would not be able to make this distinction based on the signage, and certainly cannot be expected to check the website before walking in with chest pain. There is no evidence that [South County Hospital] made patients aware that the Urgent/Walk-in Care was not an appropriate place to go for emergency care anywhere other than the website.”
When Can Treatment be Denied?
Refusal of medical treatment might occur in emergency rooms and urgent care clinics. Typically, soon after you arrive, a triage nurse talks to you about your symptoms, then checks your breathing, pulse, blood pressure and temperature.
The triage nurse must determine how urgent your injury or illness is compared to other patients waiting to be seen. People with life-threatening conditions will be seen before patients with other types of injuries or illnesses.
For example, a patient with head trauma, serious burns, or other critical injuries will be treated right away. Someone with a sprained ankle may have to wait for several hours before being seen.
If you get tired of waiting and leave the hospital, you’ll have a hard time convincing a judge that the hospital denied your emergency care.
Reasons Emergency Room Treatment Can Be Denied
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 they are seriously ill when there is no real illness.
- The patient displays destructive or dangerous behavior while waiting to be seen.
Unless the hospital has a legitimate reason to deny treatment, you will still be able to see the emergency room doctor even if you don’t have a medical emergency, although it can take hours to be seen if more critical patients arrive before you’re seen.
Patients Cannot Be Released Until Stabilized
Once you’ve been evaluated by a physician, including having any appropriate medical tests, the hospital should not release you until your condition is stable. For example, a woman in active labor cannot be released until the baby has been born and the mother’s condition is stable.
Likewise, patients suffering from a psychiatric condition should be admitted to the hospital’s psychiatric unit, even if the patient doesn’t have insurance coverage for treatment.
Case Summary: Unstable Patient Release Violates EMTALA
The family of Marie Moses-Irons sued Providence Hospital and Dr. Paul Lessem for negligence in violation of EMTALA. The lawsuit alleges the hospital was negligent in releasing Moses-Irons’ husband Howard, who murdered his wife ten days after he was released from the hospital.
Marie Moses-Irons brought her husband to the Providence Hospital emergency department complaining of headaches, aches and pains, vomiting, delusions, and hallucinations. Howard was admitted to the hospital for, among other things, “atypical psychosis.”
Hospital records indicate Howard was to be transferred to the hospital’s psychiatric unit if his insurance would cover the treatment.
However, instead of being moved to the psychiatric unit, Howard was released from the hospital, even though Marie Moses-Irons told the doctors that she feared her husband. Howard’s discharge diagnosis included “migraine headache” and an “atypical psychosis [with] delusional disorder.” Ten days later Howard killed his wife.
The court ruled that Providence violated the Federal Emergency Medical Treatment and Active Labor Act by releasing Howard before his condition was stabilized.
Private Doctors Can Refuse to Treat
A private doctor is not subject to the provisions of EMTALA and can dismiss you as a patient at any time, for just about any reason other than discrimination, without fear of liability.
Under the Civil Rights Act of 1964, you can’t be refused treatment on the basis of your age, sex, race, sexual orientation, religion, or national origin.
Doctors in private practice are essentially small business owners and are not required to treat patients who can’t pay for their services.
A doctor can refuse to treat a patient because:
- The doctor’s practice is not accepting 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 are 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. Reasons can include 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.
If your health would suffer, the doctor must continue to treat you until you’ve had time to find a new provider.
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.
You may have a right to care under your state’s laws. Talk to a personal injury attorney if you’re injured by a doctor’s failure to treat you.
When to Hire an Attorney
If you or a loved one was wrongfully denied emergency care or kicked out of the hospital before the condition was stabilized, you have the right to seek financial compensation.
Your right to emergency medical care is governed by state as well as federal laws. Your attorney will know all the laws and regulations that can help you win against the corporate litigators.
A malpractice lawsuit can help you recover:
- Medical bills
- Related out-of-pocket expenses
- An amount for pain and suffering
- Lost wages
Hospitals and doctors pay steep malpractice insurance premiums. Any malpractice claim will be aggressively defended by an army of attorneys working for the insurance company.
Malpractice and medical negligence actions are complicated, high-dollar claims.
You’ll need a skilled personal injury attorney to get anywhere near the amount of compensation you deserve for your injuries and pain and suffering.
If your loved one died from denial of treatment, talk to your attorney about a wrongful death lawsuit.
Experienced attorneys have the knowledge and money to handle complex medical malpractice cases. Most attorneys represent medical malpractice victims on a contingency fee basis, meaning your attorney won’t get paid unless your case settles or you win a court verdict.
There’s usually no charge for an initial consultation. It costs nothing to find out what a good attorney can do for you and your family.
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Medical Treatment Denial Questions & Answers
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