Medical malpractices are a large number of lawsuits stem from misdiagnosed or delayed diagnosis of a medial condition, illness, or injury. The purpose of this study was to investigate and examine the medical malpractice of the Jackson V. East Bay Hospital case trial. The appeal is whether the hospital violated the Emergency Medical Treatment and Active Labor Act. Also, if it fails to diagnose the cause of a patient’s emergency condition, but treats the symptoms identified, and concludes that the patient has been stabilized. The district court properly concluded that Adventist could not be held liable as a participant in either a joint venture or a joint enterprise. One can certainly refuse to render emergency services or care to a patient on the ground that one finds the patient to be suffering from no medical condition at all, emergency or non-emergency.
Psychosis is a familiar syndrome which affects approximately five percent of the population at one point in their lifetime. Emergency room doctors have undiagnosed psychiatric conditions like psychosis or bipolar disorders. The emergency room physicians are presented with many claims and highlight the importance of determining the onset of psychiatric disorders. Jackson v. East Bay Hospital is a case that violated the federal and states Emergency Medical Treatment and Labor Act (EMATLA) laws with state negligence claims. The family of Mr. Jackson accused the hospital for misdiagnosing and the company that gave financial services. Mr. Jackson traveled to the emergency room over the course of three days. Each day he was diagnosed with psychiatric problems. The physicians from the emergency room did not uncover any medical emergency, so they referred him to a local psychiatric facility for follow-up care (O’SCANNLAIN, n.d.). Mr. Jackson died while being transported to the Lake County psychiatry facility. Mr. Jackson died by Anafranil toxicity. Anafranil is a mediation that was used to treat his psychosis that leads to his cardiac arrest. The claim from Mr. Jackson’s family was upheld by the ninth circuit. The finding stated since the emergency room physicians performed the medical exams with the decedent’s symptoms received, the medical screening examinations were satisfied under the Emergency Medical Treatment and Labor Act. The California court statues formed a consistent standard of care. But the specification only applies if the hospital did not provide screening and or examination to verify if the patient had a medical emergency condition. To also include a decline in treating the patient. In this case, the emergency department did not detect any medical emergence to his condition, so the standards did not apply. The ninth circuit stated and agreed that the hospital and the company that maintained their administrative and financial services were not susceptible to any negligence on behalf of the hospital.
Mr. Jackson was diagnosed with psychotic disorders and borderline intellectual functions and pedophilia; while he was at the lake county mental health department. In April 2nd, 1996, the Lake County staff send Mr. Jackson to the redbud emergency room for medical clearance to return to the faciality. At Lake County he was diagnosed with psychotic disorder, borderline intellectual functioning and pedophilia (Kent, 2001). At the first emergency room visit, the first physician examined Mr. Jackson and notices the he was hallucinating, and he was dizzy, plus unsteady. At the time he was taking Anafranil and Ativan. Dr. Schug ended up diagnosing Mr. Jackson as suffering from an acute psychosis. As opposed to psychological or psychiatric condition (“Casetext- Jackson V. East Bay,” n.d.). The written policy for redbud hospital with patients that present with emergency condition such as psychiatric complaints would have to be fully examined to determine if there are any components to the problems (O’SCANNLAIN, n.d.). Redbud hospital did not offer any psychiatric care to Mr. Jackson at the time of his visit to the emergency room. If a medical problem was found, then that problem would take precedence over the psychiatrist complaint. Since no medical problem was found, Dr. schug arranged for Mr. Jackson to be evaluated by the Lack County staff since they provide psychiatric care.
April 4th My Jackson returned to Redbud emergency room and the triage nurse examined Mr. Jackson by taking his medical history, vital signs, and current conditions. Dr. Ollada an emergency room doctor, did another medical history and evaluation on Mr. Jackson. At the time, Mr. Jackson was complaining of a sore throat, chest pains while breathing, and dry heaves. While Dr. Ollada was examining Mr. Jackson, he observed that he was talking to himself and Dr. Ollada ordered a complete physical exam with a battery of tests to include an electrocardiogram (“Casetext- Jackson V. East Bay,” n.d.). Also, a urine screening and a blood gas test was ordered by Dr. Ollada. The urine screen came back and indicated the presents of tricyclic antidepressants (“Casetext- Jackson V. East Bay,” n.d.). Which was known for Mr. Jackson to be taking Anafranil. Dr. Ollada diagnosed Mr. Jackson with having chest contusion, hypertension, and psychosis, and not having a drug toxicity. The provider referred Mr. Jackson to Lake County and gave him some medication. Lake county believed that he was non-suicidal, and his condition was stable which meant that he did not need any mental health services. Dr. Ollada discharged Mr. Jackson from the hospital and advised to his wife to take him to Lake County the next day.
Mr. Jackson returned to redbud hospital the next day April 5th. The charged nurse preformed the initial vital signs and the medical examination. Dr. Ollada the doctor that examined Mr. Jackson two days ago, conducted another examination. While observing Mr. Jackson seemed agitated but had a regular heartbeat with no other physical symptoms. Mrs. Jackson advised Dr. Ollada that she thought Mr. Jackson was suicidal due to her finding him in the middle of the street waving his hands (O’SCANNLAIN, n.d.). Dr. Ollada diagnosed Mr. Jackson with having a psychological disorder that caused him to become agitated. He was not suffering from any physical disorder so Dr. Ollada prescribed and administered Haldol and Benadryl to try and stabilize Mr. Jackson. Dr. Ollada contacted Lake county regarding his condition and that morning he was evaluated, and he met the criteria for involuntary psychiatric commitment. The crisis worker conclude that he was suffering from a psychological disorder with anxiety and a dependent personality. Mr. Jackson go cleared by Dr. Ollada to be transferred to East Bay Hospital since his condition had been stabilized since he was not agitated and was not suffering from any life-threatening condition. At around 9:00 am Mr. Jackson was evaluated by an East Bay doctor. Dr. spencer preformed a psychiatric evaluation but not a physical exam. At the time his condition was stabilized but Dr. Steele gave Mr. Jackson another douse of Haldol. Shortly after he became unstable and was unable to control his movements and posed a threat to himself and others (Good, 2014). Mr. Jackson went under cardiac arrest around 2:00pm and East Bay staff began to preform CPR and orders an ambulance to transfer Mr. Jackson to Brookside Hospital. At the arrival at brookside he was pronounce dead. The autopsy determined the cause of death to be a sudden cardiac arrythmia. That was caused by an acute psychotic delirium which was caused by Anafranil toxicity (Good, 2014). None of the nurses nor doctored that Mr. Jackson saw over the past three days diagnosed him to be having a drug toxicity.
Mr. Jackson family files a lawsuit against the physicians who treated him. The claim was filed under the Emergency Medical Treatment and Labor Act (EMTALA), California Health and safety Code and the California state tort law. The district court reviewed the claim and stated that the argument between redbud and the hospital was not liable to Mr. Jacksons claim. The district dismissed the claims and the toiled the statute of limitations so that the family of Mr. Jackson would be able to refill in state court (Good, 2014). The Emergency Medical Treatment and Labor Act was imposed to the hospitals on the obligation to treat patients without medical insurance (Conder, 2009). First the hospital must provide an appropriate medical screening examination within the hospital’s capability. The examination would determine if it is an emergency or not. If an emergency is detected, then the hospital must treat the patients within the scope of the hospital or transfer the patient to another facility (O’SCANNLAIN, n.d.). If an individual at a hospital has an emergency medical condition which has not been stabilized. The hospital may not transfer the individual unless a physician has signed certification based upon the information available at the time of transfer, the medical benefits reasonably expected from the provision of appropriate medical treatment at another medical facility outweigh the increased risks to the individual (Conder, 2009). The decision revolves around whether the Code of Civil Procedures are applicable on the pendent state claim in federal court.
In order to resolve the case, it is necessary to determine under what law the punitive damages fall under. In Mrs. Jackson complain, she allocated nine counts on which relief was requested. Counts one, two, and four seek compensation damages for wrongful death under the EMATALA and the state law cause of action (Kent, 2001). Counts five, eight and nine request injunctive relief and are not relevant to the present discussion. Count three claimed that Mr. Jackson suffered personal injuries and special damages based on the strict liability and medical negligence that caused his death. East Bay at a certain point filed a claim to overturn counts one, two and four. Since those counts relayed to section 37.61 on the punitive damages in wrongful death action (Kent, 2001). The strict liability cause of action was brought against East Bay and Adventist under the EMTALA and health and Safety Code section 1317. However, the medical negligence claim was brought to all the partied involved in Mr. Jacksons Death.
The court agreed with Mrs. Jackson claim on the California statues stating reasonable standards of care are for medical examination but only applied when hospitals provide a screening or an exam to determine if the patient had a medical emergency. In Mr. Jacksons case, the hospital provided an exam but failed to detect a medical emergency, so the standard did not apply (Kent, 2001) . The parties agree that Dr. Ollada had stabilized Mr. Jackson’s condition at the time of his transfer to East Bay, and that he believed that Jackson was no longer agitated. The parties’ disagreement concerns medical conditions which remained undetected by the East Bay hospital medical staff. In the Ninth circuit the hospital and the company that provided financial support did not have any control over the patients care or hospital operations. Therefore, they are not held liable for any negligence on behalf of the hospital.
Conclusion
The court had to first issue the extent of the damages that where applicable under the Emergency Medical Treatment and Labor Act in personal injury claims. The court agreed that the hospital had stabilized the agitation at the emergency room, which was the only medical emergency symptom that was present at the time of the visit. The court rejecting that notion since Mr. Jackson did not pose a risk to himself or others. Since East Bay Hospital did not diagnose the Anafranil toxicity they were not liable to stabilize that condition (EMTALA Update ,2001). The only physical symptom that he had was altered vital signs, increase respiratory rate. Hypertension, and chest contusions. The court also noted that those where not medical emergency symptoms. The Emergency Medical Treatment and Labor Act applies only when a doctor has diagnosed a condition and declines to provide treatment EMTALA Update ,2001). Then the doctor determines if the condition is a medical condition. If the hospital cannot treat to condition due to not having the appropriate facility or personal to provide care, then the doctor can get safe harbor. If the doctor provides reasonable care and fails to diagnose any condition, then the safe harbor dose not apply. The court agreed that the nurses and doctors at Redbud hospital performed the screening within the guidelines of the hospital. In Mr. Jacksons case the interpretation is that there was no medical emergency symptom and no principle of statutory construction supported the notion and concluded that there is no reason to believe that the California Legislature would draw such a distinction.
At the emergency room, physician often provide medical clearance to psychiatric or combative patients. I believe that in diagnosing a patient that the information obtained from the patient’s history and physical examination would also be a contribution in addition to the standardized panel of laboratory and radiology for patients with psychiatric symptoms. The interpretation of the whole case was If the hospital dose not diagnose an emergency condition, then the hospital cannot refuse to render emergency care if the condition was not detected. The negative implication that the facility failed to exercise reasonable care to diagnose the medical emergency should be liable for any wrongdoing. In the Jackson v. East Bay Hospital case the appropriate medical screening requirement did not necessary mean that it was the correct diagnosis as long as the procedure screening where applied. Meaning that this claim is not covered under the Emergency Medical Treatment and Labor Act, but I believe that it can still be considered to be a negligence claim. Due to the doctors not fully examining the patient and not doing a complete workup. The doctor should have reviewed Mr. Jacksons medical records and should have known what he was taking. By doing this he would have known that he was intoxicated. Then the patient would have been observed till Mr. Jackson reached a point where a psychiatric therapeutic interview would have been conducted. The consideration of a workup should have been the concern of the psychiatrist who would have evaluated Mr. Jackson. I believe that a diagnostic study should be guided by the information obtained from the history and the physical examination. Even though some providers would order the standardized panel of labs and radiographic studies. By looking up some of the Emergency Medical Treatment and labor act past rulings. Seems that the acts where in favor of the federal government. By reviewing all the related policies and procedures would ensure that the legal and regulatory requirements are addressed adequately. Also. By identifying the parts of the Emergency Medical Treatment and Labor Act that are not clear to make it vulnerable for private cause of action.
References
- Casetext- Jackson V. East Bay. (n.d.). Retrieved September 26, 2019, from https://casetext.com/case/jackson-v-east-bay-hosp
- Conder, J. C. (2009, May 3). Lessons Learned from EMTALA Enforcement. Retrieved September 29, 2019, from https://compliance.com/wp-content/uploads/2014/11/lessonslearnedfromemtalaenforcement.pdf
- EMTALA Update 2001: Guidelines, developments, and recent court opinions | 2001-11-01 | AHC Media: Continuing Medical Education Publishing. (2001, November 1). Retrieved September 20, 2019, from https://www.reliasmedia.com/articles/30135-emtala-update-2001-guidelines-developments-and-recent-court-opinions
- Good, B. G. (2014, May 1). Assessment of the Acute Psychiatric Patient in the Emergency Department: Legal Cases and Caveats. Retrieved September 29, 2019, from https://www.ncbi.nlm.nih.gov/pmc/articles/PMC4025529/
- Kent, T. (2001, Autumn 4). Jackson v. East Bay Hospital. Retrieved September 27, 2019, from https://www.morelaw.com/verdicts/case.asp?n=98-17152
- O’SCANNLAIN, s. (n.d.). FindLaw’s United States Ninth Circuit case and opinions. Retrieved September 28, 2019, from https://caselaw.findlaw.com/us-9th-circuit/1375113.html