For decades, the adjudication of medical malpractice cases has mostly been the province of state courts that apply state laws and measure the appropriateness of care and treatment according to generally accepted standards of medical practice in their communities. Similarly, the disciplining of medical professionals for substandard performance has been left to state licensing authorities. In recent years, tort lawyers have repeatedly sought to introduce medical malpractice cases into the federal courts through pleadings that assert that the alleged malpractice also violated federal laws, usually those laws that expand the provider’s financial liability and the attendant possibilities for larger awards.
To some extent, federal suits have increased due to efforts by Congress and federal agencies to set quality standards that are higher than those of the states. For example, the Emergency Medical Treatment and Active Labor Act (EMTALA),[1]� also known as the patient anti-dumping act, was intended to prevent hospital emergency rooms from refusing to provide emergency medical services to patients based upon the patient’s ability or inability to pay. This statute’s laudable goal has largely been accomplished. But cases frequently arise in which a medical misjudgment is made, a patient is discharged from an emergency room and the resulting harm to the patient gives rise to both standard malpractice claims and an EMTALA claim, thereby enabling the case to be filed in a federal court, even though an independent state cause of action is available under EMTALA.
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