## Facts

- Susan M. Power, a 33-year-old British national, went to Arlington Hospital’s emergency department with severe pain, inability to walk, shaking, and chills.
- She was evaluated by nurses and two physicians; the workup included vital signs, hip X-rays, and urinalysis testing, but a more complete urinalysis was ordered and not obtained before discharge.
- The second physician discharged her with pain medication and an orthopedist referral, instructing her to return if pain worsened; no definitive diagnosis was made.
- Power returned the next day in an unstable condition with virtually no blood pressure, was diagnosed with septic shock, and was admitted to the intensive care unit.
- She remained in intensive care for more than four months, required life support, underwent bilateral below-the-knee amputations, lost sight in one eye, and suffered severe permanent lung damage.
- Power sued Arlington Hospital under EMTALA for failure to provide an appropriate medical screening and for improper transfer; EMTALA claims against individual physicians and groups were dismissed because EMTALA authorizes suit only against participating hospitals.
- The district court excluded application of Virginia’s malpractice and charitable-liability limits to EMTALA damages, and the case went to trial on EMTALA claims against the hospital alone.
- A jury found for Power on the EMTALA screening claim and awarded $5 million in actual damages.

## Issues

1. What standard governs an EMTALA claim for failure to provide an “appropriate medical screening examination,” and whether proof of improper motive (e.g., financial discrimination) is required.
2. Whether the evidence was sufficient to support the jury’s finding that the hospital violated EMTALA’s screening requirement.
3. Whether Virginia’s medical malpractice damages cap and charitable hospital liability limitation apply to damages awarded under EMTALA.

## Decision

- The Fourth Circuit affirmed in part, reversed in part, and remanded.
- The court rejected an independent “improper motive” element for EMTALA screening liability.
- The court reversed the judgment on the screening verdict, holding the evidence was insufficient to show Power received a non-uniform screening compared to similarly situated patients under the hospital’s usual procedures.
- The court reversed the district court’s damages ruling and held Virginia’s damages limitations apply to EMTALA actions filed in Virginia.
- The case was remanded for further proceedings consistent with these rulings.

## Legal Principles

- EMTALA’s screening duty requires a hospital to provide a screening examination reasonably calculated to identify emergency medical conditions and to apply that screening uniformly to patients with substantially similar complaints.
- EMTALA is not a federal medical malpractice statute; negligent diagnosis or substandard care, without proof of disparate screening, does not establish an EMTALA screening violation.
- Proof that a hospital deviated from its standard screening procedures for similarly situated patients is central to an EMTALA screening claim; subjective improper motive is not a separate required element.
- EMTALA’s civil remedy permitting “those damages available for personal injury under the law of the State” incorporates state law limits on damages, including applicable caps and charitable-liability limitations.

## Conclusion

The Fourth Circuit treated EMTALA’s screening requirement as an equality-of-treatment obligation tied to a hospital’s standard screening practices, set aside a plaintiff’s verdict where the record did not show disparate screening, and held that state-law damages limitations in Virginia constrain recoveries in EMTALA suits against Virginia hospitals.


Power v. Arlington Hosp. Ass’n, 42 F.3d 851 (4th Cir. 1994)