Rosa Rivera was pregnant and went to the emergency room at DeTar Hospital (DeTar) with labor pains and hypertension, or very high blood pressure. Rivera had not had any prenatal care and could not pay. Dr. Michael Burditt (defendant) was next on the hospital’s list of doctors for obstetric patients without a regular doctor, but he refused to see Rivera. Instead, Burditt ordered Rivera to be transferred to a hospital 170 miles away. After being pressured by DeTar personnel, Burditt ordered a medicine for Rivera’s blood pressure and examined Rivera. At that point, Rivera had the highest blood pressure Burditt had ever seen. Burditt knew that Rivera’s blood pressure could cause complications that could kill her or her baby. However, Burditt still insisted on transferring Rivera and did not order any life-saving equipment to go in the ambulance with her. About 40 miles into the transfer, a nurse delivered Rivera’s baby and diverted the ambulance for necessary medicine. Burditt still insisted that the transfer continue. However, at Rivera’s request, the ambulance returned to DeTar. Burditt continued to refuse to treat Rivera and gave orders to discharge her if she was stable. Instead, a new doctor was assigned to Rivera. Rivera was discharged three days later in good condition. The United States Department of Health and Human Services (plaintiff) fined Burditt $20,000 for violating the Emergency Medical Treatment and Active Labor Act (EMTALA). Burditt appealed.