When Does Denial of Medical Treatment Constitute Medical Malpractice?

Access to adequate medical care is closely tied to longer life expectancies and higher quality of life. This fact should come as no surprise. When people have access to the healthcare they need, when they need it, they are more likely to avoid health complications that reduce their quality of life or increase their risk of mortality. 

That’s why denial of medical treatment can be such a serious problem. You could face debilitating or even life-threatening complications if you are denied care. Refusal or delay of treatment may even be medical malpractice. 

However, healthcare providers have the right to deny treatment in certain circumstances. Understanding what counts as denial of treatment is important to determine whether you have been harmed by medical malpractice. 

What Constitutes Denial of Medical Care?

Until just a few decades ago, no laws required healthcare workers to provide treatment for any reason. Beginning in 1964, Title VI of the Civil Rights Act stated that institutions that received federal funding could not refuse to treat patients because of protected characteristics. However, this did not apply to private institutions and did not require any institution to treat patients as long as it was not basing its decisions on protected traits. 

In 1986, the first federal law requiring certain facilities to provide healthcare to all was enacted. The Emergency Medical Treatment and Active Labor Act (EMTALA) required healthcare facilities with dedicated emergency rooms to treat anyone with an emergency medical condition, regardless of their ability to pay or other concerns. Conditions requiring treatment under EMTALA include:

  • Active labor
  • Sudden conditions involving severe pain or psychiatric disturbances
  • Rapid onset conditions that could place the individual’s health, bodily functions, or abilities in serious jeopardy

EMTALA only applies to facilities with emergency departments, though. It does not apply to private practices, specialty hospitals without emergency rooms (ERs), and medical labs. Furthermore, once a patient is stabilized, the facility may legally refuse further care and discharge the patient if the reason is not discriminatory.

When Can a Healthcare Provider Refuse to Treat Patients?

The Civil Rights Act and EMTALA remain the basis for medical malpractice claims related to denial of treatment. However, it’s important to understand that healthcare practitioners are not always obligated to treat you, and in many cases, the refusal to treat is not malpractice. Situations when a non-emergency provider can deny care include:

  • They are not currently accepting new patients
  • They don’t take your health insurance
  • You cannot pay the costs of the procedure
  • They don’t want to treat your condition
  • They have religious or conscientious beliefs that bar them from providing certain care
  • You have acted in a destructive or disruptive manner
  • They are not acting in their capacity as a healthcare provider

Furthermore, even under EMTALA, hospitals with ERs can deny treatment to patients if:

  • The patient is not experiencing a medical emergency
  • The patient appears to be seeking care to obtain drugs
  • The patient’s behavior is endangering others

In these circumstances, refusing to provide treatment is not considered malpractice. 

When Denial of Care Becomes Medical Malpractice

While there are many circumstances where refusal of care is permitted, there are still times when it constitutes medical malpractice. These cases must meet the four elements of malpractice under California law:

  • Duty of Care: The provider or facility must have a duty to care for the patient. Under EMTALA, ERs must care for you if you are having a medical emergency. Meanwhile, all providers are responsible for following standards of care for their patients as long as they have agreed to treat them. 
  • Breach of Duty: A breach of duty occurs if a provider fails to meet standards of care while treating a patient. Common violations include an ER refusing to treat a patient during a medical emergency or a private provider halting a patient’s necessary and ongoing treatment without providing a referral to another facility.
  • Injury: Even if a facility committed a breach of duty, the patient must have been harmed somehow, or there are no grounds for a claim. For instance, if you’re refused emergency treatment for a heart attack, any resulting damage to your heart or future symptoms of heart failure may be grounds for a claim.
  • Cause: Finally, the patient’s injuries must have been caused by the breach of duty. You must prove that the lack of treatment directly led to your losses. 

If these four elements are present, the provider may have committed medical malpractice when refusing to treat you. 

It is important to note that denying treatment is different from delaying treatment. A delay of care occurs when a patient does not receive appropriate treatment in a timely fashion. It may happen because the provider:

  • Withheld medication without due cause
  • Ignored or missed common indications of serious conditions
  • Failed to order physical therapy or other care indicated by the patient’s condition

However, this doesn’t constitute a refusal of care because the provider is technically treating the patient. They are just doing a bad job. However, if they violate standards of care, this may still be considered medical malpractice if the other three elements are present.

Filing a Medical Malpractice Claim for Denial of Treatment

All malpractice complaints are complex matters. If you believe that you were unlawfully denied treatment and that this caused you harm, we encourage you to contact an experienced medical malpractice attorney as soon as possible.The skilled attorneys at the Law Offices of Michael Oran, APC, can assist you. We have over three decades of experience representing Los Angeles medical malpractice victims as they pursue justice. Schedule your consultation today to discuss your circumstances today.

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