## Facts

- Harold Summers fell from a tree stand while deer hunting near Arkadelphia, Arkansas, and was transported by ambulance to Baptist Medical Center Arkadelphia’s emergency room on a spinal board.
- Summers reported severe head, back, and chest pain and stated he heard a snapping or popping noise in his chest when breathing.
- An emergency-room physician examined Summers and ordered spinal x-rays but did not order a chest x-ray; the physician concluded Summers had no new fractures and attributed chest pain to muscle spasms.
- Summers received medication for pain and muscle spasms, was instructed to apply heat, and was told to see his personal physician the next day.
- Summers asked to stay overnight because he did not feel able to drive several hours home, but the physician declined to hospitalize him.
- Two days later, Summers was admitted to another hospital and diagnosed with an acute comminuted vertebral fracture, a sternal fracture, multiple rib fractures, and bilateral hemo-pneumothoraces; he spent fourteen days in intensive care.
- Summers sued the hospital under EMTALA, alleging it failed to provide an “appropriate medical screening examination” under 42 U.S.C. § 1395dd(a).
- The district court granted summary judgment for the hospital; a panel reversed; the Eighth Circuit reheard the case en banc and reviewed the summary judgment ruling.

## Issues

1. Whether a plaintiff states an EMTALA “appropriate medical screening” claim by showing negligent screening in an individual case, or must instead show non-uniform, disparate, or otherwise improper screening compared to similarly situated patients.
2. Whether Summers produced evidence sufficient to create a triable issue that the hospital deviated from its standard screening practices or treated him differently from comparable emergency-room patients.

## Decision

- The en banc Eighth Circuit affirmed summary judgment for Baptist Medical Center Arkadelphia.
- The court held that EMTALA is not a federal medical malpractice statute and requires “something more than, or different from, ordinary negligence” to establish a screening violation.
- The court concluded Summers’s evidence amounted to an allegation that additional tests should have been ordered, without proof that the hospital failed to apply its usual screening procedures uniformly or engaged in disparate screening.

## Legal Principles

- EMTALA’s screening duty under 42 U.S.C. § 1395dd(a) is satisfied when a hospital provides a screening examination comparable to that provided to other patients with similar symptoms.
- A hospital violates EMTALA’s screening requirement by failing to apply its standard screening procedures uniformly or by providing disparate or improper screening (including a screening so cursory that it is not designed to identify acute and severe conditions).
- EMTALA does not guarantee a correct diagnosis or impose federal liability for ordinary diagnostic errors; claims based on negligent medical judgment are generally matters for state malpractice law absent proof of non-uniform screening.

## Conclusion

The Eighth Circuit (en banc) held that EMTALA screening liability turns on whether the hospital provided uniform, non-disparate screening consistent with its usual practices, not on whether the physician’s diagnostic choices were negligent; because Summers showed only alleged misdiagnosis without evidence of differential or nonstandard screening, summary judgment for the hospital was affirmed.


Summers v. Baptist Med. Ctr. Arkadelphia, 91 F.3d 1132 (8th Cir. 1996) (en banc)