Professional Negligence Law Reporter

The Seventh Circuit Court of Appeals held that a hospital was not liable under the Emergency Medical Treatment and Active Labor Act (EMTALA), 42 U.S.C. §1395dd et seq., when it transferred a patient following a physician’s certification that the medical benefits of the transfer outweighed its potential risks.

Jodi Martindale, 50, was seen at the ER of Indiana University Health Bloomington Hospital (IUHB). Physician Francis Karle examined Martindale and ordered testing and a CT scan, which indicated that Martindale may have been suffering from mesenteric ischemia possibly related to her previous gastric bypass surgery. Karle contacted IUHB’s on-call general surgeon, Terrence Greene, who recommended that Karle contact the surgeon who performed Martindale’s bariatric surgery because, Greene said, he lacked the training and expertise required to operate safely on Martindale. Karle spoke with Martindale’s former surgeon, who agreed to accept the transfer. When Martindale arrived at the next facility in Indianapolis, she underwent surgery, which revealed no bariatric etiology for her ischemia. After the surgery, she experienced sepsis and multiple organ failure, which led to her death two days later.

Martindale’s husband sued IUHB, alleging violation of EMTALA. The plaintiff asserted that the defendant had failed to satisfy its statutory obligation to stabilize Martindale by performing surgery before transferring her. The district court granted summary judgment for the defense.

Affirming, the Seventh Circuit found that under EMTALA, a hospital must screen patients arriving at its ER and, if it is determined a patient has an emergency medical condition, staff must either provide further treatment or transfer the patient in accordance with certain parameters. The act authorizes a pre-stabilization transfer upon a written request by the patient or a certification signed by a doctor. Here, the court found, Karle completed a certified transfer form stating that the medical benefits expected from Martindale’s transfer outweighed the risks. Citing case law, the court noted that the plaintiff does not suggest Karle had completed the certification in bad faith, and that the act does not allow for second-guessing of a physician’s certified decision. The court also said that the statute’s text does not mandate that a transfer turn out to be the best medical choice, only that a physician believes the decision was warranted based on information available at the time.

The court found that EMTALA’s narrow purpose is to serve as an anti-patient-dumping law. The reasonableness of Martindale’s treating physicians’ conduct, is a question for state medical negligence law only, the court said. Consequently, the court concluded that Martindale’s transfer was appropriate under EMTALA and that summary judgment on the plaintiff’s federal claims had been warranted.

Citation: Martindale v. Ind. Univ. Health Bloomington, Inc., 39 F.4th 416 (7th Cir. 2022).