Penn hospital sued over failure to admit patient

The Hospital of the University of Pennsylvania was sued in federal court yesterday for allegedly refusing to accept a patient because he lacked health insurance.

The lawsuit on behalf of Marcus Murray, 56, and his wife, Jean, claims that Penn initially said it would accept a transfer of the man from Underwood Memorial Hospital in Gloucester County. Murray needed emergency surgery to treat a tear in a major artery.

Penn had originally agreed to accept Murray, then refused after learning he had no health insurance, according to the complaint filed in U.S. District Court in Philadelphia by Murray's lawyer, Thomas R. Kline.

Susan E. Phillips, Penn Medicine's chief of staff, said in a statement that "we believe Mr. Kline's allegations are groundless. We have expedited admission criteria for such life-and-death cases and accept patients without any regard to insurance coverage based on the urgency of their condition."

The suit also named Penn cardiothoracic surgeon Y. Joseph Woo, Underwood, and its emergency-room doctor on the case, Robert M. Sidwa. It alleged that Underwood failed to properly diagnose Murray's condition and did not transfer him to a hospital capable of dealing with his problem soon enough.

Underwood vice president Peter A. Kaprielyan said in a statement that the hospital had not been served with the lawsuit and "therefore, it would be inappropriate for us to comment at this time.

Murray, a contractor and laborer, was driving home to Felton, Del., from South Jersey on May 2, 2008, when he began experiencing chest pain and weakness, hospital records show. An ambulance reached him at 7:09 p.m.; the crew found Murray sitting in the driver's seat of his car with chest pain and weakness.

At 7:27 p.m. in the emergency room at Underwood, a nurse noted he was pale, sweating profusely and complaining of chest pain and shortness of breath.

He was moved to a bed, and it was noted that his blood pressure was dangerously low.

He was taken for a CT scan at 10:50 p.m. The scan revealed a "complex dissection of the thoracic and abdominal aorta," an emergency that required treatment by a cardiothoracic surgeon.

An aortic dissection is a life-threatening condition involving a tear in the inner lining of the major artery leaving the heart.

Underwood lacks open-heart-surgery capability, so Murray needed to be transferred to another hospital.

At 10:54 p.m., according to Murray's Underwood records, Sidwa made a note that Penn had agreed to accept Murray, and efforts were made to get a helicopter to transport him to Philadelphia.

But helicopter transport was impossible because of bad weather, Sidwa noted at 11:39 p.m.

Sidwa then wrote that he had spoken with Woo, the Penn surgeon, who told him that Murray was "not accepted at this time due to various reasons."

A nurse's note in Murray's records at 11:56 p.m. said Penn "refused to accept patient due to no medical insurance."

Sidwa then contacted Christiana Hospital in Delaware and arranged for an ambulance to transfer him. Murray left Underwood at 1:44 a.m. on May 3 and arrived at Christiana half an hour later. He was taken to an operating room and suffered a cardiac arrest at 3:07 a.m. while being given anesthesia, the lawsuit stated.

It had been nearly eight hours since EMS first reached him.

Thomas R. Kline, the lawyer who represents Murray and his wife, said that notes in the Underwood medical records clearly show that Penn "accepted and then refused the patient and refused on a very specific basis."

Murray suffered brain damage and is blind as a result of the lack of timely care at Underwood and the delay in getting him treatment caused by Penn's about-face, Kline said.

Penn billed Murray $297 but waived those charges after his lawyers contacted the hospital.

The case was filed in federal court because, Kline said, in addition to medical negligence, the suit alleges that Penn violated the Emergency Medical Treatment and Active Labor Act, or EMTALA.

According to the suit, "the 'reverse dumping' section of EMTALA states that 'a participating hospital that has specialized capabilities or facilities . . . shall not refuse to accept an appropriate transfer of an individual who requires such specialized capabilities of facilities if the hospital has the capacity to treat the individual.' "

The statute was enacted in 1986 to protect public access to emergency medical services regardless of the ability to pay. The act requires hospitals that participate in Medicare to provide stabilizing treatment and transfer the patient to a hospital with the capabilities to treat the problem.

"The statute reads like a legal prescription for what Penn cannot do but did in this case," Kline said.

Penn's Phillips, however, said, "We welcome the opportunity to defend our actions in this case."

In Penn's statement, she said that, "unless we lack the medical capacity to accommodate a transfer due to the needs of existing critically ill patients already being cared for in our hospitals, we routinely accept urgent patient transfers when medically safe."