United States District Court, D. Maryland, Southern Division
MEMORANDUM OPINION AND ORDER
W. GRIMM, UNITED STATES DISTRICT JUDGE
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.
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. 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.
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.
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.
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.
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. 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.
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.
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.
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,
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.
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.
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)).
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).