Emergency primary angioplasty was performed on two patients, resulting in good outcomes, but leaving the question of whether they should have performed the emergency angioplasty at all. Warren Hospital (“Warren”) appealed a final agency holding of the New Jersey Department of Health and Senior Services (“Department”) which led to sanctions being imposed on the hospital for performing these medical services without a license from the State in Warren Hospital v. New Jersey Dept. of Health and Senior Services, Superior Court of New Jersey, Appellate Division, Docket No.: A-5956-10T2. Warren was charged with violating N.J.S.C. 8:43G-2.4(c) for conducting primary angioplasty services on two patients in 2006 and 2007 without the appropriate license to do so. Warren is licensed to perform low-risk cardiac catheterization. The nearby hospital that can do primary angioplasty is located five miles away. The first patient arrived at Warren with a rapidly deteriorating condition in which he complained of shortness of breath and chest pain. He experienced acute myocardial infarction and extremely low blood pressure. The director of the hospital, Dr. Amin, examined the patient and decided to perform the emergency procedure after seeing his heart could not be stabilized enough to make the trip to the nearby hospital. Dr. Amin and other doctors concluded the patient would “almost certainly die en route to that facility.” Warren, because of its license, does not possess the equipment to perform the primary angioplasty in the full, appropriate manner. The procedure was overwhelmingly successful.
The second patient arrived at the hospital and emergency room physicians determined he was suffering from basically the same problem the first patient suffered. The resuscitative efforts did not help enough for him to be transported, according to Warren. Due to him remaining “extremely unstable” and the primary angioplasty was performed for this patient because benefits of doing so “greatly outweighed the risks associated with transporting [him] in his highly unstable condition. He began to stabilize and was then transported to the nearby hospital. Warren asserted congested roads and toll lines and the noticeable delay of the ambulance they would summon was not of value in these two cases.
The Department ultimately decided Warren should not have performed the operations because the hospital was not approved to do so, and willfully did so, nonetheless. On appeal, the Department sought to argue Warren did not develop an effective policy for transferring the patients to other hospitals when needed. Conversely, Warren argued on appeal the New Jersey statute should not apply; instead a conflicting federal statute, 14 U.S.C.A. § 1395dd should, which authorized the performed emergency procedures due to the risk of the patients facing imminent death if another course of action was followed, namely sending the patients to a nearby hospital to receive the appropriate care. Warren argued they complied with the federal law because “medical risks of attempting to transfer the patient to a qualified facility outweigh the potential benefits.” Warren sought to comply with the federal law to end what is nicknamed “patient dumping” where patients would not receive care for “purely financial reasons.”
Ultimately, the appellate court could not come to a conclusion due to a lack of necessary facts, and the case was sent back to the agency to figure out before an appeal could come back to court. The court wanted to know whether there were any transport providers who could supply quicker service and whether Warren investigated their options in the free market. The contract between the transport provided and the hospital was also distinctly missing from the facts. The court held the Department should have charged Warren with violating N.J.A.C. 8:33E-1.8(a) for the correct facts to be discovered. “Because the [Department’s] key conclusion on this subject is not grounded in a proper record . . . we do not owe it special deference.” The agency will have to make this new charge and then the new facts will lead to a right conclusion either justifying the actions of the physicians under federal law or leading to sanctions.