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The emergency room situation involves a legal doctrine known as "detrimental reliance." The classics legal example is the drowning man. A bystander on the shore has no duty to attempt to rescue the man. However, if the bystander does begin to swim out and rescue the man, a duty to continue the rescue may arise. This duty to continue arises if other rescuers discontinue their efforts because of the attempted rescue. The principle here is that, once the rescue attempt begins, the drowning man is forced to rely on this attempt because other rescue efforts are prevented. The bystander now has a duty to help because the bystander has interfered with other rescue attempts.

When a hospital or clinic makes it known that it provides emergency care, an injured patient who seeks care at the facility relies on its offer of care. A badly injured person does not have time to go from facility seeking care. If the emergency room personnel refuse to care for the badly injured person, that person may suffer additional injuries (or even death) due to the delay entailed in seeking care elsewhere. The refusing facility could be held liable for the injuries attributable to the delay in obtaining care.

This does not mean that the emergency room must treat everyone who walks in the door. The emergency room's duty (in the absence of special statutes or state case law) is to treat all persons who will suffer further injury during the delay necessary to seek care elsewhere. The litigation in this area seldom involves the intentional refusal of care. The cases arise when patients are turned away without the emergency room personnel realizing that the patient needs emergency care. This mistake can occur if (1) the patients are turned away without the emergency room evaluating their medical condition, (2) the patient's medical condition is evaluated by nontrained personnel, or (3) the patient's condition is misdiagnosed by properly trained medical personnel. While the injury to the patient may be the same, the liability of the facility is potentially different in each situation.

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