EMTALA and patients with psychiatric emergencies: a review of relevant case law.
OBJECTIVE
Emergency department (ED) care for patients with psychiatric complaints has become increasingly challenging given recent nationwide declines in available inpatient psychiatric beds. This creates pressure to manage psychiatric patients in the ED or as outpatients and may place providers and institutions at risk for liability under the Emergency Medical Treatment and Labor Act (EMTALA). We describe the patient characteristics, disposition, and legal outcomes of EMTALA cases involving patients with psychiatric complaints.


METHODS
Jury verdicts, settlements, and other litigation involving alleged EMTALA violations related to psychiatric patients between the law's enactment in 1986 and the end of 2012 were collected from 3 legal databases (Westlaw, Lexis, and Bloomberg Law). Details about the patient characteristics, disposition, and reasons for litigation were independently abstracted by 2 trained reviewers onto a standardized data form.


RESULTS
Thirty-three relevant cases were identified. Two cases were decided in favor of the plaintiffs, 4 cases were settled, 10 cases had an unknown outcome, and 17 were decided in favor of the defendant institutions. Most patients in these 33 cases were men, had past psychiatric diagnoses, were not evaluated by a psychiatrist, and eventually committed or attempted suicide. The most frequently successful defense used by institutions was to demonstrate that their providers used a standard screening examination and did not detect an emergency medical condition that required stabilization.


CONCLUSIONS
Lawsuits involving alleged EMTALA violations in the care of ED patients with psychiatric complaints are uncommon and rarely successful.
Mayo Medical School, Mayo Clinic College of Medicine, Rochester, MN.
Rachel A
RA
Lindor
Department of Emergency Medicine, Mayo Clinic College of Medicine, Rochester, MN.
Ronna L
RL
Campbell
Departments of Emergency Medicine and Health Policy, George Washington University, Washington, DC.
Jesse M
JM
Pines
Department of Psychiatry and Psychology, Mayo Clinic College of Medicine, Rochester, MN.
Gabrielle J
GJ
Melin
Legal Department, Mayo Clinic College of Medicine, Rochester, MN.
Agnes M
AM
Schipper
Department of Emergency Medicine, Mayo Clinic College of Medicine, Rochester, MN.
Deepi G
DG
Goyal
Department of Emergency Medicine, Mayo Clinic College of Medicine, Rochester, MN. Electronic address: sadosty.annie@mayo.edu.
Annie T
AT
Sadosty
D000293:Adolescent; D000328:Adult; D004636:Emergency Service, Hospital / Q000331:legislation & jurisprudence*; D005260:Female; D006801:Humans; D016365:Liability, Legal; D008297:Male; D008318:Malpractice / Q000331:legislation & jurisprudence; D001523:Mental Disorders / Q000628:therapy*; D008875:Middle Aged; D014481:United States; D055815:Young Adult