Gatewood v. Washington Healthcare Corp., 933 F.2d 1037 (D.C. Cir. 1991). · Go Syfert
Gatewood v. Washington Healthcare Corp., 933 F.2d 1037 (D.C. Cir. 1991). Cases Citing This Book View Copy Cite
Quick Summary

The Emergency Medical Treatment and Active Labor Act does not create a federal cause of action for medical malpractice or misdiagnosis, but only for failure to follow standard screening procedures.

A patient dies of a heart attack after being discharged from a hospital emergency room with a misdiagnosis of musculoskeletal pain. The plaintiff sues under the Emergency Medical Treatment and Active Labor Act, alleging the hospital failed to provide appropriate screening. The court addresses whether the Act applies to insured patients and whether it creates a federal cause of action for medical malpractice. The court holds that the Act applies to any individual, regardless of insurance status, but does not create a federal cause of action for negligence or misdiagnosis. Instead, the Act requires hospitals to follow their standard screening procedures. Because the plaintiff did not allege the hospital departed from its standard procedures, the federal claim fails, and the pendent state law claims are dismissed for lack of jurisdiction.

369 citation events (144 in the last 25 years) across 62 distinct courts.
Treatment trajectory · 1991 → 2026 · click a year to view as-of
1991 2008 2026
Cited for
933 F.2d at 1041 Determining trigger for stabilization and transfer provisions78 citing casesstabilization and transfer provisions "are triggered only after a hospital determines that an individual has an emergency medical condition6 citing courts put it this way · 66 listed here
  • Allen v. Clinton HMA LLC, No. 5:19-cv-00527 (W.D. Okla. Mar. 8, 2024).
    ([Q]uestions related to the adequacy of a hospital’s standard screening and diagnostic procedures must remain the exclusive province of local negligence law.)
  • Guzman ex rel. Guzman v. Mem'l Hermann Hosp. Sys., 637 F. Supp. 2d 464 (S.D. Tex. 2009).published 3 cites
    ([A]ny departure from standard screening procedures constitutes inappropriate screening in violation of the Emergency Act. The motive for such departure is not important to this analysis, which applies whenever and for…)
  • Godwin v. Mem'l Med. Ctr., 2001-NMCA-033, 25 P.3d 273.published 2 cites
    ([Plaintiffs] allegations of misdiagnosis, without more, are ... not cognizable .... Absent some allegation of differential treatment, no claim is stated under subsection 1395dd(a).)
  • Barris v. Cnty. of Los Angeles, 972 P.2d 966 (Cal. 1999).published 2 cites
    ([A] hospital fulfills the `appropriate medical screening' requirement when it conforms... its treatment of a particular patient to its standard screening procedures.)
  • Marshall ex rel. Marshall v. East Carroll Par. Hosp. Serv. Dist., 134 F.3d 319 (5th Cir. 1998).published 4 cites
    See Eberhardt, 62 *323 F.3d at 1258 (“The hospital’s failure to detect the decedent’s alleged suicidal tendency may be actionable under state medical malpractice law, but not under the EMTALA.”); Baber v. Hospital Corp. of America, 977 F.2…
  • Brodersen v. Sioux Valley Mem'l Hosp., 902 F. Supp. 931 (N.D. Iowa 1995).published 6 cites
    See Holcomb v. Monahan, 30 F.3d 116, 117 (11th Cir.1994) (“[N]o federal malpractice claims are created.”); Baber v. Hospital Corp. of Am., 977 F.2d 872 , 880 (4th Cir.1992) (EMTALA’s “purpose.... was not to guarantee that all patients are…
  • Repp v. Anadarko Mun. Hosp., 43 F.3d 519 (10th Cir. 1994).published 4 cites
    ([W]e cannot agree that [EMTALA] creates a sweeping federal cause of action with respect to what are traditional state-based claims of negligence or malpractice.)
  • Griffith v. Mt. Carmel Med. Ctr., 831 F. Supp. 1532 (D. Kan. 1993).published 4 cites
    ([Plaintiffs] allegations of misdiagnosis, without more, are simply not cognizable under the Emergency Act.... Absent some allegation of differential treatment, no claim is stated under subsection 1395dd(a).)
  • Castle v. St. Charles Med. Sys., Inc., No. 6:23-cv-01217 (D. Or. Mar. 19, 2025).
    EMTALA’s stabilization and transfer provisions are “triggered only after a hospital determines that an individual has an emergency medical condition.” Eberhardt, 62 F.3d at 1259 (quoting Gatewood v. Washington Healthcare Corp., 933 F.2d 10…
  • Norman Shaw, Jr. v. Wayne Mem'l Hosp., No. 24-1522 (3d Cir. Mar. 13, 2025).unpublished
    Instead, EMTALA claims generally focus on “disparate patient treatment.” See Torretti, 580 F.3d at 174 ; Gatewood v. Washington Healthcare Corp., 933 F.2d 1037, 1041 (D.C.
Show 56 more citing cases
933 F.2d at 1039 Determining appropriate screening under EMTALA standards34 citing cases[A]n ‘appropriate’ screening is properly determined not by reference to particular outcomes, but instead by reference to a hospital’s standard screening procedures.2 citing courts put it this way · 29 listed here
  • Marshall ex rel. Marshall v. East Carroll Par. Hosp. Serv. Dist., 134 F.3d 319 (5th Cir. 1998).published 4 cites
    (In the absence of any allegation that the [hospital] departed from its standard emergency room procedures in treating [patient], questions related to [patient’s] diagnosis remain the exclusive province of local neglige…)
  • Brodersen v. Sioux Valley Mem'l Hosp., 902 F. Supp. 931 (N.D. Iowa 1995).published 6 cites
    ([A]n ‘appropriate’ screening is properly determined not by reference to particular outcomes, but instead by reference to a hospital’s standard screening procedures.)
  • Johnson v. Bishof, 2015 IL App (1st) 131122.published 3 cites
    It was intended to address patient dumping and guarantee that all patients receive an adequate first response to a medical crisis and ensure that each is accorded the same level of treatment regularly provided to patients in similar medica…
  • Beller ex rel. Welch v. Health & Hosp. Corp., 703 F.3d 388 (7th Cir. 2012).published
    Johnson v. Univ. of Chicago Hospitals, 982 F.2d 230 , 233 n. 7 (7th Cir.1993); Gatewood v. Washington Healthcare Corp., 933 F.2d 1037, 1039 (D.C.Cir.1991).
  • Millan v. Hosp. San Pablo, 389 F. Supp. 2d 224 (D.P.R. 2005).published
    Corp. of America, 997 F.2d 872, 880 (4th Cir.1992); Gatewood v. Washington Healthcare Corp., 933 F.2d 1037, 1039 (D.C.Cir.1991).
  • Roubert Colon v. Hosp. DR. PILA, 330 F. Supp. 2d 38 (D.P.R. 2004).published 2 cites
    (stating that an appropriate screening is properly determined not by reference to a particular outcome, but instead by reference to a hospital’s standard screening procedures)
  • Heirs of Medero v. SUSONI, 281 F. Supp. 2d 352 (D.P.R. 2003).published 2 cites
    Malave Sastre, 93 F.Supp.2d at 109 -10 (quoting Gatewood v. Washington Healthcare Corp., 933 F.2d 1037, 1039 (D.C.Cir.1991)).
  • Marrero v. Hosp. Hermanos Melendez, Inc., 253 F. Supp. 2d 179 (D.P.R. 2003).published 2 cites
    Corp. of America, 977 F.2d 872 , 880 (4th Cir.1992); Gatewood v. Washington Healthcare Corp., 933 F.2d 1037, 1039 (D.C.Cir.1991).
  • Broughton v. St. John Health Sys., 246 F. Supp. 2d 764 (E.D. Mich. 2003).published 3 cites
    Assn., 42 F.3d 851 , 857 (4th Cir.1994); Gatewood v. Washington Healthcare Corp., 933 F.2d 1037, 1041 (D.C.Cir.1991)).
  • Brenord v. Catholic Med. Ctr. of Brooklyn & Queens, Inc., 133 F. Supp. 2d 179 (E.D.N.Y. 2001).published 2 cites
    Gatewood v. Washington Healthcare Corp., 933 F.2d 1037, 1039 (D.C.Cir.1991).
Show 19 more citing cases
933 F.2d at 1040 Limiting federal cause of action to failure to treat18 citing casescourt agrees with Cleland that the statute reaches "any individual" seeking emergency room care, but finds plaintiff's claims of misdiagnosis, without more, are not cognizable under the Act; Act does not create a sweeping federal cause of action with respect to traditional malpractice claims2 citing courts put it this way · 17 listed here
  • Hart v. City of La Junta, No. 1:23-cv-00134 (D. Colo. Mar. 19, 2025). 2 cites
    ([W]e cannot agree that [EMTALA] creates a sweeping federal cause of action with respect to what are traditional state-based claims of negligence or malpractice.)
  • Prince George's Hosp. Ctr. v. Advantage Healthplan Inc., 865 F. Supp. 2d 47 (D.D.C. 2012).published
    Gatewood v. Washington Healthcare Corp., 933 F.2d 1037, 1040 (D.C.Cir.1991). 6 .
  • Byrne v. Cleveland Clinic, 684 F. Supp. 2d 641 (E.D. Pa. 2010).published 2 cites
    “triggered only after a hospital ‘determines that [an] individual has an emergency medical condition”
  • Sterling v. Johns Hopkins Hosp., 802 A.2d 440 (Md. Ct. Spec. App. 2002).published
    D.C. 31, 34, 933 F.2d 1037, 1040 (1991) (no distinction between persons with and without insurance; plain language extends protections to “any individual” who seeks emergency room assistance), although "patient dumping,” as broadly defined…
  • Gardner v. Elmore Cmty. Hosp., 64 F. Supp. 2d 1195 (M.D. Ala. 1999).published
    Corp., 947 F.2d 412, 415 (9th Cir.1991) (holding that the EMTALA applies “to any and all patients”); Gatewood v. Washington Healthcare Corp., 933 F.2d 1037, 1040 (D.C.Cir.1991) (same).
  • Smith v. Janes, 895 F. Supp. 875 (S.D. Miss. 1995).published
  • Delaney v. Cade, 986 F.2d 387 (10th Cir. 1993).published
  • In the Matter of Baby \K\" (Three Cases)", 16 F.3d 590 (4th Cir. 1994).published
  • Harold Summers v. Baptist Med. Ctr. Arkadelphia, 69 F.3d 902 (8th Cir. 1996).published
  • Urban v. King, 783 F. Supp. 560 (D. Kan. 1992).published
Show 7 more citing cases
933 F.2d at 1038 cited at this page2 citing cases
  • Marshall ex rel. Marshall v. East Carroll Par. Hosp. Serv. Dist., 134 F.3d 319 (5th Cir. 1998).published 4 cites
    See Eberhardt, 62 *323 F.3d at 1258 (“The hospital’s failure to detect the decedent’s alleged suicidal tendency may be actionable under state medical malpractice law, but not under the EMTALA.”); Baber v. Hospital Corp. of America, 977 F.2…
  • Burks v. St. Joseph's Hosp., 596 N.W.2d 391 (Wis. 1999).published 4 cites
    Corp., 947 F.2d 412, 414 (9th Cir. 1991); Gatewood v. Washington Healthcare Corp., 933 F.2d 1037, 1039 (D.C.
933 F.2d at 1169 Remedy for negligent care after inpatient admission1 citing case
  • Ollison v. Alameda Health Sys., No. 3:20-cv-04944 (N.D. Cal. Dec. 8, 2020).
    “After an individual is admitted for inpatient care, state 4 tort law provides a remedy for negligent care.” Id. at 1169.
290 U.S. App. D.C. at 35 “a hospital fulfills the 'appropriate medical screening requirement' when it conforms in its treatment of a particular patient to its standard screening procedures.”0 citing cases6 citing courts quote it
    Retrieving the full opinion text from the archive…
    Alice GATEWOOD, Individually, and as Personal Representative of the Estate of William H. Gatewood
    v.
    WASHINGTON HEALTHCARE CORPORATION, t/a Washington Hospital Center
    No. 90-7094.
    Court of Appeals for the D.C. Circuit.
    May 28, 1991.
    Published opinion
    933 F.2d 1037
    1991 WL 84653
    1991 U.S. App. LEXIS 10578
    Margaret A. Beller, Washington, D.C., for appellant., Terri A. Steinhaus, with whom James A. Hourihan was on the brief, Washington, D.C., for appellees Coastal Emergency Services of Washington, D.C., Inc., and Betty Laygo, M.D., Robert E. Higdon, Washington, D.C., entered an appearance for appellees Washington Hosp. Center, et al.
    Edwards, Ginsburg, Thomas.
    Cited by 140 opinions  |  Published

    Opinion for the Court filed by Circuit Judge HARRY T. EDWARDS.

    HARRY T. EDWARDS, Circuit Judge:

    This case involves the scope of the Emergency Medical Treatment and Active Labor Act (the “Emergency Act” or “Act”), 42 U.S.C.A. § 1395dd (West Supp.1991), a statute enacted by Congress to prevent hospitals from “dumping” patients in need of emergency care. Appellant Alice Gate-wood’s husband died of a heart attack the day after he was discharged from the emergency room of appellee, Washington Hospital Center (“WHC”), where he was diagnosed as suffering from “musculoskeletal pain.” Mrs. Gatewood filed suit in federal court, raising an Emergency Act claim and pendent local claims for malpractice. The District Court dismissed the case, holding that the Emergency Act does not provide a cause of action for fully insured patients who are misdiagnosed in hospital emergency rooms. See Gatewood v. Washington Hosp. Center, et al., Civ. Action No. 89-0248 (D.D.C. May 23, 1990), reprinted in Joint Appendix (“J.A.”) 231.

    [*33] On review, we find the District Court erred to the extent that it premised dismissal on Mr. Gatewood’s status as an insured, patient. Whether a patient carries health insurance is not critical to a claim under the Emergency Act, which by its own terms covers “any individual” who presents at an emergency room. We agree with the District Court, however, that the Emergency Act does not create a broad federal cause of action for emergency room negligence or malpractice. In the absence of any allegation that the WHC departed from its standard emergency room procedures in treating Mr. Gatewood, questions related to Mr. Gatewood’s diagnosis remain the exclusive province of local negligence and malpractice law. Accordingly, we affirm the dismissal of the complaint for failure to state a claim upon which relief can be granted.

    I. Background

    This case arises from the treatment provided William Gatewood at the WHC emergency room on the night of January 28, 1987. Mr. Gatewood was fully insured when he arrived at the WHC complaining of pain radiating down his left arm and into his chest. Dr. Mehlman, a resident, examined Mr. Gatewood and performed blood tests, a chest x-ray and an EKG test. Together with Dr. Laygo, the attending physician on the night in question, Dr. Mehlman reviewed the test results and diagnosed Mr. Gatewood as suffering from musculoskeletal pain. The doctors discharged Mr. Gatewood from the hospital with instructions to use a heating pad, take Tylenol pain medicine and call his personal physician for a follow-up appointment. The next morning, Mr. Gatewood died of a heart attack.

    In January 1989, Mrs. Gatewood brought the instant action in federal district court. Named as defendants in her suit were the WHC, Drs. Mehlman and Laygo, and Coastal Emergency Services of Washington, D.C. (“Coastal”), under contract to provide emergency room services for the WHC on the date of Mr. Gatewood’s treatment (collectively, the “appellees”). Mrs. Gate-wood alleged that the emergency room treatment of her husband violated the Emergency Act, and also raised pendent local claims for malpractice. See Amended Complaint, reprinted in J.A. 9.

    In May 1990, the District Court awarded summary judgment to the appellees and dismissed the action. The District Court held that the Emergency Act was intended to prohibit “dumping” of patients for economic reasons, and that it provided no cause of action for fully insured patients presenting typical claims of “failure to properly diagnose.” See Gatewood, mem. op. at 2, reprinted in J.A. 232. Without a viable federal claim before it, the District Court dismissed Mrs. Gatewood’s pendent local law claims for lack of jurisdiction. See id. at 3, reprinted in J.A. 233. This appeal ensued.

    II. Analysis

    The Emergency Act was passed in 1986 amid growing concern over the availability of emergency health care services to the poor and uninsured. The statute was designed principally to address the problem of “patient dumping,” whereby hospital emergency rooms deny uninsured patients the same treatment provided paying patients, either by refusing care outright or by transferring uninsured patients to other facilities. See H.R.Rep. No. 241, 99th Cong., 1st Sess., pt. 1, at 27 (1985); id., pt. 3, at 5; see also Cleland v. Bronson Health Care Group, Inc., 917 F.2d 266, 268 (6th Cir.1990) (discussing legislative history of Emergency Act); Note, Preventing Patient Dumping: Sharpening the COBRA’S Fangs, 61 N.Y.U.L.Rev. 1186, 1187-88 (1986). Reports of patient dumping rose in the 1980s, as hospitals, generally unencumbered by any state law duty to treat, faced new cost containment pressures combined with growing numbers of uninsured and underinsured patients. See Note, supra, at 1189-96.

    Congress responded with the Emergency Act, which imposes on Medicare-provider hospitals a duty to afford medical screening and stabilizing treatment to any patient who seeks care in a hospital emergency[*34] room. Subsection 1395dd(a), the Act’s “medical screening requirement,” provides that

    if any individual (whether or not eligible for [Medicare] benefits under this sub-chapter) comes to the emergency department and a request is made on the individual’s behalf for examination or treatment for a medical condition, the hospital must provide for an appropriate medical screening examination within the capability of the hospital’s emergency department____

    42 U.S.C.A. § 1395dd(a) (West Supp.1991). Subsection 1395dd(b) dictates “necessary stabilizing treatment” for emergency conditions, as follows:

    [i]f any individual (whether or not eligible for [Medicare] 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.

    42 U.S.C.A. § 1395dd(b)(l) (West Supp. 1991). Subsection (c), in turn, restricts transfers prior to stabilization. See 42 U.S. C.A. § 1395dd(c) (West Supp.1991). Hospitals in violation of the Act may be sued by “[a]ny individual who suffers personal harm” as a result. See 42 U.S.C.A. § 1395dd(d)(2)(A) (West Supp.1991).[1]

    We are faced at the outset with a contention that none of these provisions applies to treatment of patients who, like Mr. Gate-wood, are covered by insurance. Citing the statute’s legislative history, the appellees argue that the Emergency Act is intended to guarantee emergency room access to uninsured and indigent patients only, and does not bring within its ambit the claims of insured patients or those otherwise able to pay for care. The District Court accepted this assertion, resting its dismissal at least in part on the fact that Mr. Gate-wood’s “release had nothing to do with insurance, inability to pay or other economic factors.” See Gatewood, mem.op. at 2, reprinted in J.A. 232.

    We find that the District Court erred in relying on Mr. Gatewood’s insured status for its holding. Though the Emergency Act’s legislative history reflects an unmistakable concern with the treatment of uninsured patients, the Act itself draws no distinction between persons with and without insurance. Rather, the Act’s plain language unambiguously extends its protections to “any individual” who seeks emergency room assistance. See 42 U.S. C.A. § 1395dd(a), (b)(1) (emphasis added). We conclude that we are bound by statutory language this clear, at least where, as here, it is not manifestly inconsistent with legislative intent. See United Mine Workers of Am. v. Federal Mine Safety and Health Review Comm’n, 671 F.2d 615, 621 (D.C.Cir.), cert. denied, 459 U.S. 927, 103 S.Ct. 239, 74 L.Ed.2d 189 (1982); Aviation Consumer Action Project v. Washburn, 535 F.2d 101, 106-07 (D.C.Cir.1976).[2] Like the only other circuit court to address this question, see Cleland, 917 F.2d at 269-70,[*35] we will give effect to the plain and inclusive terms of the Emergency Act.

    Nevertheless, we affirm the District Court dismissal on the grounds that appellant has failed to state a cause of action under the Act. While we agree with appellant that the statute reaches “any individual” seeking emergency room care, we cannot agree that it creates a sweeping federal cause of action with respect to what are traditional state-based claims of negligence or malpractice. Mrs. Gatewood’s allegations of misdiagnosis, without more, are simply not cognizable under the Emergency Act.

    The appellant relies primarily on subsection 1395dd(a) of the Act, arguing that an emergency room violates the “appropriate medical screening” requirement whenever it negligently misdiagnoses a patient’s condition. Like the Sixth Circuit in Cleland, see 917 F.2d at 271-72, we read the requirement of “appropriate medical screening” differently. As its history makes clear, the Act is intended not to ensure each emergency room patient a correct diagnosis, but rather to ensure that each is accorded the same level of treatment regularly provided to patients in similar medical circumstances. Thus, what constitutes an “appropriate” screening is properly determined not by reference to particular outcomes, but instead by reference to a hospital’s standard screening procedures.

    In our view, then, a hospital fulfills the “appropriate medical screening” requirement when it conforms in its treatment of a particular patient to its standard screening procedures. By the same token, any departure from standard screening procedures constitutes inappropriate screening in violation of the Emergency Act. The motive for such departure is not important to this analysis, which applies whenever and for whatever reason a patient is denied the same level of care provided others and guaranteed him or her by subsection 1395dd(a).[3] In this case, the appellant concedes that Mr. Gatewood received a screening examination, and does not allege that the screening procedure in question differed in any respect from that generally employed by the hospital. Absent some allegation of differential treatment, no claim is stated under subsection 1395dd(a).

    We recognize, of course, that there may be some instances in which a hospital’s normal screening procedure will fall below the standard of care established by local negligence or malpractice law. Nevertheless, we decline the appellant’s invitation to incorporate a malpractice or negligence standard into subsection 1395dd(a). The federal Emergency Act is not intended to duplicate preexisting legal protections, but rather to create a new cause of action, generally unavailable under state tort law, for what amounts to failure to treat. Though there may arise some areas of overlap between federal and local causes of action, most questions related to the adequacy of a hospital’s standard screening and diagnostic procedures must remain the exclusive province of local negligence law. See Cleland, 917 F.2d at 271-72; Stewart v. Myrick, 731 F.Supp. 433, 436 (D.Kan.1990) (claim for improper emergency room diagnosis and treatment “falls within the ambit of state negligence law, not the federal anti-dumping law”); Evitt v. University Heights Hosp., 727 F.Supp. 495, 497 (S.D.Ind.1989) (same).

    We do not in this case address the scope of the stabilization and transfer provisions of the Emergency Act, subsections 1395dd(b) and (c). Those provisions are triggered only after a hospital “determines that [an] individual has an emergency medical condition.” See 42 U.S.C.A. § 1395dd(b)(l), (c). Here, no such condition was diagnosed, and the statute’s stabilization and transfer requirements are therefore inapplicable.

    We find, then, that the appellant has failed to state a claim under the federal Emergency Act. Absent a viable federal cause of action, we affirm the District[*36] Court dismissal of the appellant’s pendent local claims for lack of jurisdiction. See United Mine Workers of Am. v. Gibbs, 383 U.S. 715, 726, 86 S.Ct. 1130, 1139, 16 L.Ed.2d 218 (1966). We express no opinion here as to the validity under local negligence or malpractice law of the appellant’s claims against any of the parties named in the amended complaint.

    III. Conclusion

    For the reasons set forth above, we find that the appellant has failed to state a claim cognizable under the Emergency Act. Accordingly, we affirm the District Court dismissal of this case.

    So ordered.

    1

    Subsection (d)(2)(A)’s civil enforcement provision is explicitly limited to actions against participating hospitals. See 42 U.S.C.A. § 1395dd(d)(2)(A) ("Any individual who suffers personal harm ... may, in a civil action against the participating hospital, obtain [damages and equitable relief].”) (emphasis added). From this, it seems clear that there is no private cause of action against physicians under the Emergency Act. Accordingly, counsel for the appellant declined at argument to press an Emergency Act claim against Drs. Mehlman and Laygo.

    2

    The appellees’ reliance on Washburn is misplaced. Though Washburn might justify resort to legislative history if "the literal words of the statute would bring about an end completely at variance with the purpose” of the Emergency Act, see 535 F.2d at 106-07, that is not the situation before us. At most, the plain language of subsections 1395dd(a) and (b) extends the Act’s reach beyond that anticipated by Congress; in no way does it undermine or conflict with Congress’ purposes to provide uninsured patients with emergency health care and to prevent "dumping.” See Cleland, 917 F.2d at 270.

    3

    In this respect, we depart from the Sixth Circuit reasoning in Cleland, 917 F.2d at 272. We do not read subsection 1395dd(a) as referring in any way to the "motives" with which an emergency room acts when it provides something less than its normal screening procedure.