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"Screen, Stabilize, Transfer": The Legal Duty of Emergency Care in Kerala

Emergency Medicine Law | By M S Sulthan Legal Associates | February 2026

On November 14, 2025, the Kerala High Court delivered a judgment that has fundamentally altered the legal landscape for Casualty and Emergency Rooms (ER) across the state. In a case involving a private hospital that turned away a trauma victim due to the inability to pay an advance deposit, the Court laid down strict liability principles.

The message to the medical community is unambiguous: Economic capacity cannot be a prerequisite for preserving life. This article outlines the legal Standard Operating Procedures (SOPs) that hospitals must adopt to comply with this ruling and avoid catastrophic "Medical Negligence" claims.

1. The Legal Mandate: Article 21 & The "Golden Hour"

The judgment reinforces the principles first laid down in Parmanand Katara v. Union of India, but applies them specifically within the context of the Kerala Clinical Establishments Act. The Court held that every medical establishment, regardless of its private or public nature, has a constitutional obligation under Article 21 (Right to Life) to provide immediate aid.

The "No-Denial" Rule: No hospital can deny screening or initial stabilization to a patient presenting with an emergency medical condition on the grounds of:

Non-payment of advance/deposit.
Lack of police intimation (in Medico-Legal Cases).
Lack of specific specialist availability (if basic life support is possible).

2. The 3-Step Legal SOP: Screen, Stabilize, Transfer

To mitigate legal risk, ER departments must follow this documented workflow. Deviation from this protocol is now primary evidence of negligence.

Step 1: SCREEN (Medical Screening Examination)

The Duty: Every patient arriving at the ER must undergo a Medical Screening Examination (MSE) to determine if an emergency exists. This cannot be delayed for registration paperwork.

Documentation: The "Triage Sheet" must record vitals and the time of arrival. If a patient is turned away at the gate by security or reception without seeing a doctor, the hospital is vicariously liable.

Step 2: STABILIZE (The Primary Obligation)

The Definition: Stabilization means providing medical treatment to ensure that no material deterioration of the condition is likely to result from a transfer.

Legal Requirement: You must secure the Airway, Breathing, and Circulation (ABC). If you do not have a neurosurgeon, you must still intubate and stabilize the vitals before referring the head injury patient. Referring an unstable patient is "Patient Dumping."

Step 3: TRANSFER (Safe Referral)

Transfer is legally permitted only after stabilization, or if the hospital lacks the capability to treat the specific condition (e.g., no Cath Lab).

Communication: The referring doctor MUST call the receiving hospital and confirm bed availability.
Transport: The patient must be transferred in an ambulance equipped with life support, accompanied by trained staff if necessary.
Consent: Written "Informed Refusal" or "Transfer Consent" must be obtained from the bystander.

3. Financial Realities: What constitutes "Free Care"?

The judgment clarifies that private hospitals are not expected to provide free surgeries or long-term ICU care indefinitely. The mandate is limited to "Emergency Stabilization."

Clarification: Once the patient is stabilized (e.g., bleeding stopped, vitals stable), the hospital can request payment or arrange for transfer to a Government Medical College if the family cannot afford further treatment. However, holding a patient hostage or refusing discharge for non-payment remains illegal.

Conclusion: Documentation is Defense

In emergency medicine law, if it isn't written down, it didn't happen. The "Referral Note" is your most critical legal document. It must explicitly state: "Patient stabilized. Reason for transfer: Higher center management required/Financial constraints. Receiving hospital informed." Adhering to the Screen-Stabilize-Transfer protocol is the only shield against the rising tide of litigation.

Risk Management for Hospitals

We draft comprehensive ER protocols and consent forms to protect hospitals from negligence liability.