The 7th Circuit Court of Appeals found that the 2003 definition of when a person is to have “come to the emergency room” is a clarification of the rule in effect in 2001 and that a woman who filed a lawsuit under the Emergency Medical Treatment and Active Labor Act did not come to the Wishard Hospital emergency department under that act.

When Melissa Welch was 34 weeks pregnant, she called 911 because she had begun labor. The Wishard ambulance dispatched consulted with a nurse at Welch’s obstetrician’s office and agreed she needed to go to the nearest hospital, which was St. Francis Beech Grove. That hospital did not have an obstetrics facility, so Welch was examined at Beech Grove but then sent to St. Francis Hospital South in the Wishard ambulance. There she gave birth to her son Joshua Beller, by Caesarean section. He suffered hypoxia resulting in severe brain damage.

Welch brought suit on behalf of her son claiming Wishard violated the EMTALA by transferring her son to Beech Grove instead of delivering him at that hospital and that resulted in his permanent injuries.

At issue is whether Welch and her son had “come to the emergency room” of Wishard Memorial Hospital when they were transported in the ambulance. The 2001 definition in effect at the time of the delivery was later amended in 2003. Both parties agree that if the 2003 definition is considered applicable because it is retroactive as it is just a clarification of the 2001 rule, then Welch and her son would not have “come to the emergency room” of Wishard and their claim can’t proceed.

The District Court held the amended definition was a clarification that applied retroactively and granted summary judgment to the defendants. The 7th Circuit agreed in Joshua Beller, a minor, by his next friend and mother, Melissa Welch, et al. v. Health and Hospital Corp. of Marion County Ind., d/b/a Wishard Memorial Hospital d/b/a Wishard Ambulance Service, 11-3691.

“There is nothing inconsistent in the 2003 and 2001 definitions. The two are consistent in holding that an individual will be deemed to have come to the emergency department if that person is in an ambulance owned and operated by the hospital. The 2003 definition merely provided guidance as to what it means for an ambulance to be ‘operated by’ a hospital,” Judge Ilana Diamond Rovner wrote.

“The district court properly held that the 2003 amendment is a clarification, which therefore applies in interpreting the meaning of the 2001 language. Because the Wishard ambulance was operating under the EMS protocol at the time the plaintiffs were in it, the plaintiffs had not come to the Wishard emergency department under the EMTALA, and the plaintiffs’ claim cannot succeed.”