EMTALA violation allegedly results in stillbirth

November 1, 2009
Dawn Collins, JD

MS COLLINS is an attorney specializing in medical malpractice in Long Beach, California. She welcomes feedback on this column via e-mail. Click on the envelope icon to email.

The woman sued the original hospital and ER physician, alleging negligence by the doctor in failing to recognize the need for an emergency cesarean section.

EMTALA violation allegedly results in stillbirth

The woman sued the original hospital and ER physician, alleging negligence by the doctor in failing to recognize the need for an emergency C/S, and alleged violation of the Federal Emergency Medical Treatment and Active Labor Act (EMTALA) statute by the hospital, arguing that she was not stable.

LEGAL PERSPECTIVE The Federal EMTALA statute1 should be well known to most ER departments, physicians, and obstetricians and requires that any patient presenting to an ER with a request for examination or treatment for a medical condition must be provided an appropriate medical screening examination, including any ancillary services routinely available to determine whether an emergency medical condition or active labor exists, regardless of ability to pay. If so, appropriate treatment and/or transfer to another facility is required.

The statute is very specific in its definitions of medical screening and requirements for appropriate transfer, and includes language for both, so that the health risk to the unborn child is taken into consideration and minimized. Violation of these requirements can result in significant fines as well as a claim for malpractice.

In the case above, it is not stated whether the fetus was appropriately evaluated, but in order to show compliance with the statute, an assessment of fetal status and proof of fetal well being with no need for emergency intervention must be documented in the medical record.

1. 42 USC 1395dd.

Failure to explain the risks of vaginal delivery

A RHODE ISLAND WOMAN HAD A SHOULDER DYSTOCIA during the delivery of her child, and the infant was subsequently diagnosed with a brachial plexus injury. The woman sued the midwife and her group who provided prenatal care, claiming that they should have given the patient proper counseling regarding the risk of injury to the fetus in a vaginal delivery, which she claimed would have led her to have a C/S for delivery, thus avoiding the shoulder dystocia. A $1 million settlement was reached with the midwife group.

LEGAL PERSPECTIVE Unlike most malpractice cases involving shoulder dystocia during delivery, where the usual issues are its prevention and prediction and the management of the dystocia in the delivery room, this case makes the sole claim that the caregivers had an obligation to inform the patient of the risks of vaginal delivery, including shoulder dystocia and brachial plexus injury, and to give her the option to choose cesarean delivery. While the basis for settlement in this case is not stated, and some cases settle for reasons that are unrelated to the actual care, it is unfortunate that it was settled in the face of this particular claim, where it is assumed that the standard of care requires a vaginal delivery consent discussion, including risks and an option for C/S-even in patients without risk factors for dystocia, and money was paid without even making the claim of excessive traction or mismanagement of the dystocia.