Please read this passage and answer discussion questions 1-4 thank you so much!
IIII Beller k. Mealith and Mospital Corp. of Marlon County 703F.3d388 (7th Cir, 2012) Rovner, Circuit Judge The plaintifls brought suit alleging that the Tefendant, Health and Hospital Corporation of Marion County. Indiana d/b/a Wishard Memorlal Hospital .... violated [EMTALA] by failing to stabilite Melissa Welch and her minor son, Joshua Bellec, during an emergency medical situation. The district court granted summary judgment for Wishard, and the plaintiffs appeaL. On fune 14, 2001, Melissa Welch called 911 and a Wishard ambulance was dispatched to her home. Welch was 34 weeks pregnant, and the paramedics ascertained that her water broke and she had a prolapsed umbilical cord. The paramedics tried to relieve pres: sure on the cord, and after consulting with the nurse at Welch's obstetrician's office. agreed that Weich needed to be transported to the nearest hospital. They then contacted the St. Francis Beech Grove ("Beech Grove") emergency room and transported her there. Beech Grove did not have an obstetrics facility. Rather than delivering the baby there, the physician at Beech Grove examined Welch and then sent her in the Wishard ambulance to St. Francis Hospital South. There, Joshua Beller was delivered by Caesarean section, but he had suffered hypoxia resulting in severe brain damage. The plaintiffs allege that Wishard violated the EMTALA by trans. erring loshua to Beech Grove instead of tabilizing him by delivering him, and that the ifure resulted in his permanent injuries. The issue in this case is whether the plainis had "come to the emergency room" of shard Memorial Hospital when they were sported in the Wishard ambulance. The regutations to the EMTALA, promule by the Department of Health and hests Services' Center for Medicare and MeServices ("DHHS"). Provide a definis " the emergency room," but the 200ddtht tion in effect at the time of the incisent subsequently amended. Both parties that under the 2003 definition, the phints would not have "come to the ernergency room" of Wishard, and therefore the the could not proceed. The core issue, then, which definition applies. The 2001 regulation provides that: Comes to the emergency departrom means... that the individual is on the hospital property. For purposes of this section ... property .... includes ambulances owned and operated by the hospital even if the ambulante is not on hospital grounds. 42 CF, $489.24(b)(2001). That regulation was later amended in 2003, and although it still provided that an individual in an ambulance owned and operated by the hospital is deemed to have come to the emergency room, it also stated that such person is not considered to have comit to the emergency room of that hospital? (i) (t)he ambulance is operated under communitywide emergency medica' service (EMS) protocols that direct to transport the individual to a hosp other than the hospital that owns t: ambulance.... The Wishard ambulance was operat ing under EMS protocols at the time it (Conthord foum pamious poge) hospital property, and [that] hospital prop: erty includes "ambulances owned and operated by the hospitat even if the ambulance is not on hospital grounds." The plaintiffs" statement that a person there fore had come to the emergency department if she was in a "hospital-owned ambulance" ignores the second qualifier, which is that the ambu. lance must be cwned "and operated by" a hospital. The 2003 definition clarified what it meant for an ambulance to be "operated by" a hospital. ... That is a classic situation of a clarifying regulation. The plaintiffs' exclusive focus on the ownership of the ambulance. and their failure to recognize the 200: requirement that the ambulance must also be operated by the hospital, misses the critical point. The advent of the EMS protocols caused confusion in that an ambulance could be owned by a hospital but not operated under its direction. The 2003 regulation fied with respect to that and another in ring situation, that the individuals hsold. be deemed to have come to the enting room of the hospital because the and by was under the operation of others. There is nothing inconsistent in the of and 2001 definitions. The two are consists in holding that an individual will be defer. to have come to the emergency departhe if that person is in an ambulance on operated by the hospital. ... Because Wishard ambulance was operating circe the EMS protocol at the time the plaintiffs had not come to th were in it, the plaintifs had not comertment under the Wishard emergency departmo succeed. The decision of the district cour granting summary judgment in favor of the defendant is Affirmed. Discussion Questions 1. Do you agree that the 2003 amendment was a "clarification" and not a substantive change to the EMTALA regulation? 2. Should the HHS denomination of the amendment be determinative? 3. Why is the named defendant the "Health and Hospital Corporation of Marion County" ad not Wishard Hospital? 4. Had the outcome here favored the plaintiffs, what would the next procedural steps hast been and what would the likely outcome of the case be on its merits? Notes 1. 42 U.S.C. $1395 dd. 2. In 1991 , more than 5,100 EDs reported 88.5 million visits. In 20 there were nearly 130 million visits to fewer than 4,500 EDs. The latest numbers show only 4,349ED. totaled
