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Williams v. Dimensions Health Corp., Inc.

United States District Court, D. Maryland, Southern Division

May 30, 2018

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

          MEMORANDUM OPINION AND ORDER

          Paul W. Grimm United States District Judge.

         Terence Williams was severely injured in a rollover motor vehicle collision and brought to Prince George's County Hospital Center, a Level II Trauma Center. Def.'s Mem. 1, ECF No. 34-1; Pl.'s Opp'n 2, ECF No. 44. Prince George's County Hospital Center screened him; performed “resuscitative and diagnostic procedures” including “[b]lood transfusions, performing a cut-down to place a Quinton catheter, endotracheal intubation, diagnostic peritoneal aspiration (DPA), and blood draws for labs”; operated on him approximately three hours and forty minutes after his arrival; admitted him as an inpatient; and treated him for eleven days, including performing additional surgical procedures, before transferring him to University of Maryland Medical System. Pl.'s Opp'n 4, 6, 12, 15, 17; Def.'s Mem. 2-8; Williams v. Dimensions Health Corp., Inc., No. PWG-16-4123, 2017 WL 5668217, at *1, *2 (D. Md. Nov. 27, 2017). Despite the extensive treatment, Williams had to have both of his legs amputated due to his injuries. Def.'s Mem. 20; Pl.'s Opp'n 13.

         Believing that he was not screened appropriately nor ever admitted to Prince George's County Hospital Center and that the tissue ischemia and tissue death he suffered in his lower limbs following the accident could have been minimized had he had surgery sooner or been transferred promptly to a Level I Trauma Facility, Williams filed suit against Defendant Dimensions Health Corporation, Inc. t/a Prince George's County Hospital Center (“PGHC” or the “Hospital”). ECF No. 2. He alleged that the Hospital's failure to perform surgery promptly amounted to a failure to provide stabilizing treatment for his emergency medical condition in violation of the Emergency Medical Treatment and Active Labor Act, 42 U.S.C. § 1395dd (“EMTALA”); he also alleged that the Hospital's failure to screen him appropriately violated EMTALA. Id.[1]

         The Hospital filed a motion to dismiss, ECF No. 22, which I construed as one for summary judgment because Williams filed exhibits to support his position and I relied on those exhibits in ruling on the motion. I granted summary judgment in the Hospital's favor on Williams's failure to screen claim because the parties' exhibits demonstrated that Williams received an appropriate screening. Williams, 2017 WL 5668217, at *1. With regard to Williams's failure to stabilize claim, the Hospital focused on the extensive care that Williams conceded he had received, arguing that Williams could not state an EMTALA claim based on his belief that “the stabilization efforts were inadequate and immediate transfer of the patient to UMMS was a more appropriate course of action, ” as “a medical negligence claim and not EMTALA is the appropriate cause of action to pursue” for such allegations. Def.'s Mem. in Support of Mot. to Dismiss 9, 12-13, ECF No. 22-2; see also Def.'s Reply in Support of Mot. to Dismiss 12, ECF No. 24. Notably, the Hospital-arguing for dismissal and therefore not relying on the exhibits (which showed that Williams had been admitted, contrary to his allegations)-did not assert that Williams's admission to the Hospital barred his recovery under EMTALA.

         Williams countered that, despite the treatment it provided to him, the Hospital failed to meet the stabilization requirements of EMTALA because it allowed his “conditions to materially deteriorate” by not performing surgery promptly. Pl.'s Opp'n to Mot. to Dismiss 25-28, ECF No. 23. I noted the well-established law that state medical malpractice law governs treatment after a patient is admitted, and a patient cannot bring an EMTALA claim based on care received after admission. Williams, 2017 WL 5668217, at *7 (citing, e.g., Bryan v. Rectors & Visitors of Univ. of Va., 95 F.3d 349, 350-51 (4th Cir. 1996)). Because I could not determine on the record before me at that time when Williams was admitted and whether the Hospital failed to stabilize Williams before admitting him, I denied the motion as to Williams's failure to stabilize claim. Id.

         The Hospital has filed a second dispositive motion, ECF No. 34, now insisting that Williams's admission to the Hospital bars his recovery under EMTALA. Def.'s Mem. 13, ECF No. 34-1; Def.'s Reply 1-2, ECF No. 47.[2] Williams continues to argue that he never was admitted prior to transfer, Pl.'s Opp'n 6, and still I cannot determine on the record before me when precisely Williams was admitted. Yet, the record establishes that there is no genuine dispute that, at some point on May 3, 2014, he was admitted as an inpatient. Williams, 2017 WL 5668217, at *2 (noting that the Medical Records that Williams filed with his opposition to the Hospital's first dispositive motion “show[] an ‘Admit' date of May 3, 2014, and stat[e] that Williams was an “INPATIENT - INTENSIVE CARE”; citing Med. Recs. DHCMTD000013).

         Further, the Hospital's briefing, as well as my additional, independent research, makes clear that “admission of an individual as an inpatient is a complete defense to an EMTALA failure-to-stabilize claim, provided that the hospital does so in good faith in order to stabilize the emergency condition.” Morgan v. N. Miss. Med. Ctr., Inc., 458 F.Supp.2d 1341, 1350 (S.D. Ala. 2006), aff'd, 225 Fed.Appx. 828 (11th Cir. 2007); see 42 C.F.R. § 489.24(d)(2)(i); Bryan, 95 F.3d at 351. Thus, contrary to my understanding when I considered the parties' arguments for the Hospital's first dispositive motion, “[t]he patient's admission to the hospital is essential to this court's decision-the time of admission is not.” Ceballos-Germosen v. Doctor's Hosp. Ctr. Manati, 62 F.Supp.3d 224, 232 (D.P.R. 2014). Because Williams was admitted and has not shown that his admission was not in good faith, I will grant the Hospital's Motion for Summary Judgment and close this case.

         Standard of Review

         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

         State medical malpractice law does not provide a cause of action against a medical provider for “failure to treat, ” such that hospitals can, without fear of repercussions under state tort law, turn away patients who cannot afford care. Bryan v. Rectors & Visitors of Univ. of Va., 95 F.3d 349, 351 (4th Cir. 1996). Recognizing this void in the law more than thirty years ago, Congress “expressed concern that hospitals were abandoning the longstanding practice of providing emergency care to all due to increasing pressures to lower costs and maximize efficiency.” Brooks v. Md. Gen. Hosp., Inc., 996 F.2d 708, 710 (4th Cir. 1993). To ensure that hospitals were not “‘dumping' patients unable to pay, by either refusing to provide medical treatment or transferring patients before their emergency conditions were stabilized, ” Congress enacted the Emergency Medical Treatment and Active Labor Act, 42 U.S.C. § 1395dd (“EMTALA”), in 1986. Brooks, 996 F.2d at 710; see Bryan, 95 F.3d at 351 (noting that Congress enacted EMTALA “to deal with the problem of patients being turned away from emergency rooms for non-medical reasons”). The statute “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, 996 F.2d at 715). And, relevantly here, 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)).

         EMTALA's passage did not “duplicate preexisting legal protections, but rather . . . create[d] 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)). Stated differently, “EMTALA is a limited ‘anti-dumping' statute, not a federal malpractice statute, ” and it does not ensure “the correctness of the treatment.” Mullins v. Suburban Hosp. Healthcare Sys., Inc., No. PX-16-1113, 2017 WL 480755, at *4, *5 (D. Md. Feb. 6, 2017) (citing Bryan, 95 F.3d at 351); see also Vickers, 78 F.3d at 143; Brooks, 996 F.2d at 710; Baber v. Hospital Corp., 977 F.2d 872, 880 (4th Cir. 1992). 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, 2017 WL 480755, at *5 (citing Vickers, 78 F.3d at 143); see also Johnson, 2013 WL 2149762, at *4; Bergwall v. MGH Health Servs., Inc., 243 F.Supp.2d 364, 370 (D. Md. 2002).

         Pursuant to EMTALA, if an emergency medical condition exists, the hospital must “stabilize the condition or, if medically warranted, . . . transfer the person to another facility if the benefits of transfer outweigh its risks.”[3] Brooks, 996 F.2d at 710; see 42 U.S.C. § 1395dd(b)(1). A hospital stabilizes a patient when it “provide[s] such medical treatment of the condition as may be necessary to assure, within reasonable medical probability, that no material deterioration of the condition is likely to result from or occur during the transfer of the individual from a facility.” 42 U.S.C. § 1395dd(e)(3)(A). Although the statute defines stabilization in terms of transfer, it obligates a hospital to stabilize a patient even if it is not transferring the patient. In re Baby K, 16 F.3d 590, 597-98 (4th Cir. 1994). That is, EMTALA also “require[s] stabilization prior to discharge.” Id.

         Significantly, when, instead of discharging or transferring a patient, a “hospital admits the individual as an inpatient for further treatment, the hospital's obligation under [EMTALA] ends.” 42 C.F.R. § 489.24(a)(1)(ii); see Leimbach v. Hawaii Pac. Health, No. 14-246 JMS, 2015 WL 4488384, at *11 (D. Haw. July 22, 2015) (“[A]ny EMTALA requirement to transfer Plaintiff ended when he was admitted to WMH.” (citing Bryant v. Adventist Health Sys. N., 289 F.3d 1162, 1168 (9th Cir. 2002))). Thus, if a hospital finds that an individual has an emergency medical condition and then “admits that individual as an inpatient in good faith in order to stabilize the emergency medical condition, the hospital has satisfied its special responsibilities under this section with respect to that individual.” 42 C.F.R. § 489.24(d)(2)(i) (emphasis added); see also Johnson v. Frederick Mem'l Hosp., Inc., No. WDQ-12-2312, 2013 WL 2149762, at *5 (D. Md. May 15, 2013) (“[A] hospital need not stabilize a patient who, although experiencing a medical emergency, has been admitted for treatment.”). Notably, “[a] hospital's EMTALA obligation ends when the individual has been admitted in good faith for ...


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