Power v. Arlington Hosp.

• Decision Date: 28 August 1992
• Docket Number: Civ. A. No. 92-0005-A.
• Citation: 800 F. Supp. 1384
• Court: U.S. District Court — Eastern District of Virginia
• Parties: Susan M. POWER v. The ARLINGTON HOSPITAL.

800 F. Supp. 1384

Susan M. POWER v. The ARLINGTON HOSPITAL.

Civ. A. No. 92-0005-A.

United States District Court, E.D. Virginia, Alexandria Division.

August 28, 1992.

Scott A. Mills, Falk & Causey, Washington, D.C., for plaintiff.

William Daniel Cremins, Walsh & Cremins, P.C., Kenneth Joseph Barton, Jr., Godard, West & Adelman, P.C., John Allen Blazer, Crews & Hancock, Fairfax, Va., Joseph Patrick McMenamin, McGuire, Woods, Battle & Boothe, Richmond, Va., Scott A. Mills, Falk & Causey, Washington, D.C., for defendants.

MEMORANDUM OPINION

ELLIS, District Judge.

This federal "patient dumping"¹ action is brought pursuant to the Emergency Medical Treatment & Active Labor Act of 1986, 42 U.S.C. § 1395dd et seq. (1988), as amended ("EMTALA").² Two questions, both novel in this circuit, are presented by the parties' cross-motions in limine. They are:

(1) Are damages recoverable by a plaintiff in a federal "patient dumping" action against a participating hospital limited by Virginia's one million dollar medical malpractice damages cap, Va.Code § 8.01-581.15?

(2) Are damages recoverable by a plaintiff in a federal "patient dumping" action against a participating hospital limited by Virginia Code § 8.01-38, which limits the tort liability of insured charitable hospitals to the limits of its liability insurance?³

For the reasons that follow, the Court concludes that neither limitation applies to this unique private federal action.

Facts

At approximately 5:45 a.m. on February 24, 1990, plaintiff Susan Power was driven to Arlington Hospital's emergency room. When she arrived at the Hospital, Ms. Power, then a thirty-three year-old British subject living in the United States, was unable to walk and required a wheelchair and assistance to enter the emergency room. She complained of hip pain, chills, and inability to walk. It appears she also had a sizeable boil visible on her cheek, although an examining physician testified he did not see it and no mention of it is found in the medical records for that day. In the emergency room, Ms. Power's vital signs were taken and recorded, an x-ray of her hip was taken, a "dipstick" urinalysis test was performed, and a more thorough urinalysis study was ordered. The physician on duty examined her, rather cursorily she believes. This physician's shift ended at 7:00 a.m. His successor also examined her. Neither physician reached a definitive diagnosis. The records reflect that the second physician said he "did not know for sure" what was causing her hip pain and that her problem could be "musculoskeletal or possibly related to a neurogenic problem...." Despite this uncertainty, no blood studies or other tests were ordered. Instead, before the urinalysis test results became available, Ms. Power was given a prescription for a pain medication,⁴ told to return if her condition worsened, and discharged from the emergency room. She left as she had arrived — by wheelchair. In all, Ms. Power's stay in the emergency room lasted no more than two hours. Early on in this period, shortly after her arrival at the emergency room, the Hospital learned that Ms. Power was uninsured and unemployed.

Ms. Power did as she was told. Her condition worsened so she returned to the emergency room the next day. This time she was immediately admitted. The differential diagnosis on admission was septic shock. So serious was her condition that she remained hospitalized for four months, during which she underwent the amputation of both legs below the knees and lost her sight in one eye.

At the end of the four month period, the Hospital transferred Ms. Power to Central Middlesex Hospital in Great Britain. Several issues concerning the transfer are material and apparently disputed. Thus, the parties dispute whether Ms. Power's condition was stabilized at the time of the transfer. Also disputed is whether Ms. Power consented to this transfer. And although unclear, it appears that Arlington Hospital sent Central Middlesex Hospital only five pages of Ms. Power's voluminous medical records. Finally, there appears to be a sharp dispute between the parties over whether Central Middlesex Hospital is an equivalent facility to Arlington Hospital. Ms. Power claims it is not and that she suffered additional harm as a result of the transfer.

On these facts, Ms. Power filed a four-count, 180 million dollar action against seven defendants. Count one alleged an EMTALA "patient dumping" action against the Hospital, a physician, and a physicians group based on the failure to provide an appropriate screening examination. See 42 U.S.C. § 1395dd. Count two alleged a state law cause of action for battery against the Hospital and a second physician based on the amputations. Count three alleged a second EMTALA action against the Hospital, yet another pair of physicians, and another physicians group, based in this instance on Ms. Power's transfer to the British hospital. Finally, Count four sought damages under state law for emotional distress from the Hospital, several physicians, and a group. Defendants filed threshold dismissal motions and following oral argument, the Court dismissed the physicians and their groups as defendants in the EMTALA actions because the Act authorizes actions only against "participating hospitals". See 42 U.S.C. § 1395dd. See also Urban v. King, 783 F.Supp. 560, 562 (D.Kan.1992). The Court also dismissed the state tort law causes of action without prejudice, inter alia, on the ground that such claims must be subjected to the Virginia Malpractice Act process before they may be asserted in court.⁵ Following these rulings, the Hospital sought summary judgment on the remaining EMTALA claims, which the Court denied given the existence of disputed material facts.⁶ Left for trial, therefore, are the two EMTALA "patient dumping" claims. But now before the Court to be resolved prior to trial are the parties' cross motions in limine concerning whether to limit damages to (i) the Virginia one million dollar medical malpractice cap or (ii) the Virginia tort liability limit for insured charitable hospitals. Each of these is separately considered.

Analysis

A. Medical Malpractice Cap⁷

Congress enacted the EMTALA prohibition against "patient dumping" to respond "to the nationwide problem of `dumping' indigent patients who have no health insurance." Stevison v. Enid Health Sys., Inc., 920 F.2d 710, 713 (10th Cir.1990). In essence, the EMTALA provisions obligate hospitals receiving medicare funds, like Arlington Hospital, to follow certain procedures when patients present themselves to an emergency room. More specifically, the provisions impose two principal obligations on covered hospitals. First, those hospitals "must provide for an appropriate medical screening" to determine whether a patient has an "emergency medical condition."⁸See 42 U.S.C. § 1395dd(a). Second, those hospitals cannot transfer⁹ a patient with an emergency medical condition unless and until that condition has been "stabilized." See 42 U.S.C. § 1395dd(c).¹⁰ Importantly, EMTALA provides for a private right of action to enforce these obligations:

(A) Personal Harm. Any individual who suffers personal harm as a direct result of a participating hospital's violation of a requirement of this section may, in a civil action against the participating hospital, obtain those damages available for personal injury under the law of the state in which the hospital is located, and such other equitable relief as is appropriate.

42 U.S.C. § 1395dd(d)(3)(A). Thus, the question presented is whether the phrase "those damages available for personal injury under the law of the state" encompasses or excludes Virginia's medical malpractice damages cap. Since this is a question of statutory interpretation, it is fundamental that the "starting point in every case involving construction of a statute is the language itself." Blue Chip Stamps v. Manor Drug Stores, 421 U.S. 723, 95 S.Ct. 1917, 44 L.Ed.2d 539 (1975).

The language of § 1395dd(d)(3)(A) is refreshingly clear and simple: the damages available for "patient dumping" actions are the state's personal injury damages. This plainly means that plaintiffs seeking recovery for "patient dumping" may recover under EMTALA for each of those elements of damage for which recovery is permitted under state law. In Virginia, these elements are well-defined. As reflected in Virginia's Model Jury Instructions, recoverable elements of damage for personal injury claims are:

1) any bodily injuries he sustained and their effect on his health according to their degree and probable duration;

2) any physical pain and mental anguish he suffered in the past and any that he may be reasonably expected to suffer in the future;

3) any disfigurement or deformity and any associated humiliation of embarrassment;

4) any inconvenience caused in the past and any that probably will be caused in the future;

5) any medical expenses incurred in the past and any that may be reasonably expected to occur in the future;

6) any earnings he lost because he was unable to work at this calling;

7) any loss of earnings and lessening of earning capacity, or either, that he may reasonably be expected to sustain in the future;

8) any property damage he sustained.

VMJI, Inst. No. 9.000 (1988).¹¹ Significantly, Virginia law places no dollar limit on personal injury damages. Equally significant is the conspicuous absence from the EMTALA "patient dumping" provision of any limiting language. The provision merely refers to "damages available for personal injury;" it does not say "damages for personal injury except as may be limited in certain states by medical malpractice statutes." As one court observed with respect to "patient dumping" under EMTALA, "had Congress desired to enact a more restrictive statute, presumably it would have done so." Jones v. Wake County Hosp. Sys., Inc. 786 F.Supp. 538, 543 (E.D.N.C.1991). It follows, therefore, that recovery for EMTALA ...