Polite Dissent

Yesterday, I briefly discussed the Federal statute EMTALA, at least as it applies to patient dumping. Today, a look at a different aspect of the law — a patient arriving at the Emergency Room in active labor.

In this scene from Pulse #12, Jessica Jones — who is 6 months pregnant — has presented to the ER in labor. The doctor is in the process of finishing his evaluation when the chief administrator of the hospital comes down into the ER and kicks her out of the hospital.

Situations like this is where EMTALA (the Emergency Medical Treatment and Active Labor Act) comes in to play. When a patient in labor presents to the ER, and is medically determined to be in active labor, then the hospital is obligated to treat her until the delivery is complete.

There can be circumstances where a patient requires transfer to another facility for appropriate medical care. For instance, a small town ER may not have the capabilities to treat a severe head injury and would need to transfer the patient to a larger hospital. It is entirely possible that Jessica Jones is a patient who will require transfer, but it’s too soon to tell and the hospital still has an obligation to treat her. Under EMTALA, this transfer should wait until the patient is stable or labor is complete. In rare circumstances, an unstable patient (or one in active labor) may be transferred to another hospital, but this has very strict requirements including:
The patient must be stabilized as much as possible by the initial hospital.
The medical benefits of the transfer must outweigh the risks of the transfer¹.
A physician² states — in writing — that this is true.
The receiving facility agrees to accept the patient.

This scene doesn’t meet these criteria. Jessica has presented to the ER in active labor, and preterm labor at that. The hospital administrator — who may or may not have some sort of medical training — has no say in the medical disposition of the patient. You’ll notice that she is over-ruling the doctor³ who is actually providing care to the patient. While she may have some valid points about risk to her facility⁴, that does not change her obligations to the patient under the law. She does make a perfunctory comment about “call[ing] the Baxter Building or SHIELD,” but she has not arranged any sort of transfer before telling the orderlies to discharge the patient.

Of course, this is assuming that EMTALA or a similar law exists in the Marvel Universe. Even if it doesn’t, you can’t tell me that the hospital wouldn’t have some sort of policy about treating superhuman patients. Hospitals have contingency plans for everything, there’s no way a hospital in Marvel’s NYC would not have some sort of plan for this scenario.

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Notes:
¹ This is medical risk and benefit to the patient, not the hospital.
² Or a medical professional under the supervision of a physician.
³ Writer Brian Michael Bendis does an excellent job depicting the interaction between the ER physician and pregnant super-hero. It’s a nice series of scenes that seems believable both from a medical perspective as well as a super-hero perspective.
⁴ I can’t deny there would be risk in treating super-heroes, but hospitals and ERs are — by definition — risky places to be. For example, that patient in the waiting room may have a particularly infectious strain of Influenza or some other equally nasty disease? The risk from that patient would much higher than any imagined risk from super-heroes.

Tags: comics medicine jessica jones pregnancy emtala