Can You Sue a Hospital for Denying Medical Treatment?

We spend a lot of time in this blog talking about when medical treatment constitutes medical malpractice. But what about when a patient is denied treatment altogether? Is a refusal to treat a patient ever considered medical malpractice, and can you sue a hospital for denying you medical treatment?

The answer is “maybe.” One of the elements of a medical malpractice claim is the existence of a duty between the medical provider and the patient. If there is no duty of care, there can be no medical malpractice. So, let’s look at when a duty of care exists between a hospital and a person seeking treatment.

When Must a Hospital Provide Treatment?

Imagine that you don’t have a lot of money, and you don’t have any medical insurance. Then imagine that you suffer a sudden and severe illness or injury, like a stroke or a car accident. You’re clearly in need of urgent medical treatment, and in fact might die without it. Can you imagine hospital staff coming out to the ambulance bay of the emergency department and telling the paramedics not to bother bringing you in?

If that scenario seems wildly improbable to you, you can thank a federal law called the Emergency Medical Treatment and Active Labor Act—EMTALA for short. Prior to EMTALA’s enactment in 1986, hospitals routinely turned away patients who needed treatment—especially those who seemed unlikely to be able to pay.

Private hospitals often “dumped” poor patients or those without insurance on public hospitals, which often meant they waited longer for treatment or received less thorough evaluation or treatment due to overcrowding or understaffing at those hospitals. Unsurprisingly, many patients died or experienced worse medical outcomes as a result of this practice.

EMTALA was signed into law to end the process of patient dumping. The law requires private hospitals with dedicated Emergency Departments that receive Medicare funds to provide patients in need, including women in labor, with emergency care regardless of their ability to pay for that care.

In most situations, however, when a person goes to a hospital that has an emergency department, the hospital has a legal duty to provide treatment. A hospital that breaches that duty by refusing to provide a patient with appropriate emergency care could be liable for medical malpractice.

What Does it Mean to Provide Treatment?

If you go to a hospital with an emergency department, the hospital cannot turn you away or “dump” you on another care provider. But what exactly must it do?

A hospital that is subject to EMTALA must give you an appropriate medical screening to determine if you do, in fact, have an “emergency medical condition.” Examples would be symptoms of a heart attack or stroke, inability to breathe, a broken arm or leg, a severe allergic reaction—anything that would make a reasonable person think, “I’d better seek help immediately.”

Part of an appropriate medical screening involves triage, a preliminary evaluation to determine how urgent the need for treatment is. If you arrive at the emergency department with a broken arm and someone comes in later with symptoms of a heart attack, they will see a doctor first (and they should).

After you are triaged, you may have to wait a while to be examined, perhaps several hours. Having to wait for evaluation and treatment is not the same as being refused treatment. If, after evaluation, you are found to have an emergency medical condition, the hospital must do one of two things: treat you until you are medically stable, or if it lacks the capability to do so, transfer you to a facility that can stabilize you.

For instance, a small rural hospital may lack the capability to stabilize someone who has been in a severe accident and needs care available at a trauma center. In that case, the hospital would need to inform the patient of the risks of transfer, and a doctor would have to certify that the benefits of transfer outweigh the potential risks. The receiving hospital would have to agree to accept the patient, and the transferring hospital would have to take measures to maximize the patient’s safety during the transfer.

When Can a Hospital Deny Treatment?

There are some circumstances in which a hospital can refuse treatment to a patient who comes in seeking care. They include:

• When the patient is determined not to have an emergency medical condition
• When the patient is seeking non-emergent care, like a prescription refill or an elective medical procedure, and there is no emergency medical condition
• When the patient refuses to consent to a medical screening examination that would determine whether there is an emergency medical condition
• When a medical screening examination indicates that there is an emergency medical condition, but the patient refuses the recommended treatment, even after hospital staff have made reasonable efforts to explain the risks and benefits of treatment
• When there is no medical necessity for treatment, such as if a patient comes into the ED seeking pain medication, but there are no clinical signs of pain or injury
• When a patient is engaging in violent or disruptive behavior
• Very rarely, if a hospital’s emergency department is at capacity (such as after a mass casualty event), it may be able to divert incoming patients to other area hospitals in accordance with local protocols

Unwarranted denials of treatment don’t happen nearly as often as they did in the days before EMTALA, but they do still occur. If you went to a hospital emergency department and you were denied an evaluation or treatment, you may have a claim for medical malpractice if none of the situations above apply. To learn more, or to discuss your situation, contact the Fraser Law Firm to schedule a consultation.