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Williams v. Dimensions Health Corporation, Inc.

United States District Court, D. Maryland, Southern Division

November 27, 2017

TERENCE WILLIAMS, Plaintiff,
v.
DIMENSIONS HEALTH CORPORATION, INC., Defendant.

          MEMORANDUM OPINION AND ORDER

          PAUL W. GRIMM, UNITED STATES DISTRICT JUDGE

         Following a rollover motor vehicle collision, Terence Williams was severely injured and brought to the emergency room at Prince George's County Hospital Center. Third Am. Compl. ¶ 10, ECF No. 18. He was screened by a physician assistant, given blood transfusions and, after two hours and forty minutes, brought to the operating room. But, ultimately, his legs had to be amputated. Williams filed suit against Defendant Dimensions Health Corporation, Inc. t/a Prince George's County Hospital Center (the “Hospital”) in the Circuit Court for Prince George's County, alleging violations of the Emergency Medical Treatment and Active Labor Act, 42 U.S.C. § 1395dd (“EMTALA”). ECF No. 1.

         The Hospital removed the case to this Court and then moved to dismiss Williams's complaint, which now is in its fourth iteration. Def.'s Mot., ECF No. 22.[1] In the Hospital's view, Williams “conflate[s] the requirements of EMTALA with traditional state medical negligence requirements.” Def.s' Reply 2; see also Def.'s Mem. 9-10, 11. Williams attached exhibits to his opposition that were not previously attached to or referenced in his complaint, Med. Recs., ECF No. 23-5, and I have considered them in deciding the pending motion; accordingly, I will treat it as a motion for summary judgment. See Fed. R. Civ. P. 12(d). Because the exhibits belie Williams's assertion that he did not receive an appropriate screening, the Hospital is entitled to judgment as a matter of law on Williams's failure to screen claim. But, inasmuch as I cannot determine as a matter of law whether the Hospital failed to stabilize Williams before admitting him, I will deny the Hospital's motion as to that claim.

         Background

         Williams was severely injured in a motor vehicle crash just after midnight on May 3, 2014. Third Am. Compl. ¶ 10. He “suffer[ed] from active exsanguination, mangled limbs, open fractures, severe pain, and pulse-less extremities.” Id. ¶ 15. Emergency Medical Services reached him about a half hour later, designated his status as “Bravo, ” the second highest level of trauma, and alerted the Hospital, a Level II Trauma Center, that it would bring Williams to its emergency room. Id.

         Williams arrived at the Hospital at 1:33 a.m. Four minutes later, he received an initial screening and evaluation from a physician assistant and “his status was upgraded from a Bravo to an Alpha code trauma patient, which meant he was suffering from a major trauma with multiple injuries thereby constituting an emergency medical condition.” Id. ¶¶ 12-13; see Med. Recs. DHCMTD000015. “[T]he primary diagnosis listed on the emergency room records for Williams” is “hypovolemic shock.” Third Am. Compl. ¶ 41; see Med. Recs. DHCMTD000008. Additionally, the physician assistant noted that he was “in severe distress.” Third Am. Compl. ¶ 40. When the on-call trauma surgeon, Dr. Mohammad Ali Kahn, arrived at 1:53 a.m., twenty minutes after Williams, id. ¶ 17, he “confirmed” the emergency medical condition that the physician assistant had identified, and noted that “Williams was suffering from: (a) Severe hypovolemic shock and massive bleeding from the arteries and extremities, (b) Massive soft tissue injury, (c) Vascular injury to the left extremity, [and] (d) Multiple open fractures to the extremities.” Id. ¶¶ 71-72; see Med. Recs. DHCMTD000016. Dr. Kahn noted the “possibility that the patient's extremities may require amputation, ” as well as the “possibility that the patient may succumb to the multiple traumas.” Med. Recs. DHCMTD000016. The Hospital does not dispute these allegations or the authenticity of the Medical Records and therefore, considered in the light most favorable to Williams, he was diagnosed as being in “severe distress” from “[s]evere hypovolemic shock and massive bleeding from the arteries and extremities, ” “[m]assive soft tissue injury, ” “[v]ascular injury, ” and “[m]ultiple open fractures.” Third Am. Compl. ¶¶ 30-31, 71-72; see Med. Recs. DHCMTD000016.

         The Hospital records indicate that he was supposed “to go immediately to the OR for vascular and orthopedic repair, ” but the surgical specialists were a “‘no show' in the ER” and “extreme[ly] tard[y] in the OR.” Third Am. Compl. ¶ 36; see Med. Recs. DHCMTD000022. He was therefore admitted to the Hospital's intensive care unit at 4:13 a.m. Williams claims that he was admitted “merely for ‘observation, '” alleging that “[a]dmission for observation is an ‘outpatient status' given to allow the doctor time to decide if the patient needs to be admitted as an inpatient or discharged; it is not a formal hospital inpatient admission.” Third Am. Compl. ¶ 55. He claims that he was never admitted as an inpatient. Id. ¶ 59. But, the documents he attached to his opposition contradict his pleadings, showing an “Admit” date of May 3, 2014, and stating that Williams was an “INPATIENT - INTENSIVE CARE.” Med. Recs. DHCMTD000013. It is unclear, however, whether he was admitted only for observation at 4:13 a.m. and later admitted as an inpatient, or whether he was admitted as an inpatient at 4:13 a.m.

         Williams was transported to the operating room at 4:15 a.m., with surgery scheduled for 4:24 a.m. Third Am. Compl. ¶¶ 48, 57. The on-call orthopedic and vascular surgeons arrived at 4:35 a.m. and surgery began at 5:13 a.m. Id. ¶ 61. By that time, “his lower extremities [had] become ischemic, gangrenous, and ultimately necrotic due to oxygen deprivation.” Id. ¶ 62. One of the surgeons noted that Williams's open tibia was “bleeding very profusely” and that “the patient came in about 1:30 and by the time [the Hospital was] finally able to restore circulation due to a very complex destruction of his left lower extremity, a little over 6 hours had passed, ” and a “fasciotomy was deemed necessary to facilitate release of potential compartment syndrome, which was very likely given the duration of time since the injury.” Med. Recs. DHCMTD000045.[2] After eleven days, on May 14, 2014, the Hospital transferred Williams to the University of Maryland Shock Trauma. Third Am. Compl. ¶ 93. “[U]ltimately . . . Williams['s] legs [had to] be[] amputated just to save his life.” Id. ¶ 62. It is unclear from the record before me which facility performed the amputation.

         Standard of Review

         The Hospital moves to dismiss pursuant to Rule 12(b)(6), under which Williams's pleadings are subject to dismissal if they “fail[ ] to state a claim upon which relief can be granted.” Fed.R.Civ.P. 12(b)(6). A pleading must contain “a short and plain statement of the claim showing that the pleader is entitled to relief, ” Fed.R.Civ.P. 8(a)(2), and must state “a plausible claim for relief, ” Ashcroft v. Iqbal, 556 U.S. 662, 678-79 (2009). “A claim has facial plausibility when the [claimant] pleads factual content that allows the court to draw the reasonable inference that the [opposing party] is liable for the misconduct alleged.” Iqbal, 556 U.S. at 678.

         For purposes of considering a motion to dismiss, this Court accepts the facts alleged in the operative pleading as true. See Aziz v. Alcolac, 658 F.3d 388, 390 (4th Cir. 2011). Williams attaches various documents to his opposition to support and augment his factual allegations. ECF Nos. 23-1 - 23- 9. Yet, an opposition to a dispositive motion is not a proper vehicle for amending a pleading. See Dyer v. Oracle Corp., No. PWG-16-521, 2016 WL 7048943, at *7 (D. Md. Dec. 5, 2016); Whitten v. Apria Healthcare Grp., Inc., No. PWG-14-3193, 2015 WL 2227928, at *7 (D. Md. May 11, 2015). Nonetheless, I may consider these documents if I treat the Hospital's motion as one for summary judgment, which I may do pursuant to Fed.R.Civ.P. 12(d). See Syncrude Canada Ltd. v. Highland Consulting Grp., Inc., No. RDB-12-318, 2013 WL 139194, at *2 (D. Md. Jan. 10, 2013).

         When a court converts a motion to dismiss to one for summary judgment, “[a]ll parties must be given a reasonable opportunity to present all the material that is pertinent to the motion.” Fed.R.Civ.P. 12(d). Notably, “the Federal Rules do not prescribe that any particular notice be given before a Rule 12 motion is converted to a Rule 56 motion.” Ridgell v. Astrue, DKC-10-3280, 2012 WL 707008, at *7 (D. Md. Mar. 2, 2012). Thus, this requirement “can be satisfied when [as here] a party is ‘aware that material outside the pleadings is before the court.'” Walker v. Univ. of Md. Med. Sys. Corp., No. CCB-12-3151, 2013 WL 2370442, at *3 (D. Md. May 30, 2013) (quoting Gay v. Wall, 761 F.2d 175, 177 (4th Cir. 1985)). Indeed, while the Court “clearly has an obligation to notify parties regarding any court-instituted changes in the pending proceedings, [it] does not have an obligation to notify parties of the obvious.” Laughlin v. Metro. Wash. Airports Auth., 149 F.3d 253, 261 (4th Cir. 1998). And, “the fact that [a party] had attached other materials to its [briefing] should have alerted [the other party] to the possibility” that the Court would treat the motion as a motion for summary judgment. Ridgell, 2012 WL 707008, at *7; see Laughlin, 149 F.2d at 260-61. Here, the Hospital acknowledged the attached documents in its reply, demonstrating its awareness of them. See Def.'s Reply 1, 15-19. I will therefore treat the Hospital's motion as a motion for summary judgment. Accordingly, I consider the undisputed facts and take the disputed facts in the light most favorable to Williams as the non-moving party. See White v. Pauly, 137 S.Ct. 548, 550 (2017).

         Summary judgment is proper when the moving party demonstrates, through “particular parts of materials in the record, including depositions, documents, electronically stored information, affidavits or declarations, stipulations . . ., admissions, interrogatory answers, or other materials, ” that “there is no genuine dispute as to any material fact and the movant is entitled to judgment as a matter of law.” Fed.R.Civ.P. 56(a), (c)(1)(A); see Matherly v. Andrews, 859 F.3d 264, 279, 280 (4th Cir. 2017). If the party seeking summary judgment demonstrates that there is no evidence to support the nonmoving party's case, the burden shifts to the nonmoving party to identify evidence that shows that a genuine dispute exists as to material facts. See Matsushita Elec. Indus. Co. v. Zenith Radio Corp., 475 U.S. 574, 585-87 & n.10 (1986). The existence of only a “scintilla of evidence” is not enough to defeat a motion for summary judgment. Anderson v. Liberty Lobby, Inc., 477 U.S. 242, 251 (1986). Instead, the evidentiary materials submitted must show facts from which the finder of fact reasonably could find for the party opposing summary judgment. Id.

         Discussion

         The Emergency Medical Treatment and Active Labor Act, 42 U.S.C. § 1395dd (“EMTALA”), “imposes a ‘limited duty on hospitals with emergency rooms to provide emergency care to all individuals who come there.'” Vickers v. Nash Gen. Hosp., Inc., 78 F.3d 139, 142 (4th Cir. 1996) (quoting Brooks v. Md. Gen. Hosp., Inc., 996 F.2d 708, 715 (4th Cir. 1993)). Moreover, it “creates a private cause of action for ‘[a]ny individual who suffers personal harm as a direct result of a participating hospital's violation of a requirement of this section.'” Johnson v. Frederick Mem'l Hosp., Inc., No. WDQ-12-2312, 2013 WL 2149762, at *3 (D. Md. May 15, 2013) (quoting 42 U.S.C. § 1395dd(d)(2)(A)). Congress enacted this statute “to deal with the problem of patients being turned away from emergency rooms for non-medical reasons.” Bryan v. Rectors & Visitors of Univ. of Va., 95 F.3d 349, 351 (4th Cir. 1996). It is “commonly known as the ‘Patient Anti-Dumping Act, '” because it “was enacted to prevent hospitals' suspected practice of ‘dumping' patients who were unable to pay for care, either by refusing to provide basic emergency treatment (‘failure to screen') or by transferring patients to other hospitals before the patients' conditions were sufficiently stabilized (‘failure to stabilize').” Johnson, 2013 WL 2149762, at *3; see also Vickers, 78 F.3d at 142; Power v. Arlington Hosp. Ass'n, 42 F.3d 851, 856 (4th Cir. 1994).

         Importantly, EMTALA is intended to “eliminat[e] disparate treatment, not [to ensure] the correctness of the treatment, ” and therefore “[w]hether [a] [h]ospital properly cared for and treated [a] [p]laintiff is, if anything, a question left to state tort law.” Mullins v. Suburban Hosp. Healthcare Sys., Inc., No. PX-16-1113, 2017 WL 480755, at *5 (D. Md. Feb. 6, 2017) (citing Vickers, 78 F.3d at 143); see also Johnson, 2013 WL 2149762, at *4 (“The Act's proscriptions apply solely to ‘a hospital's disparate treatment of-or its total failure to treat-an individual in need of emergency medical care.'” (quoting Bergwall v. MGH Health Servs., Inc., 243 F.Supp.2d 364, 370 (D. Md. 2002))). The Fourth Circuit and this Court have emphasized repeatedly that “EMTALA is a limited ‘anti-dumping' statute, not a federal malpractice statute.” Mullins, 2017 WL 480755, at *4 (citing Bryan, 95 F.3d at 351); see also Vickers, 78 F.3d at 143 (noting the Fourth Circuit's “repeated admonition that EMTALA not be used as a surrogate for traditional state claims of medical malpractice”); Power, 42 F.3d at 856 (“EMTALA is not a substitute for state law malpractice actions, and was not intended to guarantee proper diagnosis or to provide a federal remedy for misdiagnosis or medical negligence.”); Brooks, 996 F.2d at 710 (“The Act was not designed to provide a federal remedy for misdiagnosis or general malpractice.”); Baber v. Hospital Corp., 977 F.2d 872, 880 (4th Cir. 1992) (“EMTALA is no substitute for state law medical malpractice actions.”). Indeed, “construing EMTALA to reach claims sounding in medical malpractice ‘would eviscerate any distinction between EMTALA actions and state law actions for negligent treatment and misdiagnosis.'” Mullins, 2017 WL 480755, at *5 (quoting Vickers, 78 F.3d at 141). The federal statute “is not intended to duplicate preexisting legal protections, but rather to create a new cause of action, generally unavailable under state tort law.” Johnson, 2013 WL 2149762, at *4 (quoting Gatewood v. Wash. Healthcare Corp., 933 F.2d 1037, 1041 (D.C. Cir. 1991)).

         Thus, EMTALA imposes only “a limited duty on hospitals with emergency rooms to provide emergency care to all individuals who come there.” Brooks, 996 F.2d at 714-15. The required care has two components. Johnson, 2013 WL 2149762, at *3. Initially, “when a person seeks treatment at a hospital's emergency room, the hospital must provide ‘an appropriate medical screening examination' to determine whether an ‘emergency medical condition' exists, ” and then, “if the screening reveals the presence of an emergency medical condition, the hospital must either provide the medical examination and treatment necessary to ‘stabilize' the condition, or transfer the person to another medical facility.” Id. (quoting 42 U.S.C. § 1395dd(a), (b)(1))) (footnotes omitted); see also Vickers, 78 F.3d at 142; Williams v. United States, 242 F.3d 169, 173-74 (4th Cir. 2001).

         Failure ...


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