Vanderbilt Law Review


Scott B. Smith

First Page



Congress enacted the Emergency Medical Treatment and Active Labor Act ('EMTALA" or "the Act") in 1986 to prevent hospi- tals from "dumping" patients due to an improper economic motive. Patient dumping occurs when a hospital emergency room either refuses to admit an indigent and uninsured patient with an emergency condition or improperly transfers this patient to another hospital. Congress enacted EMTALA in response to the widespread practice of hospitals dumping indigent and uninsured patients. Yet despite the Act's explicit legislative intent to prevent patient dumping, the language of EMTALA extends protection to "any individual" who enters a hospital's emergency room. Initially, EMTALA requires hospitals to provide emergency patients with an "appropriate medical screening examination." If the patient is diagnosed with an "emergency medical condition," the hospital must either stabilize the patient's condition or transfer the patient after fulfilling several statutory requirements.

As a result of the inconsistency between the Act's legislative intent and its broad language, the federal courts have used two different standards to define a cause of action under EMTALA. Several federal district courts have narrowly construed the Act in light of its legislative history, allowing a cause of action only in cases involving economic dumping. On the other hand, the federal circuit courts have broadly applied EMTALA's statutory language, permitting "any individual" who alleges improper medical treatment to sue under the statute. This judicial expansion of the Act has encroached upon other federal laws enacted to remedy instances of non-economic discrimination.

Congress designed EMTALA to remedy economic discrimination against indigent and uninsured patients by hospitals; yet, most federal courts have overlooked the Act's legislative purpose by allowing paying patients to challenge their emergency treatment under the Act. Thus the federal courts have done little to improve indigent patients' access to emergency care. Instead, most of the judicial ink spilled interpreting EMTALA has involved the federal standards of emergency care for paying patients.

In 1994, the Fourth Circuit handed down the surprising opinion of In the Matter of Baby "K" ("Baby K'), which extended EMTALA beyond any prior decision. This decision used EMTALA to control the sensitive medical and ethical issues surrounding an infant with anencephaly, a congenital birth defect. The Baby K court's interpretation of EMTALA forced a Virginia hospital to stabilize the infant's recurrent respiratory distress even though the hospital considered the treatment medically and ethically inappropriate. The Fourth Circuit's decision established a troubling precedent because the Act was not designed to determine such specific treatment issues. Notwithstanding the Act's clearly defined goal of improving access for indigent patients, the court transformed EMTALA into an expansive remedy for plaintiffs in search of medical treatment. Consequently, this Note encourages Congress to amend the Act's language to Pnsure that EMTALA addresses the dumping of indigent and uninsured patients without controlling medical situations unforeseen by Congress. Amending EMTALA will help the federal courts remedy instances of economic discrimination against indigent and uninsured patients without encroaching upon federal laws better designed to control other types of discrimination.

Part II of this Note traces the history of EMTALA's enactment and implementation to investigate the legislative intent supporting the Act. Part III examines the federal courts' inconsistent application of the Act and encourages the circuits that have not interpreted EMTALA to adopt an approach that follows the legislative intent more closely. Part IV discusses the Fourth Circuit's extension of EMTALA in Baby K, illustrating how a broad application of the Act's current language controls medical treatment decisions beyond the Act's antidumping purpose. Part V presents some of the troubling ethical and legal ramifications of Baby K and argues that the Fourth Circuit's opinion extended EMTALA's protections into areas better governed by federal laws such as the Rehabilitation Act, the Americans with Disabilities Act ("ADA")," and the Child Abuse Amendments of 1984. To address these ramifications, Part VI proposes an amendment to EMTALA that will remove the inconsistency between the Act's anti-dumping purpose and its broad statutory language.