Premature Discharge From Hospital Can Give Rise to Multiple Legal Claims

The US District Court for the Southern District of New York recently issued an opinion in which an incarcerated individual sued for damages he allegedly sustained due to his premature discharge from the emergency room.

In Jones v. Beth Israel Hospital, Docket No. 1:17-cv-3445 (S.D.N.Y. April 12, 2018), the plaintiff came to the ER at Beth Israel after hot coffee was thrown in his face. During his medical screening examination, he allegedly told the doctor he was suffering from suicidal and homicidal thoughts. He added that he was on psychiatric medication and in and out of various psychiatric facilities in months before his ER visit. He stated he had "no real reason to live," explaining that he lost custody of his children, his brother had been murdered, and his wife was allegedly using drugs and cheating on him. The physician then sent a hospital employee to further discuss the plaintiff's comments, but the plaintiff received no additional treatment and was discharged from the hospital.

Immediately after his discharge, the plaintiff assaulted three NYPD officers. His behavior appeared to be "suicide by cop," designed to provoke the officers into shooting him. The officers, however, were able to restrain the plaintiff without causing any fatal injuries. He was then incarcerated and commenced this action pro se (without an attorney), claiming that he was improperly discharged by Beth Israel and should have been held overnight for a suicide watch and medication. The plaintiff additionally claimed he was neglected and discriminated against by the employees in the hospital ER and that these failures caused the violence that subsequently resulted. He sought damages of $100 million as well as payment of all his medical expenses.

Because the plaintiff was pro se, the court read the allegations broadly and in the most favorable light to the plaintiff. First, the court examined the plaintiff's allegations that he was denied medical services because of his race. This, the court noted, suggested a claim under 42 USC §1981, a civil rights law that guarantees citizens the right to the "equal benefit of all laws and proceedings for the security of persons and property." The court held that New York laws designed to protect patients from medical malpractice may fall within the ambit of protecting the security of persons under Section 1981, and, therefore, a Section 1981 claim could be viable. The plaintiff, however, neglected to identify his race in his court filings. Therefore, the claim was dismissed on this technicality, although the court gave the plaintiff leave to correct the deficiency.

Next, the court examined whether the hospital breached the Emergency Medical Treatment and Active Labor Act (EMTALA). The court noted that there is a distinction between a claim under EMTALA and a state law claim for medical malpractice. In order to state a claim under EMTALA, the plaintiff must allege that the hospital did not adequately screen him/her to determine whether he had an emergency medical condition or the hospital discharged/transferred him/her before the condition had been stabilized. For psychiatric conditions, an individual is considered stable for discharge when he/she is no longer considered to be a threat to him/herself or others. EMTALA's medical screening and stabilization requirements do not guarantee a proper diagnosis or provide a federal remedy for misdiagnosis or medical negligence. Here, the plaintiff informed medical personnel at the hospital of his mental state, was discharged without medication or further observation, and assaulted three police officers immediately after discharge. Under these circumstances, the complaint stated a claim against the hospital under EMTALA for failure to stabilize.

In addition, the court found that the complaint also stated a claim for medical malpractice under New York State law. The plaintiff's allegations were adequate to state a deviation from the standard of care, which would have been to admit the plaintiff for psychiatric observation and, therefore, the plaintiff could pursue a malpractice cause of action.

Finally, the plaintiff alleged that he was treated poorly by the emergency room physicians and discharged without mental health treatment because the hospital believed him to be homeless, and he additionally claimed that he was a victim of racial discrimination. The court examined these claims under the New York State Human Rights Law, which prohibits discrimination based upon race. The court noted that an individual's perceived financial status is not a protected classification under the Human Rights law. The plaintiff did not provide any other facts upon which a claim of discrimination could be based, and, therefore, the court dismissed the claim but allowed the plaintiff time to present additional facts.

Jones did not decide whether each of these claims could ultimately be successful. It does, however, alert hospitals that many different legal claims for relief can be based upon one incident in the ER and that each legal theory has its own rules and standards for a remedy. The best protection for a hospital is to train and educate emergency department staff, emphasizing that "stabilization" of a patient includes both physical and psychiatric conditions. Further, there must be thorough documentation of the patient's medical status as close as possible to the time of discharge and/or transfer, demonstrating that the patient was truly stable before disposition.