United States District Court, D. Maryland
JERRY W. MULLINS, Plaintiff,
THE UNION MEMORIAL HOSPITAL, INC., d/b/a MedStar Union Memorial Hospital Defendant.
Paula Xinis United States District Judge
before the Court is Defendant MedStar Union Memorial
Hospital's motion for summary judgment. ECF No. 75.
Plaintiff Jerry Mullins has opposed the motion, and the
matter is now ripe for decision. See D. Md. Loc. R.
105.2. No. hearing is necessary. See D. Md. Loc. R.
105.6. Upon consideration of the parties' briefing and
the evidence in the record, the Court GRANTS Defendant's
following facts are undisputed. On April 15, 2014, Plaintiff
Jerry Mullins' (“Mullins”) finger was injured
by a fan blade. ECF No. 5 ¶8, ECF No. 75 at 2. Mullins
traveled in an ambulance to John's Hopkins Suburban
Hospital (“Suburban”). There, a physician's
assistant treated Mullins by applying a numbing agent and
splinting his injured hand. ECF No. 5 ¶17, ECF No. 75-1
at 14. Emergency department physician, Dr. Leonard, then
examined Mullins. ECF No. 75-1 at 24. Suburban is a Level II
Trauma center, with on-call orthopedic and hand specialists.
ECF No. 75-1 at 33-39. Dr. Leonard consulted with
the first on-call hand specialist who was too busy to see
Mullins, but suggested contacting the second on-call hand
specialist at Suburban Hospital or transferring Mullins to
Medstar Union Memorial Hospital (“Union
Memorial”). The second on-call hand specialist
could not be located. Dr. Leonard also tried to contact the
two hand surgeons affiliated with Suburban without success.
Dr. Leonard then discussed Mullins' medical situation
with Dr. Elliot at Union Memorial. Dr. Elliot advised that
after Mullins was seen by a Suburban orthopedic or hand
specialist, they should follow up with Union Memorial to
determine the appropriate course of care. ECF No. 75-1 at
interim, Suburban's on-call orthopedic surgeon, Dr.
Gasho, evaluated Mullins. Dr. Gasho concluded that
Mullins' hand required surgery and advised Mullins of the
risks, benefits, and alternatives regarding the surgery. ECF
No. 75-1 at 20. Mullins consented to the surgery and did not
request a second opinion. ECF No. 75-1 at 20. Mullins'
finger currently has not returned to full function and is
physically deformed. ECF No. 5 ¶¶49, 55.
result, Mullins, pro se, brought claims against Suburban and
its affiliates, Union Memorial and its affiliates, and
physicians Dr. Feledy (Suburban's on-call hand
specialist), Dr. Leonard, Dr. Elliot, and Dr. Zimmerman
(Union Memorial's on-call attending physician) for
violations of the Emergency Medical Treatment and Active
Labor Act (“EMTALA”), 42 U.S.C. § 1395dd,
and for medical malpractice. See ECF. No. 49 at 3-4
(describing claims). On February 6, 2017, the Court dismissed
all claims against all defendants except for the EMTALA claim
against Union Memorial. ECF No. 49. At the close of discovery,
Union Memorial moved for summary judgment. ECF No. 75. Union
Memorial argues that Mullins' EMTALA claim fails as a
matter of law. For the reasons articulated below, the Court
Standard of Review
Summary judgment is appropriate when the court, viewing the
evidence in the light most favorable to the non-moving party,
finds no genuine disputed issue of material fact, entitling
the movant to judgment as a matter of law. See Fed.
R. Civ. P. 56(a); Celotex Corp. v. Catrett, 477 U.S.
317, 322 (1986); Emmett v. Johnson, 532 F.3d 291,
297 (4th Cir. 2008). “A party opposing a properly
supported motion for summary judgment ‘may not rest
upon the mere allegations or denials of [his] pleadings,'
but rather must ‘set forth specific facts showing that
there is a genuine issue for trial.'” Bouchat
v. Baltimore Ravens Football Club, Inc., 346 F.3d 514,
522 (4th Cir. 2003) (quoting former Fed.R.Civ.P. 56(e)).
“A mere scintilla of proof . . . will not suffice to
prevent summary judgment.” Peters v. Jenney,
327 F.3d 307, 314 (4th Cir. 2003). Importantly, “a
court should not grant summary judgment ‘unless the
entire record shows a right to judgment with such clarity as
to leave no room for controversy and establishes
affirmatively that the adverse party cannot prevail under any
circumstances.'” Campbell v. Hewitt, Coleman
& Assocs., Inc., 21 F.3d 52, 55 (4th Cir. 1994)
(quoting Phoenix Sav. & Loan, Inc. v. Aetna Casualty
& Sur. Co., 381 F.2d 245, 249 (4th Cir. 1967)).
Where the party bearing the burden of proving a claim or
defense “fails to make a showing sufficient to
establish the existence of an element essential to that
party's case, and on which that party will bear the
burden of proof at trial, ” summary judgment against
that party is likewise warranted. Celotex, 477 U.S.
at 322. Although a pro se party is “given some
latitude, ” he may not avoid summary judgment by
“relying on bald assertions and speculative
arguments.” Mansfield v. Kerry, No. DKC
15-3693, 2016 WL 7383873, at *2 (D. Md. Dec. 21, 2016)
(citing Smith v. Vilsack, 832 F.Supp.2d 573, 580 (D.
Court previously allowed Mullins' claim against Union
Memorial to proceed under EMTALA's
“nondiscrimination” provision, on the theory that
Union Memorial violated EMTALA when it refused to accept
Mullins as an “urgent transfer request.” ECF No.
49 at 9-10. Now, Union Memorial argues broadly that
Mullins' case falls outside EMTALA because Mullins was
stabilized at Suburban, contending that no duty attaches to
any medical provider under the Act once a patient is stable.
Alternatively, Union Memorial contends that EMTALA does not
reach this case because Union Memorial did not have any more
specialized forms of care than did Suburban, nor did it have
the capacity to accept Mullins as a transfer. Finally, Union
Memorial argues that it did not “decline” Mullins
as a patient, but instead offered to consult on his care.
was passed by Congress in 1986 in response to a growing
concern that hospitals were ‘dumping' patients
unable to pay, by either refusing to provide emergency
medical treatment or transferring patients before their
emergency conditions were stabilized.” Brooks v.
Maryland Gen. Hosp., Inc., 996 F.2d 708, 710 (4th Cir.
1993). Notably, “[t]he Act was not designed to provide
a federal remedy for misdiagnosis or general malpractice,
” but rather to ensure that hospitals will provide
emergency care to all. Id. See also Baber v. Hosp. Corp.
of Am., 977 F.2d 872, 880 (4th Cir. 1992) (“The
avowed purpose of EMTALA was not to guarantee that all
patients are properly diagnosed, or even to ensure that they
receive adequate care, but instead to provide an
‘adequate first response to a medical crisis' for
all patients[.]” (quoting 131 Cong. Rec. S13904 (Oct.
addition to the “anti-dumping” provisions that
require hospitals to screen and stabilize patients who
present to the emergency department for treatment, 42 U.S.C.
§ 1395dd (a)-(b), EMTALA includes a
“nondiscrimination” provision which expressly
provides that “participating hospitals” with
“specialized capabilities or facilities, ” may
not refuse “an appropriate transfer of an individual
who requires such specialized capabilities or facilities if
the hospital has the capacity to treat the individual.”
42 U.S.C. § 1395dd (g). Known also as the
“reverse-dumping” provision of EMTALA, hospitals
with such “specialized capabilities” must not
refuse transfer if such hospital can provide such necessary
services. See Ercan E. Iscan, Emtala's
Oft-Overlooked "Reverse Dumping" Provision and the
Implications for Transferee Hospital Liability Following
St. Anthony Hospital, 82 Wash. U. L.Q. 1201, 1202 (2004).
assuming that Mullins has demonstrated his condition was not
stable and thus warranted transfer, he must also show that
Union Memorial, as the putative receiving hospital, possessed
“specialized capabilities” relative to the
transferring hospital. St. Anthony Hosp. v. U.S.
Dep't of Health & Human Servs., 309 F.3d 680,
701 (10th Cir. 2002). Assuming without deciding that Union
Memorial is a “participating hospital, ” and thus
covered under EMTALA, Mullins has failed to put forward
sufficient evidence to survive summary judgment. The record
evidence reflects that Suburban retained on-call hand
specialists and orthopedic surgeons. ECF No. 75-1 at 33-39.
Indeed, that Mullins had his surgery performed by an
orthopedic surgeon at Suburban further supports the relative
parity of the two hospitals.Viewing the evidence most
favorably to Mullins, he cannot show that Suburban was
lacking such “specialized capabilities.”
Attempting to generate a genuine dispute of fact in this
regard, Mullins submits Union Memorial's webpage to
highlight claimed material differences between it and
Suburban. ECF No. 81-10. Although this website touts Union
Memorial's accomplishments and expertise in the relevant
field, it offers nothing to advance that Suburban lacked
similar specialized capabilities. Mullins also concedes that
Suburban is a Level II Trauma Center with both orthopedic and
hand specialists on call. ECF No. 81-1 at 3. Because Mullins
has not generated sufficient evidence showing Union Memorial
is any more “specialized” than Suburban, the
EMTALA claim fails. See St. Anthony, 309 F.3d at 701
(affirming a finding that “Congress intended th[is]
term to encompass those capabilities and facilities which
enable a hospital to offer specialized care that is not
offered by hospitals that are less well-endowed[.]”).
Union Memorial contends that even if Mullins could
demonstrate that the hospital was a “specialized
facility, ” the record evidence viewed most favorably
to Mullins shows that Union Memorial lacked the capacity to
treat him. Federal regulations implementing EMTALA define
capacity as “the ability of the hospital to accommodate
the individual requesting examination or treatment of the
transferred individual. Capacity encompasses such things as
numbers and availability of qualified staff, beds and
equipment and the hospital's past practices of
accommodating additional patients in excess of its occupancy
limits.” 42 C.F.R. § 489.24 (2013). See St.
Anthony, 309 F.3d at 701 (applying this regulatory
definition). Union Memorial's on-call fellow, Dr. Elliot,
attests without contradiction that at the time he received
the call about Mullins, Union Memorial's hand specialists
were also called to operate on a multi-digit amputation case
which would have been triaged as a higher priority than
Mullins if he had been accepted as a patient. ECF No. 75-1 at
35. Because of this other surgery, Mullins would not have
received treatment at Union Memorial until the next day.
Id. In contrast, the orthopedic surgeon at Suburban