PHILADELPHIA – Whether a four-hour ER delay in 2015 cost a Pennsylvania woman vision in one eye and adversely impacted her life remains on the books following a memorandum opinion issued by a judge in Philadelphia Feb. 6.
Multiple allegations of neglect characterized Dawn L. McClure’s complaint lodged against a consortium of health care providers — Eric L. Parvis M.D., Chester County Hospital (CCH) and Penn Valley Medicine Unionville — in a case reviewed in the U.S. District Court for the Eastern District of Pennsylvania in Philadelphia on Feb. 6.
After she suffered a brain hemorrhage leading to partial loss of vision and impaired functioning in September 2015, McClure prevailed over the defendants' objections when Judge Timothy J. Savage ruled that she presented sufficient evidence for the case to continue based on two distinct counts against the defendants.
By overruling the defendants’ motion to dismiss the claims of corporate negligence, the court has cleared the way for the plaintiff to pursue legal action against the named health care facilities and practitioners.
Specifically, McClure suffered a right parietal (brain) hemorrhage on Sept. 8, 2015, first signaled by awakening with a severe headache and vision issues that morning, according to the memorandum. After scheduling an appointment with primary care at Unionville she was denied her time slot after arriving 15 minutes late; at that point office staff instructed her to proceed to an urgent care facility.
According to the complaint, McClure was disoriented and vomiting by the time she reached the nearest facility, at which point she was transported by ambulance to the CCH emergency department.
Records indicate that the patient was admitted at 1 p.m. but was not seen until 4:42 p.m., when a CT scan revealed a brain hemorrhage. the opinion states.
Subsequently, the plaintiff was airlifted by helicopter to the Hospital of the University of Pennsylvania. The opinion states that she remained there for six days until her release Sept. 14.
In her complaint, McClure stated that she lost vision in her left eye, struggles with balance and coordination, and now receives occupational and physical therapy.
The defendants moved to dismiss the case claiming that CCH did perform a timely first screening and that the plaintiff allegedly failed to provide proof of “disparate” treatment.
The legal question became not one of whether treatment was rendered at all, but rather whether a delay in treatment can be classified as “the functional equivalent of a denial” of treatment - in this case screening - when McClure endured that four-hour wait upon her Sept. 8, 2015, hospital arrival.
McClure’s case was technically twofold: she filed an Emergency Medical Treatment and Labor Act (EMTALA) claim against CCH based on the extreme delay; and she additionally charged the defendants with corporate neglect in a separate but related allegation.
Emergency Medical Treatment and Labor Act (EMTALA) is a federal law mandating that any individual entering a health care facility’s emergency department must be stabilized and treated, regardless of their insurance or financial status.
“CCH argues that a mere delay in treatment does not amount to disparate treatment,” the opinion states. “CCH also argues that McClure’s presenting symptoms of vision problems and vomiting did not constitute an emergency medical condition that would warrant immediate attention.”
Yet, significantly, McClure’s condition was duly classified as a neurological emergency by admitting personnel, according to the opinion. Her complaint included a claim of breach of duty on the defendants’ part to exercise reasonable care for her safety and well-being which in turn increased her risk of complications.
The defendants argued that hospital personnel did act appropriately by ordering tests, further contending that the patient did not actually go so far as to claim “disparate treatment.”
However, judicial authorities countered that - aside from the possibility of having exacerbated the patient’s condition - the delay itself may have been in violation of EMTALA.
“This may be true,” the court’s response to the claim of taking suitable action reads. “But … these tests were not ordered or conducted until several hours after she had arrived at the ER. Whether the testing and examination was timely is a factual determination that is inappropriate on a motion to dismiss.”
Savage further explained that CCH’s rationale - that treatment delay itself does not support McClure’s claim - misinterprets the law. He also found that performing the act of screening per se does not automatically or legally constitute adequacy, with effective treatment ultimately dependent on an attending physician’s assessment of an individual’s presenting condition.
The court denied the defendants’ motion to dismiss claims of corporate negligence based on business structure, stating within the memorandum: “Under Pennsylvania law, a hospital has a non-delegable duty to adhere to the proper standard of care to ensure the patient’s safety and well-being.”
Unionville and others attempted to dispute corporate liability by denying its application to physician practice groups. It even went so far as to state that as a legal entity, the organization is "not a hospital" and "merely operates as the parent corporation for various health care entities, practices, groups and hospitals."
In response, the court found the corporate practice wholly liable.
“Liability for corporate negligence … arises from the medical entity’s own acts or omissions,” the opinion continued. “The focus is not on what the employee did or did not do, but rather on what the employer did or did not do.”
Furthermore, the court ruled that the plaintiff presented sufficient evidence for her case — satisfying both the EMTALA and corporate negligence claims. It therefore denied the defendants’ motion for dismissal, allowing the case to proceed.