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The CMS regulations provide a limited exception to EMTALA's obligations, but only in the event that a hospital "admits [an] individual as an inpatient."
On May 28, 2012, at approximately 2:47 a.m., Mr. Salata arrived at PMMC's emergency department complaining of chest pain. Mr. Salata was discharged at approximately 11:30 a.m. on May 29. The discharge progress note listed his primary diagnosis as "esophageal reflux" with a secondary diagnosis of "essential hypertension, unspecified benign or malignant." Less than twenty-four hours later, on May 30, at 7:55 a.m., Mr. Salata again presented to PMMC's emergency department, this time as a "full code" with CPR in progress. He was pronounced dead two minutes later. Plaintiff, as administrator of Mr. Salata's estate, then filed suit in this Court against PMMC, Dr. Chung, and Dr. Patel, alleging five claims: (1) wrongful death against all Defendants; (2) a survival action against all Defendants; (3) negligence against all Defendants; (4) corporate negligence against PMMC; and (5) a failure-to-stabilize claim under the Emergency Medical Treatment and Active Labor Act ("EMTALA") against PMMC. PMMC has moved for summary judgment on the EMTALA claim only; Dr. Chung has moved for summary judgment on all claims against him; and Dr. Patel has moved to dismiss all claims for lack of subject-matter jurisdiction in the event that the Court grants PMMC's motion on the EMTALA claim, because the remaining claims all arise under state law, rather than federal law. PMMC argued that its EMTALA stabilization duties ended when it placed Mr. Salata in observation, and that it therefore cannot be held liable for failing to stabilize Mr. Salata
Did Mr. Salata's admission for observation preclude EMTALA liability?
The court found that EMTALA's text is ambiguous regarding whether Mr. Salata's admission for observation cuts off liability, and there is a dearth of case law on the subject as well. However, regulations bearing on this issue have been promulgated by the Centers for Medicare & Medicaid Services ("CMS"), the agency within the Department of Health and Human Services responsible for implementing EMTALA. The relevant CMS Final Rule, issued in 2003, also makes clear that CMS interprets "hospital obligations under EMTALA as ending once the individuals are admitted to the hospital inpatient care." Nowhere do the regulations state that admission for observation similarly ends a hospital's EMTALA obligations. To the contrary, later CMS interpretative guidance makes clear that observation status does not qualify as inpatient admission for purposes of EMTALA liability. In 2009, CMS explained: "Individuals who are placed in observation status are not inpatients, even if they occupy a bed overnight. Therefore, placement in an observation status of an individual . . . does not terminate the EMTALA obligations of that hospital or a recipient." The court held that the CMS regulations and guidance make clear that admission for observation does not end a hospital's EMTALA obligations, and PMMC's arguments to the contrary are not persuasive.