Fourth Circuit Adopts EMTALA’s Good Faith Admission Requirement

Since the spread of COVID-19 has become a national emergency, those focused on Emergency Medical Treatment and Labor Act (“EMTALA”) compliance have justifiably concentrated on analyzing the Centers from Medicare & Medicaid Services (“CMS”) guidance provided in: i) a March 9, 2020, Memorandum and ii) the limited EMTALA waiver made retroactively effective as of March 1, 2020, pursuant to Section 1135 of the Social Security Act. The compliance implications of this CMS guidance are discussed in more detail here. However, hospitals should take note of a recent decision issued by the United States Court of Appeals for the Fourth Circuit on March 13, 2020, which, for the first time in the Fourth Circuit, upheld the good faith admission requirement protecting hospitals from a “failure to stabilize” EMTALA claim as long as an individual is admitted as an inpatient and in good faith.

At its most fundamental level, EMTALA imposes two obligations on hospitals with emergency departments. First, hospitals must screen individuals who come to the hospital’s emergency department to determine whether the individual has an emergency medical condition. Second, hospitals must treat an individual’s emergency medical condition or stabilize the patient if the patient is to be transferred, which includes discharge.

Consistent with what case law had already established, CMS explained these responsibilities via notice-and-comment rulemaking in 2003. CMS specifically clarified that the stabilization requirement only applies when a patient is to be transferred or discharged. In the 2003 Final Rule preamble, CMS described the limited reach of EMTALA’s stabilization requirement:  “should a hospital determine that it would be better to admit an individual as an inpatient, such a decision would not result in a transfer or a discharge, and, consequently, the hospital would not have an obligation to stabilize under EMTALA.” Importantly, however, the preamble goes on to caution that “a hospital cannot escape liability under EMTALA by ostensibly admitting a patient, with no intention of treating the patient and then inappropriately transferring or discharging the patient without having met the stabilization requirement.”

Therefore, effective September 9, 2003, the good faith admission requirement was incorporated into federal regulation as follows:

If a hospital has screened an individual…and found the individual to have an emergency medical condition, and admits that individual as an inpatient in good faith in order to stabilize the emergency medical condition, the hospital has satisfied its special responsibilities under this section with respect to that individual.

The recent Fourth Circuit decision¹ is significant in that it places on the party alleging an EMTALA violation the burden of establishing that an admission was not in good faith. In upholding the trial court’s granting summary judgment in favor of the hospital, the Fourth Circuit explicitly held that any party claiming to have his or her rights violated under EMTALA because of a bad faith admission must establish that the hospital admitted the patient as a “subterfuge or ruse” without any intent to appropriately treat the patient.

If you have any questions about EMTALA or would like further information on this recent judicial precedent, please contact:

• Eric Crowder at (443) 951-7047 or ecrowder@hallrender.com;
• Patrick Garcia at (445) 951-7043 or pgarcia@hallrender.com;
• Al Adelman at (443) 951-7046 or aadelman@hallrender.com; or
• Your regular Hall Render attorney.

Hall Render’s attorneys and professionals continue to maintain the most up-to-date information and resources at our COVID-19 Resource page, through our 24/7 COVID‑19 Hotline at (317) 429-3900 or by contacting your regular Hall Render attorney.

Hall Render blog posts and articles are intended for informational purposes only. For ethical reasons, Hall Render attorneys cannot—outside of an attorney-client relationship—answer specific questions that would be legal advice.