Harry v. Marchant

• Decision Date: 16 May 2002
• Docket Number: No. 99-13205.,99-13205.
• Parties: Bernie HARRY, as Personal Representative of the Estate of Lisa Normil, deceased, Plaintiff-Appellant, v. Wayne MARCHANT, M.D., Ali Bazzi, M.D., et al., Defendants-Appellees.
• Court: U.S. Court of Appeals — Eleventh Circuit

291 F.3d 767

Bernie HARRY, as Personal Representative of the Estate of Lisa Normil, deceased, Plaintiff-Appellant, v. Wayne MARCHANT, M.D., Ali Bazzi, M.D., et al., Defendants-Appellees.

No. 99-13205.

United States Court of Appeals, Eleventh Circuit.

May 16, 2002.

Peter Loblack, Law Office of Peter Loblack, P.A., Miami, FL, for Plaintiff-Appellant.

Miles Ambrose McGrane, McGrane & Nosich, P.A., William G. Edwards, Marlow, Connell, Valerius, Abrams & Adler, Miami FL, Esther Elisa Galicia, George, Hartz, Lundeen, Flagg & Fulmer, Vanessa Reynolds, Conrad & Scherer, Ft. Lauderdale, FL, for Defendants-Appellees.

Appeal from the United States District Court for the Southern District of Florida.

Before ANDERSON, Chief Judge, and TJOFLAT, EDMONDSON, BIRCH, DUBINA, BLACK, CARNES, BARKETT, HULL, MARCUS and WILSON, Circuit Judges.

BLACK, Circuit Judge:

This case involves the Emergency Medical Treatment and Active Labor Act (EMTALA), 42 U.S.C. § 1395dd. EMTALA was enacted to prevent "patient dumping," the publicized practice of some hospitals turning away or transferring indigent patients without evaluation or treatment. Under EMTALA, when an individual presents for treatment at the emergency department of a hospital, the hospital must provide an appropriate medical screening to determine whether an emergency medical condition exists. If an emergency medical condition is determined to exist, the hospital ordinarily must provide stabilization treatment before transferring the patient.¹ The issue before this Court is whether EMTALA imposes a federal statutory obligation on a hospital to provide stabilization treatment to a patient with an emergency medical condition who is not transferred. We hold no such duty exists under EMTALA.

I. BACKGROUND

A. Factual Background

The complaint in this case alleges the following facts. At approximately 1:17 a.m. on November 26, 1997, Miami-Dade Fire Rescue brought Lisa Normil to the emergency room at Aventura Hospital and Medical Center (Aventura Hospital) and requested medical treatment on her behalf. Normil was seen first by Dr. Wayne Marchant, an emergency room physician, whose notes indicated a diagnosis of "pneumonia rule out sepsis."

Dr. Marchant contacted Dr. Kevin Coy, who was acting as the on-call attending physician on behalf of Normil's primary care provider, to report his diagnosis and to request permission to admit Normil into the intensive care unit (ICU) of the hospital for concentrated care and management.² Dr. Coy refused to authorize admission into the ICU and instead directed Dr. Marchant to obtain a ventilation perfusion scan (VQ Scan). Dr. Marchant advised Dr. Coy a VQ Scan could not be performed because the hospital had insufficient isotopes to conduct the scan. Despite the unavailability of a VQ Scan, Dr. Coy continued to deny authorization for Normil's admittance into the ICU.

Later that morning, Dr. Marchant was able to contact Normil's primary care physician, Dr. Ali Bazzi. Approximately five hours after he was contacted by Dr. Marchant, Dr. Bazzi examined Normil in the emergency room, reviewed her available radiological evidence, and assessed her vital signs. Following Normil's examination by Dr. Bazzi, she was admitted into the ICU at Aventura Hospital. Although Dr. Bazzi prescribed antibiotics, the ICU nurse, Polly Linker, never administered the medication.

After Normil's admittance into the ICU, she lapsed into respiratory and cardiac failure. Dr. Christopher Hanner, a physician working at the hospital, unsuccessfully attempted to resuscitate Normil. She died at approximately 12:45 p.m.

B. Procedural Background

Following Normil's death, Appellant Bernie Harry, personal representative of her estate, filed suit against Dr. Marchant, Dr. Bazzi, Dr. Hanner, Dr. Coy, Linker, and Aventura Hospital³ (collectively, Appellees). In his complaint, Appellant alleged Aventura Hospital violated EMTALA by failing to stabilize and treat Normil's emergency medical condition.⁴ Appellant, however, did not allege Normil was transferred by Aventura Hospital. Rather, Appellant's primary allegation under EMTALA was the treatment provided to Normil was negligent and not sufficiently aggressive to treat and stabilize her condition.

In response to Appellant's complaint, Aventura Hospital moved to dismiss for failure to state a claim under EMTALA.⁵ The district court granted the motion with prejudice.⁶ On appeal, a panel of this Court reversed, holding the allegations contained in Appellant's complaint supported a claim against Aventura Hospital under EMTALA for failing to treat and stabilize Normil's condition. Harry v. Marchant, 237 F.3d 1315, vacated, reh'g granted en banc, 259 F.3d 1310 (11th Cir.2001).⁷ Rehearing en banc was granted solely to determine the scope of EMTALA's stabilization requirement.

II. STANDARD OF REVIEW

We review de novo the dismissal of a complaint for failure to state a claim, accepting all allegations in the complaint as true and construing facts in the light most favorable to the plaintiff. Brown v. Budget Rent-A-Car Sys., Inc., 119 F.3d 922, 923 (11th Cir.1997).

III. DISCUSSION

In 1986, Congress enacted EMTALA in response to widely publicized reports of emergency care providers transferring indigent patients from one hospital to the next while the patients' emergency medical conditions worsened. EMTALA was designed specifically to address this important societal concern; it was not intended to be a federal malpractice statute. Under EMTALA, hospital emergency rooms are subject to two principal obligations, commonly referred to as the appropriate medical screening requirement and the stabilization requirement. See 42 U.S.C. § 1395dd (1994). The appropriate medical screening requirement obligates hospital emergency rooms to provide an appropriate medical screening to any individual seeking treatment in order to determine whether the individual has an emergency medical condition. Id. § 1395dd(a). If an emergency medical condition exists, the hospital is required to provide stabilization treatment before transferring the individual. Id. § 1395dd(b). The sole issue before this Court is the extent to which EMTALA requires a hospital to provide stabilization treatment to a patient with an emergency medical condition who is not transferred.⁸

In resolving this issue, we begin by scrutinizing the language of the statute. Then, we review the statute's legislative history. Finally, we examine the cases discussing EMTALA's stabilization requirement.

A. Language of the Statute

As with any question of statutory interpretation, we begin by examining the text of the statute to determine whether its meaning is clear. See Hughes Aircraft Co. v. Jacobson, 525 U.S. 432, 438, 119 S.Ct. 755, 760, 142 L.Ed.2d 881 (1999); Cmty. for Creative Non-Violence v. Reid, 490 U.S. 730, 739, 109 S.Ct. 2166, 2172, 104 L.Ed.2d 811 (1989); United States v. Gilbert, 198 F.3d 1293, 1298 (11th Cir.1999). "In construing a statute we must begin, and often should end as well, with the language of the statute itself." United States v. Steele, 147 F.3d 1316, 1318 (11th Cir.1998) (en banc) (quoting Merritt v. Dillard Paper Co., 120 F.3d 1181, 1185 (11th Cir.1997)). We do this because we "presume that Congress said what it meant and meant what it said." Steele, 147 F.3d at 1318.

The stabilization requirement of EMTALA provides in relevant part:

(b) Necessary stabilizing treatment for emergency medical conditions and labor.

(1) In general.

If any individual (whether or not eligible for benefits under this subchapter) comes to a hospital and the hospital determines that the individual has an emergency medical condition, the hospital must provide either —

(A) within the staff and facilities available at the hospital, for such further medical examination and such treatment as may be required to stabilize the medical condition, or

(B) for transfer of the individual to another medical facility in accordance with subsection (c).⁹

42 U.S.C. § 1395dd(b)(1) (1994) (emphasis added).

The term "to stabilize" is specifically defined by the statute. Under EMTALA, the term "to stabilize" means "with respect to an emergency medical condition ... [a hospital must] 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 or occur during the transfer of the individual from a facility." 42 U.S.C. § 1395dd(e)(3)(A). When a statute includes an explicit definition, that definition must be followed, even if it varies from the term's ordinary meaning. See Stenberg v. Carhart, 530 U.S. 914, 942, 120 S.Ct. 2597, 2615, 147 L.Ed.2d 743 (2000). Thus, to the extent the definition of "to stabilize" departs from its common or ordinary usage, the statutory prescription governs.

In order to accurately determine the requirements of EMTALA, we must insert the definition of the term "to stabilize" where the term is used in the statute. When the definition of "to stabilize" is inserted into the stabilization requirement, the statute provides:

(b) Necessary stabilizing treatment for emergency medical conditions and labor.

(1) In general.

If any individual (whether or not eligible for benefits under this subchapter) comes to a hospital and the hospital determines that the individual has an emergency medical condition, the hospital must provide either —

(A) within the staff and facilities available at the hospital, for such further medical examination and such treatment as may be required [to assure, within reasonable medical probability, that no material deterioration of the condition is likely to result or occur during the transfer of the individual from a facility], or

(B) for transfer of the individual to another medical facility in accordance with subsection (c).

42 U.S.C. § 1395dd(b)(1). Reading the statute in its specifically defined context, it is evident EMTALA...