North Carolina Trial Law Blog

NC House Bill 542 the Omibus "Tort Reform" Bill, has a provision that on its face seems to give immunity to "Emergency Rooms" for negligence.  But the Bill is very subtle in the way it defines "emergency."  This information was brought to my attention by a lawyer who used to be a Hospital Administrator and know how EMTALA works.  The drafters of the Bill used legal "slight of hand" to also make the Bill give complete immunity from negligence to any Doctor, nurse, or Hospital delivering a baby under anything than scheduled visit.

Here is the language from the proposed law:

In any medical malpractice action arising out of the furnishing or the failure to furnish services pursuant to obligations imposed by 42 U.S.C. § 1395dd for an emergency medical condition as defined in 42 U.S.C. § 1395dd(e)(1), the defendant health care provider  shall not be liable for the payment of damages unless the trier of fact finds by the greater weight of the evidence that the health care provider's deviation from the standard of care required under subsection (a) of this section constituted gross negligence, wanton conduct, or  intentional wrongdoing. Nothing in this subsection shall be construed to change, alter, override,  or otherwise affect the provisions of G.S. 90-21.14, 90-21.15, 90-21.16, or 20-166."

42 U.S.C. § 1395dd is EMTALA , the Emergency Medical Treatment and Active Labor Act, and it says:

(b) Necessary stabilizing treatment for emergency medical conditions and labor (1) In general

If any individual (whether or not eligible for benefits under this subchapter) comes to a hospital and the hospital determines that the individual has an emergency medical condition, the hospital must provide either—

(A) within the staff and facilities available at the hospital, for such further medical examination and such treatment as may be required to stabilize the medical condition, or

(B) for transfer of the individual to another medical facility in accordance with subsection (c) of this section.

 

(e) Definitions

In this section:

(1) The term “emergency medical condition” means—

(A) a medical condition manifesting itself by acute symptoms of sufficient severity (including severe pain) such that the absence of immediate medical attention could reasonably be expected to result in—

(i) placing the health of the individual (or, with respect to a pregnant woman, the health of the woman or her unborn child) in serious jeopardy,

(ii) serious impairment to bodily functions, or

(iii) serious dysfunction of any bodily organ or part; or

(B) with respect to a pregnant woman who is having contractions—

(i) that there is inadequate time to effect a safe transfer to another hospital before delivery, or

(ii) that transfer may pose a threat to the health or safety of the woman or the unborn child.

Legal Slight of Hand

It certainly looks like the lobbyists for the medical community knew exactly what they were doing when they crafted this portion of the proposed law.  The EMTALA definition is a little bit "loosey goosey" (mostly because it was intended as a way to be broad and make sure hospitals did not "dump" people who were uninsured in the middle of giving birth).

Because of this broad definition of emergency, and because our statute integrates that definition, most people undergoing any serious treatment in a hospital:  delivering a baby, having a heart attack, bleeding profusely, etc, will be defined by EMTALA as being "in an Emergency" and thus, ANYONE treating them will have IMMUNITY.

I think the legal inquiry will be:

"When the alleged negligence took place, could the patient have been transferred to another facility pursuant to EMTALA?" 

If yes--->  no immunity
If no ---->  Emergency under EMTALA = Immunity

Do you want just about every Obstetrician to have immunity if they make an error?

Also, because this "definitional slight of hand" is not as obvious as saying "doctors delivering babies have immunity" will the Medical Malpractice Insurance Companies use this "gray area" to say "Well, the Legislature didn't give you outright immunity, so we can't lower the insurance rates of OBGYNs because we don't actually know if the immunity applies.  We'd have to look at it on a case by case basis."?

Bingo!  The doctors will raise an "EMTALA Immunity Defense" in EVERY case, creating a cottage industry for Insurance Defense Lawyers to bill hundreds of thousands of dollars, the Medical Malpractice Carriers will continue to charge too much money to the Doctors while enjoying the "Immunity Defense" that will probably kill most claims, and the babies who are born maimed or injured or die- well, they will have no right to a jury trial.

Please contact a member of the Committee and voice your opinion on HB 542.  Say no to IMMUNITY!

NC House Select Commitee on Tort Reform Contact Information