Baber v. Hospital Corporation Of America

977 F.2d 872 (4th Cir. 1992)

Purchase the Printed Copy at bsmsphd.com

Nature of the Case

To access this section all you need to do is click here and register.

Facts

Brenda, accompanied by P sought treatment at RGH's emergency department. She was nauseated, agitated, and thought she might be pregnant. She was also tremulous and did not appear to have orderly thought patterns. She had stopped taking her anti-psychosis medications, Haldol and Cogentin, and had been drinking heavily. Dr. Kline stated that “She refused to remain on the stretcher and cannot be restrained verbally despite repeated requests by staff and by me. P has not assisted either verbally or physically in keeping the patient from pacing throughout the Emergency Room. Restraints would place patient and staff at risk by increasing her agitation.” Dr. Kline examined her central nervous system, lungs, cardiovascular system, and abdomen. He also ordered several laboratory tests, including a pregnancy test. While waiting for results, she began pacing about and Dr. Kline gave her five milligrams of Haldol. This failed and he administered 100 milligrams of Thorazine. He also gave her 100 milligrams of Thiamine and two ounces of magnesium citrate because of her earlier alcohol consumption. P described his sister as becoming restless, 'worse and more disoriented after she was given the medication,' and wandering around the emergency department. While roaming around midnight, without warning, she convulsed and fell, striking her head upon a table and lacerating her scalp. The seizure lasted three minutes, but she quickly regained consciousness and emergency department personnel carried her by stretcher to the suturing room. Dr. Kline examined her again. He obtained a blood gas study that did not reveal any oxygen deprivation or acidosis. She was verbal and could move her head, eyes, and limbs without discomfort. With attendants restraining her limbs, Dr. Kline closed the one-inch laceration with a couple of sutures. She was easily arousable and easily disturbed. She experienced some anxiety, disorientation, restlessness, and some speech problems. Dr. Kline concluded these were caused by her pre-existing psychiatric problems of psychosis with paranoia and alcohol withdrawal. Dr. Kline discussed her condition with Dr. Whelan, the psychiatrist who had treated her for two years. Dr. Whelan believed she suffered from undifferentiated schizophrenia and noted that her mental illness was associated with periods of extreme alcohol abuse. They were concerned about the seizure and believed it might be linked to her psychosis. They decided to transfer her to the psychiatric unit at BARH because RGH did not have a psychiatric ward, and both doctors believed it would be beneficial for her to be treated in a familiar setting. Any tests to diagnose the cause of her initial seizure, such as a computerized tomography scan (CT scan), could be performed at BARH once her psychiatric condition was under control. P neither expressly consented nor objected. His only request was that his sister be x-rayed because of the blow to her head when she fell. Dr. Kline believed her head injury was not that serious and that she could be transferred safely to BARH where she would be under the observation of the BARH psychiatric staff personnel. P was admitted directly to the psychiatric department of BARH upon Dr. Whelan's orders. She was not processed through the emergency department. No physician gave her an extensive neurological examination upon her arrival. P repeated his request for an x-ray. A nurse found her having a grand mal seizure. At Dr. Whelan's direction, the psychiatric unit staff transported her to BARH's emergency department. Her pupils were unresponsive, and hospital personnel began CPR. The emergency department physician ordered a CT scan, which revealed a fractured skull and a right subdural hematoma. BARH immediately transferred her back to RGH because that hospital had a neurosurgeon on staff, and BARH did not have the facility or staff to treat serious neurological problems. When RGH received her, she was comatose. She died later that day, apparently as a result of an intracerebrovascular rupture that the first hospital failed to diagnose before transferring her to the second hospital. P filed suit against Ds for violation of the Emergency Medical Treatment and Active Labor Act (EMTALA). The court granted summary judgment for Dr. Kline and Dr. Whelan because it found that EMTALA does not give patients a private cause of action against their doctors. It concluded that P failed to submit evidence tending to show either that RGH failed to provide 'an appropriate medical screening,' or that RGH knew she had an 'emergency medical condition' that required stabilization before transfer to another hospital. It found that BARH was not required to perform an 'appropriate medical screening' on her upon her admission to that hospital because the screening requirement applies only to a patient who seeks treatment from an emergency department. P appealed.