Bryant v. Adventist Health Systems/West

• Decision Date: 20 May 2002
• Docket Number: No. 00-16399.,00-16399.
• Citation: 289 F.3d 1162
• Parties: Sandra BRYANT, Successor-in-Interest to David Howard Bryant, deceased; David Wayne Bryant, Heir and Surviving Parent of David Wayne Bryant, deceased; Tom Worthy; Michael Bryant, Plaintiffs-Appellants, v. ADVENTIST HEALTH SYSTEM/WEST; Redbud Community Hospital District; Wolfgang Schug, M.D.; Robert Rosenthal; Andrew J. Dorfman; Richard Furtado, M.D.; J.J. & R. Management Group, Inc.; Adventist-Redbud Hospital, Inc.; Michael H. Schultz; Mark Freeman, M.D.; Redbud Community Healthcare District, Defendants-Appellees.
• Court: U.S. Court of Appeals — Ninth Circuit

Page 1162

289 F.3d 1162

Sandra BRYANT, Successor-in-Interest to David Howard Bryant, deceased; David Wayne Bryant, Heir and Surviving Parent of David Wayne Bryant, deceased; Tom Worthy; Michael Bryant, Plaintiffs-Appellants, v. ADVENTIST HEALTH SYSTEM/WEST; Redbud Community Hospital District; Wolfgang Schug, M.D.; Robert Rosenthal; Andrew J. Dorfman; Richard Furtado, M.D.; J.J. & R. Management Group, Inc.; Adventist-Redbud Hospital, Inc.; Michael H. Schultz; Mark Freeman, M.D.; Redbud Community Healthcare District, Defendants-Appellees.

No. 00-16399.

United States Court of Appeals, Ninth Circuit.

Argued and Submitted November 7, 2001.

Filed May 20, 2002.

Richard J. Massa, Massa & Associates, Lakeport, CA, for the plaintiffs-appellants.

Sonja M. Dahl, Anderson, Galloway & Lucchese, Walnut Creek, CA; John S. Gilmore, Goldsberry, Freeman & Swanson, Sacramento, CA; David A. Heck, Bradley, Curley, Asiano & McCarthy, PC, San Francisco, CA, for the defendants-appellees.

Appeal from the United States District Court for the Northern District of California; Vaughn R. Walker, District Judge, Presiding. D.C. No. CV-98-00759-VRW.

Before: CANBY, GRABER, and PAEZ, Circuit Judges.

PAEZ, Circuit Judge.

Plaintiffs, the heirs of minor decedent David Bryant ("David"), brought this wrongful death action against Redbud Community Hospital ("Redbud") for damages and injunctive relief for, among other things, violation of the Emergency Medical Treatment and Active Labor Act ("EMTALA"), 42 U.S.C. § 1395dd, commonly known as the "Patient Anti-Dumping Act." Plaintiffs alleged that when David sought care from Redbud's emergency room, the emergency room staff failed to detect his emergency medical condition and then discharged him without stabilizing his condition, in violation of EMTALA's stabilization requirement. Plaintiffs further alleged that after David returned to the emergency room the next day and was admitted to the hospital for inpatient care, Redbud again violated EMTALA's stabilization requirement by failing to stabilize his condition during the three days after it admitted him for treatment.

The district court granted Redbud's motion for summary judgment on the EMTALA claims, and it declined to exercise supplemental jurisdiction over related statelaw claims. The district court ruled that Redbud could not be liable under EMTALA merely because its medical staff failed to detect an emergency medical condition. The district court also ruled that once Redbud admitted David for inpatient care, Plaintiffs' remedies for David's alleged inadequate medical care were under state law, not EMTALA. We agree with the district court and, therefore, affirm.

I. Factual and Procedural History

David was a 17-year-old boy who was severely disabled and had the mental capacity of a young child. He was unable to communicate with anyone other than close relatives. He had a history of asthma, bronchitis, and pneumonia. On the evening of January 24, 1997, David, accompanied by his mother and other family members, went to Redbud's emergency room because he had been coughing up blood and had a fever. After examining David, a nurse classified his condition as "urgent."

Soon thereafter, Dr. Robert Rosenthal examined David. David's mother told Dr. Rosenthal that her son had suffered from a fever for approximately four days and appeared to be experiencing pain in the right side of his chest. Dr. Rosenthal noticed that David was coughing up yellow phlegm, had a mild fever, and was wheezing. Dr. Rosenthal ordered a chest x-ray and blood tests. He failed to detect on the x-ray a large lung abscess, which Defendants concede constituted an emergency medical condition, and diagnosed David with only pneumonia and asthma. Dr. Rosenthal then treated David with Albuterol, which assists breathing, and prescribed an antibiotic, Rocephrin, for the pneumonia. Because David was agitated, the medical staff was not able to inject the full dosage of Rocephrin. Nonetheless, the medical staff determined that it had injected a sufficient amount of the antibiotic to stabilize his pneumonia. Because David's condition appeared stable and because Dr. Rosenthal and David's family agreed that David would be more relaxed at home, Dr. Rosenthal discharged him. Dr. Rosenthal, however, requested that the family return with David the following day for further diagnosis and treatment. David and his family left the hospital at approximately 2:30 a.m. on January 25.

In the afternoon of January 25, as David and his family were preparing to leave for the hospital, a hospital employee called and told them to return immediately because Dr. Richard Furtado had determined from David's chest x-ray that he had a lung abscess. Dr. Furtado considered the abscess to be a "problem worthy of admission." Shortly after David's arrival at the emergency room, Dr. Furtado admitted David to the hospital, and he was transferred from the emergency room to a medical/surgical room.

By January 28, David's condition had declined rapidly, and the doctor responsible for his care decided to transfer him to the Intensive Care Unit. Because there were no beds available in the Intensive Care Unit, David was transferred to U.C. Davis Medical Center, where he eventually had surgery. Plaintiffs do not contend that this emergency transfer to the Center was improper or a violation of EMTALA. On February 20, David was released from U.C. Davis and returned home. Although David appeared to be improving, he died suddenly and unexpectedly on March 1, 1997.

Plaintiffs filed this action in district court against Redbud Community Healthcare District; Adventist Health System/West, Inc.; Janzen, Johnston & Rockwell Emergency Medical Group of California; and several of the treating physicians. The amended complaint alleged violations of EMTALA, violation of a similar state law (California Health & Safety Code § 1317), and negligence.¹

Defendants moved for summary judgment. They argued that Redbud's medical staff was not required under EMTALA to stabilize David's lung abscess before discharging him on January 25, 1997, because the medical staff had not yet detected the abscess. Defendants also maintained that once Redbud admitted David for treatment later that day, EMTALA no longer applied.

The district court agreed with Defendants and granted summary judgment on the EMTALA claims. After dismissing the federal claims, the court exercised its discretion to dismiss the supplemental state-law claims without prejudice.

II. Standard of Review

We review de novo a district court's grant of summary judgment. Botosan v. Paul McNally Realty, 216 F.3d 827, 830 (9th Cir.2000). We review a district court's dismissal of supplemental state-law claims for an abuse of discretion. San Pedro Hotel Co. v. City of Los Angeles, 159 F.3d 470, 478 (9th Cir.1998).

III. Discussion

A. EMTALA

Congress enacted EMTALA to ensure that individuals, regardless of their ability to pay, receive adequate emergency medical care. Jackson v. E. Bay Hosp., 246 F.3d 1248, 1254 (9th Cir.2001). "Congress was concerned that hospitals were `dumping' patients who were unable to pay, by either refusing to provide emergency medical treatment or transferring patients before their conditions were stabilized." Eberhardt v. City of Los Angeles, 62 F.3d 1253, 1255 (9th Cir.1995). EMTALA protects all individuals, not just those who are uninsured or indigent. Arrington v. Wong, 237 F.3d 1066, 1069-70 (9th Cir. 2001).

If an individual seeks emergency care from a hospital with an emergency room and if that hospital participates in the Medicare program, then "the hospital must provide for an appropriate medical screening examination within the capability of the hospital's emergency department ... to determine whether or not an emergency medical condition ... exists."² 42 U.S.C. § 1395dd(a); Eberhardt, 62 F.3d at 1255-56. If the hospital's medical staff determines that there is an emergency medical condition, then, except under certain circumstances not relevant here, the staff must "stabilize" the patient before transferring or discharging the patient. 42 U.S.C. § 1395dd(b)(1); Baker v. Adventist Health, Inc., 260 F.3d 987, 992 (9th Cir. 2001). The term "to stabilize" means "to provide 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). Transfer includes both discharge and movement to another facility. Id. § 1395dd(e)(4).

B. The January 24-25 Emergency Room Visit

Plaintiffs concede that Redbud's staff performed an appropriate medical screening on January 24 but argue that the hospital violated EMTALA by failing to stabilize David's lung abscess condition. Plaintiffs contend that § 1395dd(b)(1) should be read to include a reasonableness standard in determining whether a hospital has detected an emergency medical condition. Thus, Plaintiffs argue, in effect, that a hospital should be liable under EMTALA if its staff negligently fails to detect an emergency medical condition.

EMTALA, however, was not enacted to establish a federal medical malpractice cause of action nor to establish a national standard of care. Baker, 260 F.3d at 993; see also, e.g., Summers v. Baptist Med. Ctr. Arkadelphia, 91 F.3d 1132, 1137 (8th Cir.1996) (en banc) ("So far as we can tell, every court that has considered EMTALA has disclaimed any notion that it creates a general federal cause of action for medical malpractice in emergency rooms."); Holcomb v. Monahan, 30 F.3d 116, 117 (11th Cir.1994) ("Section 1395dd(a) is not designed to redress a negligent diagnosis by the hospital; no federal malpractice claims are created."). Thus, we have held that a hospital has a duty to stabilize only those emergency medical conditions that its staff detects. Jackson, 246 F.3d at 1254-55...