## Facts

- Brenda Baber presented to Raleigh General Hospital’s (RGH) emergency department late at night with nausea, agitation, and concern about pregnancy; she had chronic mental illness, had stopped antipsychotic medication, and had been drinking heavily.
- RGH emergency physician Dr. Richard Kline examined her, ordered labs (including a pregnancy test), and administered sedatives that did not effectively calm her.
- While in the emergency department, Brenda convulsed, fell, and struck her head, causing a scalp laceration that Dr. Kline sutured.
- After suturing, she was verbal and able to move her head, eyes, and limbs, with good oxygen saturation, but remained disoriented and anxious.
- Dr. Kline attributed her condition primarily to psychiatric illness, paranoia, and alcohol withdrawal and did not order a CT scan or skull x-rays.
- Dr. Kline coordinated with Dr. Joseph Whelan, Brenda’s psychiatrist at Beckley Appalachian Regional Hospital (BARH), to transfer Brenda to BARH’s psychiatric unit; her brother was present and did not object.
- BARH admitted Brenda directly to its psychiatric unit rather than through its emergency department.
- At BARH, Brenda had a grand mal seizure, became unresponsive, and a CT scan showed a skull fracture and subdural hematoma; she was transferred back to RGH comatose and died the next day.
- The estate sued hospitals and physicians under EMTALA and asserted related state-law negligence/wrongful death claims.

## Issues

1. Whether EMTALA authorizes a private damages action against individual physicians, or only against participating hospitals.
2. Whether RGH failed to provide an “appropriate medical screening examination” under EMTALA by not performing imaging and by allegedly misdiagnosing Brenda’s condition.
3. Whether RGH violated EMTALA’s stabilization and transfer provisions by transferring Brenda to BARH without stabilizing an emergency medical condition.
4. Whether BARH had an EMTALA screening duty when Brenda was admitted directly to its psychiatric unit rather than presenting to BARH’s emergency department.

## Decision

- The Fourth Circuit affirmed summary judgment for all defendants on the EMTALA claims.
- EMTALA’s private civil action permits damages suits against participating hospitals, not against individual physicians.
- RGH’s screening did not violate EMTALA absent evidence that it departed from its own standard screening procedures for similarly situated patients.
- RGH did not violate EMTALA’s stabilization/transfer provisions because there was no evidence RGH actually knew Brenda had an EMTALA-defined emergency medical condition at the time of transfer.
- BARH had no EMTALA screening duty on these facts because Brenda did not come to BARH’s emergency department.
- The dismissal without prejudice of the pendent state-law claims was left intact.

## Legal Principles

- EMTALA’s private right of action runs against participating hospitals; physician liability under EMTALA is addressed through administrative sanctions rather than private damages suits.
- An “appropriate medical screening examination” under EMTALA is measured by whether the hospital applies its own screening procedures uniformly to similarly situated emergency-department patients, within the department’s capabilities.
- EMTALA does not create a federal malpractice cause of action; misdiagnosis or negligent treatment, without disparate screening or failure to follow established screening procedures, does not establish an EMTALA screening violation.
- EMTALA’s stabilization and transfer duties require proof the hospital actually recognized an EMTALA-defined emergency medical condition; a serious condition later discovered does not, by itself, show the requisite knowledge at transfer.
- EMTALA’s screening duty is triggered when an individual comes to a hospital’s emergency department; direct admission to an inpatient or specialty unit does not trigger EMTALA screening obligations.

## Conclusion

The Fourth Circuit held that EMTALA targets discriminatory or non-uniform emergency-department access and improper transfers by hospitals, not ordinary diagnostic or treatment errors, and it affirmed judgment for defendants because the estate showed neither disparate screening nor actual hospital knowledge of an emergency medical condition at transfer and because EMTALA was not triggered by direct admission to a psychiatric unit.


Baber v. Hosp. Corp. of Am., 977 F.2d 872 (4th Cir. 1992)