Wisconsin Appeals Court Rules Newborn Infant Qualifies As Inpatient Under Federal Law

Main Category: Pediatrics / Children's Health
Also Included In: Litigation / Medical Malpractice;  Women's Health / Gynecology
Article Date: 30 Jan 2008 - 6:00 PDT

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The Wisconsin Court of Appeals on Thursday ruled that for purposes of coverage under the federal Emergency Medical Treatment and Labor Act, both a woman in labor and her newborn infant are considered inpatients at the time of the birth, BNA reports (Wilder, BNA, 1/28). According to CMS, EMTALA, which passed in 1986, requires Medicare-participating hospitals that offer emergency services to provide medical screening "when a request is made for examination or treatment for an emergency medical condition ... including active labor, regardless of an individual's ability to pay" (CMS EMTALA Overview, 1/28).

The case involves a woman who was admitted at Meriter Hospital in Madison, Wis., in 1999 and taken to the hospital's birthing center. The woman, Shannon Preston, delivered a premature infant who died. After receiving nursing care, the hospital did not resuscitate or treat the infant, BNA reports. Preston sued Meriter for medical negligence, failing to obtain informed consent and neglecting a patient in violation of state law and EMTALA. A circuit court in Dane County, Wis., dismissed Preston's claims, and an appeals court upheld the ruling.

The state Supreme Court in 2005 reversed the dismissal of the EMTALA claim. However, a dissenting opinion suggested that the majority did not consider that the infant was an inpatient and that therefore, the infant would not be covered under EMTALA. When the case was remanded to the circuit court, Meriter asked that a judgment be made on the inpatient issue. The court ruled that since Preston was admitted as an inpatient when she was taken to the birthing center, the fetus simultaneously became an inpatient and remained so as an infant.

Preston appealed the ruling, arguing that the fetus came to the birthing center for purposes covered under EMTALA. However, Appeals Court Judge Burnie Bridge wrote, "We agree with the circuit court's observation that by this direction, the Supreme Court suggested that the question of [the infant's] inpatient status could affect the validity of Preston's screening requirement claim." Bridge added, "We therefore conclude that the EMTALA screening requirement ceases to apply once an individual has been admitted to a hospital for inpatient care." Bridge wrote that because Preston became an inpatient after arriving at Meriter, concluding that the infant was not an inpatient under EMTALA even though Preston would "defy common sense" (BNA, 1/28).

The Court of Appeals opinion is available online.

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