Obtaining a Transfer
With her oxygen saturation holding in the 80s, the physician began the process to transfer her to a hospital with ICU capabilities. This process was unfortunately fraught with unnecessary delays. An emergency physician (Dr. H) at a regional medical center recommended that she be transferred to an academic center. The academic center was called, took down the patient’s information, and said they would call back, but 30 minutes later there was still no response. The doctor then tried a third hospital, and the cardiologist on-call declined the admission until the emergency physician consulted the patient’s outpatient cardiologist. The outpatient cardiologist worked at the first hospital that had been called, and he ultimately accepted the patient.
Explore This IssueACEP Now: Vol 39 – No 09 – September 2020
The patient departed the emergency department via helicopter with an oxygen saturation of approximately 80 percent. On arrival to the receiving hospital, her oxygen saturation was noted to be 40 percent. The anesthesia team was waiting for the patient at the bedside in the ICU, removed the King airway, and intubated the patient.
The patient’s status continued to decline. She sadly passed away five days after going into the emergency department, with the final diagnoses shown in Figure 2.
The patient’s family was understandably upset and contacted an attorney. The subsequent lawsuit is unusual and demonstrates an interesting legal twist emergency physicians should be aware of and understand. The lawsuit alleged an EMTALA violation by Dr. H, the emergency physician at the receiving hospital. He had originally recommended that the patient be transferred to a nearby academic medical center instead, but she ultimately was transferred to his facility after numerous phone calls. In addition to an alleged EMTALA violation, the lawsuit also alleged that he was negligent in his responsibility to the patient.
Dr. H was deposed (see Figure 3). He stated that he did not explicitly decline the transfer but that he was helping the sending physician brainstorm the best arrangement for the transfer.
Ultimately, Dr. H’s attorneys filed for summary judgment. The lawsuit was dismissed because EMTALA allows for legal action against hospitals but not against individual physicians. Further, the defense asserted that Dr. H could not be personally liable for negligence because he did not establish a relationship with the patient solely on the basis of taking a phone call about her possible transfer.