On April 3, 2004, Matthew Bonnette was involved in an automobile collision in New Orleans. He was arrested in connection with the incident, although the grounds for his arrest are not detailed in this opinion. The police transported him to the Medical Center of Louisiana New Orleans emergency department (ED), where he was diagnosed with muscle strains to his back and suicidal ideation.
The emergency department physicians ordered a psychiatric evaluation. During the evaluation Bonnette informed the doctors that for approximately a month he had experienced a decrease in sleep and appetite along with drastic weight loss. He discussed hanging himself and disclosed that on two prior occasions he had attempted suicide.
The ED doctors diagnosed him as suffering from a major depressive episode. A suicide risk assessment and treatment plan identified numerous specific risk factors for suicide, including, but not limited to, psychic distress, global insomnia, and past suicide attempts. An antidepressant was prescribed and he was released to the New Orleans Police Department, which was advised to place Bonnette on suicide watch while in its custody. He was to be reevaluated on release. Bonnette was transferred to the custody of the Orleans Parish criminal sheriff's office, where he was placed in a cell at the House of Detention. Somehow, a leather restraint strap was left in the cell and Bonnette committed suicide by hanging. It is not clear whether the suicide precaution warnings were transmitted to the officers of Orleans Parish.
Suit was brought in state court for medical malpractice and violation of the Emergency Medical Treatment and Active Labor Act (EMTALA), 42 U.S.C. §1395dd. The trial court dismissed the medical malpractice claim as premature (it had not been presented to the Medical Review Panel as required by Louisiana law) and dismissed the EMTALA claim. The plaintiff appealed the dismissal of the EMTALA claim.
Had the state of Louisiana waived its sovereign immunity with regard to its state owned hospitals? Was Bonnette suffering from an emergency medical condition that was not stabilized prior to his incarceration?
The court held that the state of Louisiana had waived sovereign immunity and, thus, was subject to suit under EMTALA. It noted that a cause of action under EMTALA was different from an action for medical malpractice; therefore, the action was not subject to the Louisiana Medical Malpractice Act. Although the court did not specifically address whether Bonnette had an emergency medical condition, by reversing the judgment of the trial court it impliedly indicated that the petition had adequately stated a cause of action under EMTALA.
The court of appeals reversed the decision of the trial court and remanded the case for further proceedings.
The regulations issued by the Centers for Medicare and Medicaid Services construing EMTALA define an “emergency medical condition” as:
A medical condition manifesting itself by acute symptoms of sufficient severity (including severe pain, psychiatric disturbances and/or symptoms of substance abuse) such that the absence of immediate medical attention could reasonably be expected to result in
Placing the health of the individual (or, with respect to a pregnant woman, the health of the woman or her unborn child) in serious jeopardy;
Serious impairment to bodily functions; or
Serious dysfunction of any bodily organ or part.
42 C.F.R. §489.24(b)
There is no question that a psychiatric condition can be an emergency medical condition that requires stabilization, if detected.
It was obvious, at least in hindsight, that Bonnette was suffering from an emergency medical condition. He had attempted suicide twice in the past, which is one of the best predictors of a high risk of suicide in the future. He had many of the somatic complaints that indicate major depression, and the doctors duly diagnosed major depression. Major depression is a primary indicator of a high level of suicide risk. Since the hospital diagnosed major depression, it was on notice that Bonnette had an emergency medical condition and was in need of stabilizing treatment.
John C. West, J.D., M.H.A., is a senior health care consultant with Global Loss Prevention, Inc., a Chartis company. This column constitutes general advice not legal advice. Readers should consult with counsel for legal concerns. For questions or comments contact .
Incarceration may not be an adequate substitute for stabilizing treatment. Once the hospital knew that he had an emergency medical condition, it was required either to stabilize the condition or to transfer Bonnette to another health care facility (medical or psychiatric) for stabilizing treatment. Transferring him to jail was a discharge without stabilization.
Hospitals need to be extremely careful with patients who are going to be incarcerated. There should be a good medical examination to ensure that there are no medical conditions that may require treatment during incarceration. If there are medical conditions that can be treated appropriately in jail, the medical clearance should specify them. There must also be a good psychiatric evaluation and necessary stabilization to ensure that the patient may be safely housed in a correctional facility. Failure to meet these requirements may spell liability for the hospital.
Bonnette v. Louisiana,
972 So. 2d 340 (Ct. App. La. 2007).