Emergency services

• Adventist Health System v. Blue Cross and Blue Shield of Florida
• Burrows v. Schug
• Cherukuri v. Shalala

Adventist Health System v. Blue Cross and Blue Shield of Florida
934 So. 2d 602 (Fla. App. 2006)

Issue

The issue in this case was whether Florida's Emergency Services Statute (ESS) can be enforced by a non-government entity.

AMA interest

The AMA supports prompt and fair payment for physicians' services.

Case summary

The ESS provides that if emergency medical services are provided to an HMO subscriber, the HMO is to pay for those services at the market rate.  Adventist Health System, which owned a chain of hospitals in Florida, sued Blue Cross and Blue Shield of Florida (Florida Blue) under the ESS, claiming that it had been underpaid for emergency services.  The trial court ruled in favor of Florida Blue, without considering whether Florida Blue had violated the ESS payment requirements.  It held that the ESS cannot be a basis for a lawsuit by a non-government entity, and that, even if it could, Adventist had not exhausted the administrative review process.  Adventist appealed.

The District Court of Appeal reversed the trial court, finding that the ESS implied a private right of action.  It further held that Adventist was not required to exhaust its administrative remedies.

Litigation Center involvement

The Litigation Center filed an amicus curiae brief to support Adventist's interpretation of the ESS -- in favor of an implied private right of action.

View the brief (PDF, 112KB).

Burrows v. Schug, 528 U.S. 867 (1999)

Burrows, a patient, sued Dr. Schug for common law malpractice and for violation of EMTALA.  The underlying incident involved the death of an eleven-month old child while being transferred between hospitals.  Dr. Schug, an emergency room physician, had ordered the transfer.  His actions were subsequently reviewed by his hospital’s peer review committee.

Under California law, the peer review records are not discoverable.  However, the United States District Court held that, because part of the action was based on EMTALA, those records would be discoverable.  The Ninth Circuit, in an unpublished decision, affirmed the District Court order.  Dr. Schug petitioned to the United States Supreme Court for a writ of certiorari.  The California Medical Association and various other organizations filed a supporting brief, which the Litigation Center joined, urging the grant for certiorari. 

Result:  The Supreme Court denied the petition.

Cherukuri v. Shalala, 175 F.3d 446 (6th Cir. 1999)

Issue

The issue in this case was whether  a patient can be transferred out of an emergency room, even if bleeding and suffering a deteriorating medical condition, if the transfer is necessitated by the circumstances of the emergency room ordering the transfer. 

AMA interest

The AMA believed that Dr. Cherukuri had acted justifiably when he ordered the transfer, since his hospital lacked the facilities and/or the personnel needed to provide the emergency care required for these patients.  Even though the patients were still bleeding when Dr. Cherukuri ordered the transfer, his decision was in their best medical interest.

Case summary

Dr. Cherukuri, the doctor in this case who had ordered the transfer, was accused of violating the Emergency Medical Treatment and Active Labor Act, 42 U.S.C. § 1395dd(b) (“EMTALA”), which prohibits the transfer of emergency room patients unless they are in a “stable” condition at the time of the transfer.  The United States Department of Health and Human Services fined Dr. Cherukuri $100,000, which was the largest fine ever assessed against a physician for an EMTALA violation.  Dr. Cherukuri appealed to the United States Court of Appeals for the Sixth Circuit.

Ultimately, the Sixth Circuit found that Dr. Cherukuri had performed exemplarily under extreme emergency circumstances. It not only reversed the fine, but it admonished the Health and Human Services Department Appeals Board for not having reviewed the case more carefully.

AMA involvement

The AMA filed an amicus brief on Dr. Cherukuri’s behalf.  After filing the brief, the AMA learned that Dr. Cherukuri had sustained a disability and could not afford an attorney to represent him on the appeal.  The AMA attorney therefore represented Dr. Cherukuri without charge.