Arrington v. Wong

• Decision Date: 22 January 2001
• Docket Number: No. 98-17135,98-17135
• Citation: 237 F.3d 1066
• Parties: (9th Cir. 2001) MARIA MARIE ARRINGTON, Individually; Estate of HAROLD E. ARRINGTON, Deceased; TISHA MAUNAALA ARRINGTON, a minor, a nfr Maria Marie Arrington; Estate of HAROLDLIND KEALAPULANI FITZGERALD, Deceased; PEARL MOMILANI ARRINGTON; CHARLOTTE NALANI PARKS; LYNNETTE LEILANI ARRINGTON; HAROLD EDWARD ARRINGTON, JR.; KELLY ARRINGTON; ARDELLA AHLOHA ARRINGTON; ERIC ANTHONY ARRINGTON; DEREK BRUCE ARRINGTON; MICHELLE LEHUA MALIAFAU; NATALIE PULANI LOPA; LEALOHA; SOLOMON SAMUEL KALUNA; MICHELLE LEHUA MALAFAU, Plaintiffs-Appellants, v. NORBERT B. WONG, M.D; THE EMERGENCY GROUP, INC.; THE QUEEN'S MEDICAL CENTER; CITY AND COUNTY OF HONOLULU; CLARENCE UYEMA, EMT; JERRY HO, EMT, Defendants-Appellees
• Court: U.S. Court of Appeals — Ninth Circuit

Page 1066

237 F.3d 1066 (9th Cir. 2001)

MARIA MARIE ARRINGTON, Individually; Estate of HAROLD E. ARRINGTON, Deceased; TISHA MAUNAALA ARRINGTON, a minor, a nfr Maria Marie Arrington; Estate of HAROLDLIND KEALAPULANI FITZGERALD, Deceased; PEARL MOMILANI ARRINGTON; CHARLOTTE NALANI PARKS; LYNNETTE LEILANI ARRINGTON; HAROLD EDWARD ARRINGTON, JR.; KELLY ARRINGTON; ARDELLA AHLOHA ARRINGTON; ERIC ANTHONY ARRINGTON; DEREK BRUCE ARRINGTON; MICHELLE LEHUA MALIAFAU; NATALIE PULANI LOPA; LEALOHA; SOLOMON SAMUEL KALUNA; MICHELLE LEHUA MALAFAU, Plaintiffs-Appellants, v. NORBERT B. WONG, M.D; THE EMERGENCY GROUP, INC.; THE QUEEN'S MEDICAL CENTER; CITY AND COUNTY OF HONOLULU; CLARENCE UYEMA, EMT; JERRY HO, EMT, Defendants-Appellees.

No. 98-17135

UNITED STATES COURT OF APPEALS FOR THE NINTH CIRCUIT

Argued and Submitted July 12, 2000

Filed January 22, 2001

[Copyrighted Material Omitted] Magali V. Sunderland and Hilary Benson Ganges, Trecker & Fritz, Honolulu, Hawai'i, for the plaintiff-appellants.

Peter C.-P. Char and Deborah A. de Quevedo, Char, Hamilton Campbell & Thom, Honolulu, Hawai'i, for defendants appellees Norbert B. Wong, M.D. and the Emergency Group, Inc.

William S. Hunt, Ellen Godbey Carson, and Jason H. Kim, Alston Hunt Floyd & Ing, Honolulu, Hawai'i, for defendant appellee The Queen's Medical Center.

Thomas E. Cook, Lyons, Brandt, Cook & Hiramatsu, Honolulu, Hawai'i, for defendants-appellees City and County of Honolulu, Clarence Uyema, EMT, and Jerry Ho, EMT.

Appeal from the United States District Court for the District of Hawai'i David A. Ezra, District Judge, Presiding. D.C. No.CV-98-00357-DAE

Before: William C. Canby, Jr., Stephen Reinhardt, and Ferdinand F. Fernandez, Circuit Judges.

Opinion by Judge Reinhardt; Dissent by Judge Fernandez

REINHARDT, Circuit Judge:

We are required on this appeal to construe the language of the Emergency Medical Treatment and Active Labor Act of 1986 (EMTALA), 42 U.S.C. 1395dd, as implemented by 42 C.F.R. 489.24. EMTALA prevents transfers, without stabilizing treatment, of patients who "come to" a hospital's emergency room. The complaint alleges that: (1) decedent Harold E. Arrington suffered a heart attack on his way to work; (2) in the ambulance, on the way to the Queen's Medical Center (Queen's hospital), the emergency personnel radioed ahead to advise the hospital's emergency room of their imminent arrival; (3) Dr. Norbert Wong, the emergency room doctor on duty, redirected the ambulance to a different hospital five miles away from Queen's; and (4) Mr. Arrington died soon after arrival at the more distant hospital. The issue before us is whether the plaintiffs have stated a claim under EMTALA on the basis of the defendants' failure to provide emergency treatment to Mr. Arrington.

I. Background¹

On May 5, 1996, at approximately 11:30 p.m., Harold Arrington (Arrington) was driving to his job as a security guard when he experienced difficulty breathing. One of his co-workers called for an ambulance; it arrived shortly after midnight. The ambulance left the scene at 12:24 a.m. to take Arrington to the closest medical facility, the Queen's Medical Center (Queen's hospital).

Dr. Norbert Wong was the emergency room physician on duty at Queen's hospital. While under way, the ambulance personnel contacted the hospital emergency room by radio. They relayed the details of Arrington's medical condition to Dr. Wong. Arrington was "in severe respiratory distress speaking 1-2 words at a time and . . . breathing about 50 times a minute." Dr. Wong asked the ambulance personnel who was the patient's doctor. The ambulance personnel replied "patient is a Tripler [Army Medical Center] patient, being that he was in severe respiratory distress we thought we'd come to a close facility." Dr. Wong responded: "I think it would be okay to go to Tripler." The ambulance personnel took this as a directive and changed their route so as to proceed to the more distant hospital. By the time the ambulance arrived at Tripler it was 12:40 a.m. and Arrington's condition had deteriorated. He was pronounced dead at 1:17 a.m.

On May 18, 1998 plaintiffs filed an amended complaint in federal district court against three sets of defendants: (1) Dr. Wong and his employers, the Emergency Group., Inc.; (2) the emergency personnel, Clarence Uyema and Jerry Ho, and their employers, the City and County of Honolulu; and (3) The Queen's Medical Center. The amended complaint alleged, among other things, a violation of the Emergency Medical Treatment and Active Labor Act of 1986(EMTALA). Subsequently, Queens filed a Rule 12(b)(1) motion to dismiss (lack of subject-matter jurisdiction), Wong and The Emergency Group filed a Rule 12(b)(6) motion to dismiss (failure to state a claim), and the City and County of Honolulu, Clarence Uyema and Jerry Ho filed a motion for judgment on the pleadings under Rule 12(c). The district court heard all three motions on September 21, 1998, and two days later filed its order. It granted the defendants' motions and dismissed the plaintiffs' complaint on the ground that, for the purposes of EMTALA, Arrington had never "come to" Queens emergency department. The court concluded that EMTALA applied only in the case of a patient's "physical presence" in the emergency room. See Arrington v. Wong, 19 F. Supp. 2d 1151, 1156 (D.C. Haw. 1998). This appeal ensued.

II. Standard of Review

We review de novo a district court's dismissal of a complaint: for failure to state a claim pursuant to Federal Rule of Civil Procedure 12(b)(6), see Partnership Exch. Sec. Co. v. NASD, 169 F.3d 606, 608 (9th Cir. 1999); for lack of subject matter jurisdiction pursuant to Rule 12(b)(1), see Hodge v. Dalton, 107 F.3d 705, 707 (9th Cir. 1997); and for judgment on the pleadings pursuant to Rule 12(c). See Fajardo v. County of Los Angeles, 179 F.3d 698, 699 (9th Cir. 1999).

III. Analysis

To provide emergency treatment to indigent and uninsured patients, Congress enacted the Emergency Medical Treatment and Active Labor Act of 1986 (EMTALA), commonly known as the Patient Anti-Dumping Act, 42 U.S.C. 1395dd, to prevent "hospitals . . . `dumping' [indigent ] patients . . . by either refusing to provide emergency medical treatment or transferring patients before their conditions were stabilized." James v. Sunrise Hosp., 86 F.3d 885, 886 (9th Cir. 1996) (quoting Eberhardt v. City of Los Angeles, 62 F.3d 1253, 1255 (9th Cir. 1995) (internal quotation marks omitted). See also Gatewood v. Washington Healthcare Corp., 933 F.2d 1037, 1039 (D.C. Cir. 1991) (stating that EMTALA passed amid growing reports in the 1980's of hospitals denying emergency health care services to the poor and uninsured). The provisions of EMTALA are not limited to the indigent and uninsured however. "Because [EMTALA] is clear on its face, we have held `that the Act applies to any and all patients, not just to patients with insufficient resources.' " James, 86 F.3d at 887 (quoting Brooker v. Desert Hosp. Corp., 947 F.2d 412, 414 (9th Cir. 1991)).

Under EMTALA, for those hospitals with an emergency department: "if any individual . . . comes to the emergency department and a request is made on the individual's behalf for examination or treatment for a medical condition, the hospital must provide for an appropriate medical screening examination within the capability of the hospital's emergency department." 42 U.S.C. 1395dd(a) (emphasis added). If, after screening, the hospital determines that an emergency medical condition exists, the hospital generally may not transfer the patient without stabilizing his condition. Id. 1395dd(b)(1)(A). In the case before us, the question we must decide is whether Arrington's attempt to reach the hospital falls within the scope of EMTALA's "comes to" language.

To do so, we must first determine whether the language of EMTALA is sufficiently clear to apply without interpretation. In the ordinary case, courts simply apply the unambiguous terms of a statute to the case before them. See Chevron, U.S.A. Inc. v. Natural Res. Def. Council, Inc., 467 U.S. 837, 842 (1984) ("If the intent of Congress is clear, that is the end of the matter; for the court, as well as the agency, must give effect to the unambiguously expressed intent of Congress."). If the language of the statute is not clear on its face, courts examine the specific and general statutory context in which the phrase is used in an effort to discern a determinate meaning. See Robinson v. Shell Oil Co., 519 U.S. 337, 341 (1997) ("The plainness or ambiguity of statutory language is determined by reference to the language itself, the specific context in which that language is used, and the broader context of the statute as a whole"); Estate of Cowart v. Nicklos Drilling Co., 505 U.S. 469, 477 (1992); McCarthy v. Bronson , 500 U.S. 136, 139 (1991); see also Brown v. Gardner, 513 U.S. 115, 118 (1994) ("Ambiguity is a creature not of definitional possibilities but of statutory context."); King v. St. Vincent's Hosp., 502 U.S. 215, 221 (1991) ("[T]he meaning of statutory language, plain or not, depends on context")). When a "statute is silent or ambiguous with respect to the specific issue," courts will generally interpret the statute, unless an agency with the power to construe the statute has already provided a construction. Chevron, 467 U.S. at 843. In that circumstance, the court must determine whether the agency's interpretation is "permissible:" if so, that interpretation applies. Id. Where Congress expressly delegates to an agency the power to construe a statute, we review the agency's interpretation under the "arbitrary and capricious" standard; where delegation is implicit, the agency's interpretation must be "reasonable. " Id. at 84344; see also FDA v. Brown & Williamson Tobacco Corp., 529 U.S. 120, 157-159, 120 S.Ct. 1291, 1314 (2000).

In the instant case, appellees urge in their briefs that the phrase "comes to the emergency department" inS 1395dd(a)...