On April 15, 2009, the United States District Court for the District of New Jersey, in Gonzalez v. Choudhary (2009 U.S. Dist. LEXIS 32342 (D.N.J. 2009)), expanded the boundaries of discovery under the particular circumstances of a pending Emergency Medical Treatment and Labor Act (EMTALA) case by ordering the South Jersey Healthcare Regional Medical Center (the hospital) to produce the medical records of other hospital patients similarly situated to the plaintiff in the Gonzalez case, as potentially relevant to her claim for alleged disparate treatment in the emergency room at the hospital.
EMTALA provides as follows with respect to a medical screening:
In the case of a hospital that has a hospital emergency department, if any individual (whether or not eligible for benefits under this subchapter) comes to the emergency department and a request is made on the individual’s behalf for examination or treatment for a medical condition, the hospital must provide for an appropriate medical screening examination within the capability of the hospital’s emergency department, including ancillary services routinely available to the emergency department, to determine whether or not an emergency medical condition (within the meaning of subsection (e)(1) of this section) exists.
42 U.S.C. §1395dd(e).
Grisselle Gonzalez alleged that the hospital violated EMTALA by failing to provide her with an appropriate medical examination during her emergency room visit because of her "lack of insurance, indigency, appearance, race, gender and/or age," and argued that discovery of other patients’ records would provide her with the only means of ascertaining the hospital’s standard screening procedures for purposes of proving that she received disparate treatment. Because the hospital did not have a specific written policy for screening patients with chest pain, the court held that the emergency room records of similarly situated patients, i.e., patients who presented with the chief complaint of chest pain within a two-week period prior to the plaintiff’s treatment, were relevant to Gonzalez’s EMTALA claim and subject to discovery.
The effect of this decision must be viewed in the context of the facts presented by the case: Gonzalez visited the hospital’s emergency room complaining of chest pain and shortness of breath. After examining Gonzalez, a staff physician diagnosed her with extra-pyramidal symptoms and dystonia, but allegedly failed to provide her with "adequate cardiac testing" or "supplemental oxygen, nitroglycerine, or aspirin" prior to her hospital discharge. Feeling that her symptoms had not dissipated, Gonzalez returned to the emergency room two days later and suffered cardiac arrest while waiting to be seen.
In her ensuing lawsuit against the hospital for negligence and alleged violation of EMTALA, Gonzalez filed a motion to compel the production of redacted medical records for patients who had presented to the hospital’s emergency room with similar complaints during the same general time period as her visit. In deciding Gonzalez’s motion to compel, the court noted that a "key requirement" of a hospital’s duty under EMTALA is to screen all emergency room patients uniformly, "regardless of whether they are insured or can pay." The court stated that a plaintiff can potentially meet the burden of proving non-compliance with that duty through "sources other than the express standard policies" of the defendant.
The court found that the medical records of other patients presenting at the hospital’s emergency room with similar symptoms could, potentially, be probative of Gonzalez’s claim that she was not given equal and appropriate screening during her visit. In granting Gonzales’ motion, the court also rejected the hospital’s argument that there was no need to produce other patients’ records because it had already produced its general written policies for screening patients in prior discovery. The court held that "in the absence of documents setting forth particular screening procedure for patients complaining of chest pain," Gonzales was entitled to discovery of other patients’ records to determine whether the screening she received was different than what the hospital provided to others.
The Gonzalez decision cannot be read as meaning that the records of non-parties will be discoverable in any EMTALA case where disparate emergency room treatment is being claimed. It is clear, however, that not having a written, symptom-specific policy for screening emergency room patients can open the door to court-mandated production of other patients’ records in an EMTALA case. To avoid such problematic discovery obligations, hospitals should be sure to maintain policies delineating symptom-specific screening procedures for emergency room treatment. Maintenance of such written policies will not only minimize the risk of being compelled to produce other patients’ medical records as occurred in the Gonzalez case, but may also protect against the risk of a negligence claim for not having such a policy in place for proper emergency room care.
Jonathan M. Preziosi and Ryan Hart
Written by
Ryan Hart
Ms. Hart is a 2009 summer associate in Pepper’s Princeton office, and is not admitted to practice.
The material in this publication is based on laws, court decisions, administrative rulings and congressional materials, and should not be construed as legal advice or legal opinions on specific facts. The information in this publication is not intended to create, and the transmission and receipt of it does not constitute, a lawyer-client relationship.
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