## Facts

- A Virginia acute-care hospital participating in Medicare and Medicaid treated an infant, Baby K, born with anencephaly, a congenital condition for which no curative treatment exists.
- Baby K was permanently unconscious, lacked cerebral function, and could not see or hear; she retained limited brain-stem reflexes and had relatively stable organ function.
- Baby K experienced recurrent episodes of respiratory distress after birth that required mechanical ventilation to prevent deterioration or death.
- The hospital’s physicians concluded ventilatory support was medically inappropriate and sought to limit care to warmth, nutrition, and hydration.
- Baby K’s mother, based on religious beliefs, insisted that the hospital provide mechanical ventilation when respiratory distress occurred; the father was minimally involved.
- No other nearby hospital would accept Baby K for transfer, and she was repeatedly brought to the hospital’s emergency department during respiratory crises.
- The hospital filed a federal declaratory judgment action seeking confirmation that it could lawfully withhold ventilatory support without violating EMTALA, the Rehabilitation Act, or the ADA; the court declined to decide state-law questions.

## Issues

1. Whether EMTALA permits a participating hospital to withhold ventilatory support needed to stabilize an emergency medical condition based on physicians’ determination of medical futility and poor prognosis.
2. Whether withholding ventilatory support from Baby K would violate federal disability-discrimination law under § 504 of the Rehabilitation Act or the ADA.

## Decision

- The court denied the hospital’s request for declaratory relief authorizing it to forgo ventilatory support.
- The court held that Baby K’s respiratory distress constituted an EMTALA “emergency medical condition,” triggering duties of appropriate screening and stabilizing treatment.
- Because an appropriate transfer was not available, the hospital was required under EMTALA to provide ventilatory support necessary to stabilize Baby K when she presented in respiratory distress.
- The court treated EMTALA’s stabilization requirement as not subject to a judicially created “medical futility” exception.
- The court concluded the federal statutory analysis resolved the requested relief and declined to rule on state-law issues.

## Legal Principles

- EMTALA requires a participating hospital to provide an appropriate medical screening examination to any person who comes to the emergency department.
- When an emergency medical condition is identified, EMTALA requires stabilizing treatment necessary to prevent material deterioration, unless the patient is appropriately transferred.
- EMTALA’s stabilization duty turns on the existence of an emergency medical condition and immediate risk of deterioration, not on the patient’s long-term prognosis or the perceived overall benefits of treatment.
- Where transfer is not feasible, a hospital may not refuse stabilizing emergency treatment solely because clinicians deem the intervention non-beneficial in light of an underlying, incurable condition.
- Federal disability statutes may bar withholding emergency treatment based on disability-linked judgments about the value of the patient’s life, reinforcing nondiscriminatory provision of comparable emergency care.

## Conclusion

The court held that EMTALA obligated the hospital to provide ventilatory support to stabilize Baby K’s respiratory distress whenever she presented to the emergency department and transfer was unavailable, rejecting the hospital’s attempt to withhold emergency stabilization based on medical futility and poor prognosis.


In re Baby K., 832 F. Supp. 1022 (E.D. Va. 1993)