Summers v. Baptist Medical Center Arkadelphia

• Decision Date: 18 January 1996
• Docket Number: No. 95-1468,95-1468
• Citation: 69 F.3d 902
• Parties: Harold SUMMERS, Appellant, v. BAPTIST MEDICAL CENTER ARKADELPHIA, Appellee.
• Court: U.S. Court of Appeals — Eighth Circuit

Page 902

69 F.3d 902

49 Soc.Sec.Rep.Ser. 335

Harold SUMMERS, Appellant, v. BAPTIST MEDICAL CENTER ARKADELPHIA, Appellee.

No. 95-1468.

United States Court of Appeals,

Eighth Circuit.

Submitted Sept. 12, 1995.

Decided Nov. 9, 1995.

Order Granting Rehearing En Banc and Vacating Opinion Jan. 18, 1996.

Troy L. Henry, Jonesboro, AR, argued, for appellant.

Stuart P. Miller, Little Rock, AR, argued, for appellee.

Before RICHARD S. ARNOLD, Chief Judge, and HEANEY and McMILLIAN, Circuit Judges.

HEANEY, Circuit Judge.

Harold Summers appeals the district court's grant of summary judgment for Baptist Medical Center (Baptist) on Summers' claim under the Emergency Medical Treatment and Active Labor Act (EMTALA), 42 U.S.C. Sec. 1395dd(a) (Supp.1995). ¹ Because Summers presented a genuine issue of material fact, we reverse.

I. BACKGROUND

Summary judgment is appropriate only when there is no genuine issue as to any material fact so that the dispute may be decided solely on legal grounds. Fed.R.Civ.P. 56(c); Holloway v. Lockhart, 813 F.2d 874, 878 (8th Cir.1987). Reviewing the district court's grant of summary judgment, we consider the facts presented to the district court in a light most favorable to Summers, the non-moving party.

On October 25, 1992, Summers was taken by ambulance on a spinal board to the emergency room at Baptist after he had fallen from a tree stand while hunting. Emergency room staff, nurse Paul Toll and physician Dr. Griffith H. Ferrell, attended to Summers, who complained of severe pain in his head, back, and chest. Summers also told them that he could hear a snapping and popping noise in his chest when he breathed. Nurse Toll took Summers' medical history, which included prior lower back injuries, and gave Summers a physical examination. Dr. Ferrell ordered a series of spinal x-rays. He did not, however, request an x-ray of Summers' chest area, which would have revealed Summers' injury. After review of the x-rays and further physical examination of Summers, Dr. Ferrell determined that Summers did not have any new fractures and that his chest pain was due to muscle spasms. Dr. Ferrell gave Summers muscle relaxants and an injection for pain, told him to apply heat, and to see his personal physician the next day. Summers requested to stay at the hospital overnight, indicating that he did not feel up to the over-five-hour drive back home. Dr. Ferrell denied the request, stating that he did not think Summers' condition warranted hospitalization.

Two days later, after staying at home in bed due to his pain, Summers was taken by ambulance to St. Bernard's Hospital where he was diagnosed with an acute comminuted fracture of one of his vertebrae, a sternal fracture, and multiple rib fractures that led to bilateral hemo-pneumothoraces. Summers spent fourteen days in St. Bernard's intensive care unit for his condition.

II. DISCUSSION

Summers claims that Baptist failed to provide him with an appropriate medical screening examination in violation of EMTALA. 42 U.S.C. Sec. 1395dd. Section 1395dd(a) requires emergency rooms to provide all patients with an "appropriate medical screening examination" to determine whether or not an emergency medical condition ² exists. 42 U.S.C. Sec. 1395dd(a).

Although the statute does not define "appropriate," we have interpreted it to mean uniform, non-discriminatory medical treatment. Williams v. Birkeness, 34 F.3d 695, 697 (8th Cir.1994) (citing Brooks v. Maryland Gen. Hosp., Inc., 996 F.2d 708, 710-11 (4th Cir.1993), and noting agreement with the D.C. and Sixth Circuits). EMTALA is not a federal malpractice statute and it does not set a national emergency health care standard; claims of misdiagnosis or inadequate treatment are left to the state malpractice arena. Williams, 34 F.3d at 697. Nor is EMTALA an anti-discrimination statute that requires a plaintiff to prove that he was "dumped" or that his treatment was motivated by a particular type of discrimination. ³ Rather, EMTALA requires hospitals to develop screening procedures that identify critical conditions and to apply the procedures uniformly to all patients. All patients complaining of the same problem or exhibiting the same symptoms must receive similar screening examinations from a given emergency room. Williams, 34 F.3d at 697; Baber v. Hospital Corp. of Am., 977 F.2d 872, 879 (4th Cir.1992). Thus, not all medical malpractice claims can be converted into EMTALA actions.

Applying the correct standard, the district court concluded that Summers failed to produce any evidence that Baptist would have given another patient in the same condition as Summers additional x-rays or different treatment. We disagree.

Baptist has developed general screening procedures by which incoming patients are to be treated based upon that patient's complaints, symptoms, and medical history. More specifically, during his deposition Dr. Ferrell stated that under these screening procedures, had Summers complained of chest pain, as Summers claims he did, Baptist should have provided the plaintiff with a chest x-ray. Thus, it is essential that a trier of fact determine whether or not Summers made such a complaint. Dr. Ferrell does not recall Summers complaining of chest pain. Summers, on the other hand, insists that he complained of pain in his chest and difficulty in breathing. If Dr. Ferrell's recollection is correct, then Summers does not have a cause of action under section 1395dd(a). EMTALA is not intended to be a substitute for a medical malpractice action. If, however, one believes Summers' testimony, then Baptist did not give Summers the screening examination that Dr. Ferrell concedes Baptist provides to persons with complaints of that nature.

Given the posture of this case, we conclude that Summers has demonstrated that there is an issue of fact as to what symptoms Summers presented at the emergency room. The factual issue is material and must be decided by a factfinder to resolve whether Baptist failed to uniformly apply its screening procedures as required under EMTALA.

We therefore reverse the district court's grant of summary judgment and remand this case to the district court for the appropriate fact finding and resolution of Summers' claim.

RICHARD S. ARNOLD, Chief Judge, dissenting.

I think the District Court was right to dismiss this complaint, and write briefly to explain why.

This Court's reason for reversal is simple and easily grasped: Mr. Summers says he complained of chest pain. Dr. Ferrell does not remember any such complaint, but concedes that patients who complain of chest pain are normally given a chest x-ray. Mr. Summers was given no such x-ray. Therefore, if in fact he did complain of chest pain (a dispute of fact that would require a trial if it is material), Mr. Summers was treated differently from the hospital's normal practice.

The syllogism is neat--in my view, too neat, because it converts the Emergency Medical Treatment and Active Labor Act (EMTALA), 42 U.S.C. Sec. 1395dd, into a federal malpractice statute, a result disavowed by the plaintiff and this Court alike. Consider the following: a hospital's normal screening procedure for emergency patients is to treat them with due care. (Presumably every hospital would say this.) There is a genuine issue of material fact as to whether a certain patient was treated with due care. Therefore the patient is entitled to go to trial on the issue whether he was treated differently from other patients. I take it that all would acknowledge the error of this proposition, as it would completely obliterate any distinction between EMTALA and a state-law claim for negligence.

This statement of the issue is at the highest level of generality, of course. The problem with the Court's approach in this case is that it will always, if logically applied, convert any malpractice claim into an EMTALA case, with the possible exception of cases (of which this is not one)...