## Facts

- Baby K was born at a Virginia hospital with anencephaly, leaving her permanently unconscious with no cognitive awareness, though she retained brain-stem autonomic functions.
- Shortly after birth, Baby K experienced respiratory difficulty and was placed on mechanical ventilation to stabilize her and confirm diagnosis and prognosis.
- Physicians advised the mother that aggressive treatment would provide no therapeutic or palliative benefit and recommended only comfort-oriented supportive care (nutrition, hydration, warmth).
- The mother rejected that recommendation and demanded mechanical ventilation whenever Baby K had breathing difficulty.
- The hospital attempted to transfer Baby K to another facility, but no area hospital would accept her.
- Baby K was transferred to a nursing home about a month after birth and was later readmitted multiple times to the hospital for respiratory distress, stabilized, and discharged back to the nursing home.
- After a subsequent admission for respiratory problems, the hospital sought declaratory relief that federal law did not require it to provide resuscitation or mechanical ventilation it considered medically and ethically inappropriate; the father and guardian ad litem supported the hospital’s position.

## Issues

1. Whether EMTALA requires a hospital to provide stabilizing treatment, including mechanical ventilation, to an anencephalic infant who presents to the emergency department in respiratory distress when treatment is requested.
2. Whether state law principles concerning medical futility or decision-making for incompetent patients limit or displace EMTALA’s stabilization duty.
3. Whether a hospital may refuse EMTALA-mandated stabilization based on physician judgment that treatment is nonbeneficial.

## Decision

- The Fourth Circuit affirmed the district court’s judgment.
- The court held that when Baby K presents in respiratory distress and treatment is requested, EMTALA obligates the hospital to provide stabilizing respiratory support.
- The court rejected a nontextual “futility” exception to EMTALA’s stabilization requirement.
- The court concluded that state law could not override EMTALA’s federal stabilization duty in the event of conflict.

## Legal Principles

- EMTALA requires a hospital emergency department to provide appropriate screening to any individual seeking examination or treatment to determine whether an emergency medical condition exists.
- If an emergency medical condition is identified, EMTALA requires stabilizing treatment within the hospital’s capability or an appropriate transfer.
- EMTALA’s stabilization duty is triggered by the patient’s emergency condition at presentation (here, respiratory distress), not by the patient’s long-term prognosis or the perceived lack of curative potential.
- Courts will not create extra-statutory exceptions (such as medical futility) where the statute does not provide them.
- Federal EMTALA duties are not displaced by contrary state law standards concerning withholding treatment, to the extent such standards conflict with EMTALA’s requirements.

## Conclusion

The Fourth Circuit held that EMTALA required the hospital to provide stabilizing respiratory support, including mechanical ventilation, to Baby K whenever she arrived in respiratory distress and treatment was requested, notwithstanding the infant’s anencephaly and the hospital’s view that such treatment was medically inappropriate.


In re Baby K, 16 F.3d 590 (4th Cir. 1994)