Doctors Hosp. of Augusta v. Dep’t of Health and Hosp. (Summary)

EMTALA

Doctors Hosp. of Augusta v. Dep’t of Health and Hosp., No. 2013 CA 1762 (La. Ct. App. Sept. 17, 2014)

The Court of Appeal of Louisiana reversed the Louisiana Department of Health and Hospitals’ (“DHH”) determination that DHH does not have to reimburse Doctors Hospital, an out-of-state hospital, for the treatment the hospital rendered. The court held that the availability of comparable medical care in Louisiana is not a bar to an out-of-state hospital’s Louisiana Medicaid reimbursement, and doing so would contradict the Emergency Medical Treatment and Active Labor Act (“EMTALA”).

Doctors Hospital, located in Georgia, has a renowned burn unit. It was contacted by a Louisiana hospital, East Jefferson General Hospital (“East Jefferson”), to treat an emergency room patient who suffered second and third degree burns to 40% of her body. Neither hospital inquired into who the patient’s payor was. The patient was life-flighted to Doctors Hospital, where the patient received inpatient treatment for three months.

The patient was a Louisiana Medicaid recipient.   After the patient’s discharge, Doctors Hospital submitted a claim to Medicaid of Louisiana, which was ultimately denied. DHH rejected the claim on the grounds that the needed treatment was possibly available in Louisiana at two other hospitals, so that the patient did not necessarily have to be treated at Doctors Hospital, an out-of-state hospital. Additionally, DHH determined that, as the patient’s air ambulance transfer took three hours, this showed that the patient was not in an emergency medical condition.

The court found that DHH’s conclusions were arbitrary and capricious. First, the court stated that DHH disregarded the “overwhelming and undisputed evidence” that the patient suffered from an emergency medical condition. Next, the court found that under Louisiana law DHH had wrongly decided that an out-of-state hospital was barred from payment because the services were potentially available in the state. Furthermore, DHH never offered evidence that there was actually an available bed at an in-state burn unit. Lastly, the court pointed out that DHH’s interpretation contradicted EMTALA because it would require a participating hospital with specialized facilities to refuse acceptance of an appropriately transferred patient who requires such specialized care.