Cherukuri v. Shalala

In 1991 Williamson Hospital received five patients who had been in an automobile accident. Theodore Cherukuri (plaintiff), the on-call general surgeon, determined that two of the patients had severe head injuries and needed immediate abdominal surgery because of internal bleeding. The on-call anesthesiologist refused to administer the anesthesia for the surgery because the hospital lacked equipment to monitor brain activity. Cherukuri was unable to change the anesthesiologist’s mind or locate another anesthesiologist. Cherukuri determined that the patients should be transferred to a different hospital and contacted the physicians at the transferee hospital. The physicians instructed Cherukuri not to transfer the patients. However, Cherukuri transferred the patients. The physicians reported Cherukuri to the secretary of the Department of Health and Human Services, Donna Shalala (defendant), for violating the Emergency Medical Treatment and Active Labor Act (EMTALA). An administrative-law judge (ALJ) held a hearing. Two expert witnesses for the government testified that Cherukuri had not stabilized the patients prior to the transfer, because a patient with internal bleeding is not stabilized until receiving abdominal surgery. At the hearing, the physicians who had reported Cherukuri testified that they had assessed the situation and no longer believed that Cherukuri had violated EMTALA. The ALJ accepted the expert’s definition of stabilization, determined that anesthesia was available for the surgery, and found that Cherukuri had violated EMTALA. Cherukuri appealed to the EMTALA review board. The board refused to review the case. Cherukuri filed a petition for review at the United States Court of Appeals for the Sixth Circuit.