EMTALA. You may have noticed at the beginning of the case that the Harry v Marchant opinion at 291 F.3d 767 is an en banc opinion (an opinion issued by the full appellate court – in this case the 11th Circuit Court of Appeals – and not by a panel of three judges), issued upon the full court granting rehearing. The original panel opinion is found at 237 F.3d 1315 and you should read that also, since the portion of that opinion explaining “appropriate medical screening” [§1395dd(a)] was reinstated in the en banc opinion, (as was the portion reversing the trial court’s dismissal of the §1981 claim). [original panel opinion prior to en banc opinion is posted, with the unadopted language shown in red]
The en banc opinion in Harry v Marchant explains:
“In 1986, Congress enacted EMTALA in response to widely publicized reports of emergency care providers transferring indigent patients from one hospital to the next while the patients’ emergency medical conditions worsened. EMTALA was designed specifically to address this important societal concern; it was not intended to be a federal malpractice statute.”
The en banc opinion further explains:
“The statute is logically structured to set forth two options for transferring a patient with an emergency medical condition: a hospital must either provide stabilization treatment prior to transferring a patient pursuant to subsection (A), or, pursuant to subsection (B), provide no treatment and transfer according to one of the statutorily recognized exceptions. Hence, the stabilization requirement only sets forth standards for transferring a patient in either a stabilized or unstabilized condition. By its own terms, the statute does not set forth guidelines for the care and treatment of patients who are not transferred. . . . Construing EMTALA to mandate stabilization treatment irrespective of a transfer renders the words “during the transfer,” contained in the statutory definition of the term “to stabilize,” superfluous. To give effect to the clear language of the statute, we must conclude the triggering mechanism for stabilization treatment under EMTALA is transfer.”
The en banc opinion concludes:
“There is no duty under EMTALA to provide stabilization treatment to a patient with an emergency medical condition who is not transferred. Because Normil was not transferred, Appellant’s § 1395dd(b) stabilization requirement claim fails to state a valid cause of action. In so holding, we recognize Appellant is not without recourse. Remedies provided by state malpractice and tort law remain available to redress negligent patient care by hospitals. Accordingly, the judgment of the district court is affirmed with respect to the dismissal of the EMTALA claims (§§ 1395dd(a) and (b)), and reversed, in accordance with the panel opinion, with respect to the dismissal of Appellant’s § 1981 claim.”
“FN15. We reinstate the panel opinion except for Part 1.B., which discusses EMTALA’s stabilization requirement.”
1. Do you think the Circuit Court of Appeals was correct in limiting the stabilization requirement in EMTALA to patients who are in fact transferred, leaving any remedy for negligent patient care by hospitals to state malpractice and tort law? Why or why not?
2. Please comment on the propriety, desirability, workability, and ethics of the exceptions to patient stabilization before an appropriate hospital transfer in §1395dd(c)(1)(A), those exceptions being paraphrased here as:
(i) An informed written request for transfer by the patient or legally responsible representative;
(ii) a physician’s signed certification that at the time of transfer, the medical benefits reasonably expected from receiving appropriate medical treatment at another medical facility outweigh the increased risks to the patient, and, in the case of labor, to the unborn child from effecting the transfer;
(iii) when if a physician is not physically present in the emergency department at the time a patient is transferred, a qualified medical person has signed a certification as described in (ii) above, after a physician, in consultation with that person, has made the determination and subsequently countersigns the certification.
3. Please comment on the enforcement provisions in §1395(d)(1) and (d)(2). Are they reasonable? Are they an effective deterrent for future violations or only punishment for past violations? Why or why not?
ADA. Americans with Disabilities Act of 1990, 42 U.S.C. §12101 et seq. Discuss your views on PGA Tour, Inc. v. Martin, and share any examples of which you are aware where an accommodation under the ADA either was or was not made — without providing any identifying information of any parties, of course – and explain how that decision was either consistent with or not consistent with the holding of PGA Tour, Inc. v. Martin , the law of the land.
Writing for the majority, Justice Stevens concludes first, that Martin, a professional golfer, is a “client or customer” of the PGA, and thereby protected by the ADA. Stevens notes that the ADA specifically includes a “golf course” as one of the places of “public accommodation” covered by the Act. In dissent, Justice Scalia opines that Martin is no more a “customer” of the PGA than a professional baseball player is a customer of the American League or the Yankees. Scalia feels that professional baseball players and professional golfers are not “customers.” Rather, “[t]hey are themselves the entertainment that the customers pay to watch.” Scalia states that Martin wasn’t a customer buying recreation or entertainment; he was a professional athlete selling it.
Second, the majority opinion concluded that allowing Martin to use a golf cart, despite the walking requirement of the PGA tour, was not a modification that would “fundamentally alter the nature” of the golf tournament. Of this conclusion, the majority states “we have no doubt.” The majority believes use of a cart does not alter an essential aspect of the game of golf, such as changing the diameter of the hole. Further, the majority does not believe that allowing Martin the use of a cart provides him with an advantage over others that would fundamentally alter the character of the competition. Even if the purpose of the walking rule is to subject golfers to fatigue, the majority notes the District Court finding that Martin easily endures greater fatigue even with the use of a cart than other competitors do by walking. In dissent, Scalia mocks the determination by the majority that the accommodation of a cart does not fundamentally alter the nature of the golf game, even the decision to made any such determination. He states, “[e]ither out of humility or out of self-respect (one or the other) the Court should decline to answer this incredibly difficult and incredibly silly question.” Scalia doesn’t opine on whether the PGA tour ought to allow Martin to use a cart, he calls that a close question. He says he just feels the Court’s judgment in the issue before the Court is wrong, even Kafkaesque, although decent, tolerant, progressive, benevolent, and compassionate. I urge you to read this very interesting and important case, including the dissent, with a view on how it has affected and will continue to affect our society.
Do you think the Supreme Court opinion was correct or not, and why? Writing for the majority, Justice Stevens spent a great deal of time describing the seriousness of Martin’s disability. How do you think the seriousness of Martin’s disability factored into the decision? The majority states, “Martin’s claim thus differs from one that might be asserted by players with less serious afflictions that make walking the course uncomfortable or difficult, but not beyond their capacity. In such cases, an accommodation might be reasonable but not necessary.”
It would be most helpful if you don’t only state your conclusions to the prompts in these discussion posts, but also share your analysis and reasoning. Sharing the basis for your conclusions is the best way to educate and persuade your classmates.
