Bryan v. Rectors and Visitors of University of Virginia

• Decision Date: 13 September 1996
• Docket Number: No. 95-2023,95-2023
• Citation: 95 F.3d 349
• Parties: Cindy BRYAN, Administratrix and Personal Representative of the Estate of Shirley A. Robertson, deceased, Plaintiff-Appellant, v. RECTORS AND VISITORS of the UNIVERSITY OF VIRGINIA, t/a University of Virginia Medical Center, Defendant-Appellee.
• Court: U.S. Court of Appeals — Fourth Circuit

Page 349

95 F.3d 349

51 Soc.Sec.Rep.Ser. 696

Cindy BRYAN, Administratrix and Personal Representative of

the Estate of Shirley A. Robertson, deceased, Plaintiff-Appellant, v. RECTORS AND VISITORS of the UNIVERSITY OF VIRGINIA, t/a

University of Virginia Medical Center, Defendant-Appellee.

No. 95-2023.

United States Court of Appeals,

Fourth Circuit.

Argued May 9, 1996.

Decided Sept. 13, 1996.

ARGUED: Michael Vincent Greenan, Michael V. Greenan, P.C., Warrenton, VA, for Plaintiff-Appellant. Gerald Richard Walsh, Gerald R. Walsh, P.C., Fairfax, VA, for Appellee. ON BRIEF: Michael J. Carita, Gerald R. Walsh, P.C., Fairfax, VA, for Defendant-Appellee.

Before MURNAGHAN and WILLIAMS, Circuit Judges, and PHILLIPS, Senior Circuit Judge.

Affirmed by published opinion. Senior Judge PHILLIPS wrote the opinion, in which Judge MURNAGHAN and Judge WILLIAMS joined.

OPINION

PHILLIPS, Senior Circuit Judge:

Cindy Bryan, as administratrix of the estate of Shirley Robertson, brought this action against the University of Virginia under the Emergency Medical Treatment and Active Labor Act (EMTALA), 42 U.S.C. § 1395dd (1994). She alleged that the university's hospital failed to provide Mrs. Robertson with the stabilizing treatment that the Act requires and thereby caused her death. The hospital moved to dismiss under Rule 12(b)(6) of the Federal Rules of Civil Procedure for failure to state a claim, and the district court granted the motion. We affirm, though on somewhat different grounds than those relied upon by the district court.

I.

The gist of Bryan's complaint is that the hospital violated EMTALA when, having treated Mrs. Robertson for an emergency condition for twelve days, it determined pursuant to its internal procedures that no further efforts to prevent her death should be made and then eight days later, when Mrs. Robertson faced a life-threatening episode, adhered to its prior determination and allowed her to die. The complaint reads, in pertinent part, as follows:

4. On February 5, 1993, Shirley Robertson was transferred from Fauquier Hospital to the University of Virginia Medical Center for an emergency medical condition, most emergently, respiratory distress.

5. At all times relevant, The university of Virginia Health Science Center (U.Va.) received clear instructions from Mrs. Robertson's husband, Charles and all of her children that the Defendant Hospital take all necessary measures to keep her alive and trust in God's wisdom.

6. In violation of 42 USC § 1395dd, the Defendant hospital refused to be instructed by the husband and family of their patient Shirley Robertson, and on February 17, 1993, entered "do not resuscitate" order against the family's wishes.

7. As a result of the "do not resuscitate" order, Mrs. Robertson was not stabilized and died on February 25, 1993.

In dismissing the action, the district court interpreted the complaint as alleging a violation of subsection (b) of the Act, which requires a hospital to stabilize or transfer any patient who arrives at the hospital with an emergency condition. It then held that the Act imposes no obligations on a hospital once the hospital has admitted the patient. At that point, according to the district court, the hospital's obligations are covered by state tort law, and EMTALA is out of the picture. Since Mrs. Robertson had been admitted to the hospital long before the occurrence of the hospital's alleged misdeeds, the complaint did not state a claim under EMTALA. On this basis, the court dismissed the action on the merits.

This appeal followed.

II.

Bryan's essential contention is that EMTALA imposed upon the hospital an obligation not only to admit Mrs. Robertson for treatment of her emergency condition, which concededly was done, but thereafter continuously to "stabilize" her condition, no matter how long treatment was required to maintain that condition. Such a theory requires a reading of the critical stabilization requirement in subsection (b)(1) of EMTALA that we cannot accept.

Subsection (b)(1) provides that:

If any individual ... comes to a hospital and the hospital determines that the individual has an emergency medical condition, the hospital must provide either--

(A) ... 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....

Bryan's proffered interpretation of that subsection is boldly that, "If a hospital ... accepts a patient with an emergency medical condition either by admission or transfer and continues stabilizing treatment for any period of time, whether it be one hour, one week or twelve days and then refuses such stabilizing treatment, such refusal of stabilizing treatment without transfer violates EMTALA." Appellant's Brief at 5.

As is admitted in the complaint, and so necessarily conceded by Bryan in her brief and oral argument, stabilizing treatment was provided by the hospital from Robertson's arrival on February 5 until February 17. But, the claim is that the hospital's abandonment of such treatment as of its entering the anti-resuscitation order on February 17 and its failure to offer stabilizing treatment in response to Robertson's heart attack eight days later constituted an EMTALA violation.

Under this interpretation, every presentation of an emergency patient to a hospital covered by EMTALA obligates the hospital to do much more than merely provide immediate, emergency stabilizing treatment with appropriate follow-up. Rather, without regard to professional standards of care or the standards embodied in the state law of medical malpractice, the hospital would have to provide treatment indefinitely--perhaps for years--according to a novel, federal standard of care derived from the statutory stabilization requirement. We do not find this reading of the statute plausible.

As Bryan recognizes and as this court has frequently observed, EMTALA is a limited "anti-dumping" statute, not a federal malpractice statute. Vickers v. Nash Gen. Hosp., Inc., 78 F.3d 139, 142-43 (4th Cir.1996) (citing numerous cases). Its core purpose is to get patients into the system who might otherwise go untreated and be left without a remedy because traditional medical malpractice law affords no claim for failure to treat. Brooks v. Maryland Gen. Hosp., Inc., 996 F.2d 708, 710 (4th Cir.1993) (recognizing that "[u]nder traditional state tort law, hospitals are under no legal duty to provide [emergency care to all]" and holding that EMTALA's purpose is simply to impose on hospitals the legal duty to provide such emergency care); Gatewood v. Washington Healthcare Corp., 933 F.2d 1037, 1041 (D.C.Cir.1991) (holding that EMTALA's purpose is "to create a new cause of action, generally unavailable under state tort law, for what amounts to failure to treat"). Numerous cases and the Act's legislative history confirm that Congress's sole purpose in enacting EMTALA was to deal with the problem of patients being turned away from emergency rooms for non-medical reasons. See, e.g., Correa v. Hospital San Francisco, 69 F.3d 1184, 1189 (1st Cir.1995) (Congress enacted EMTALA because it was " 'concerned about the increasing number of reports that hospital emergency rooms are refusing to accept or treat patients with emergency conditions if the patient does not have medical insurance.' ") (quoting H.R.Rep. No. 241(I), 99th Cong., 1st Sess. 27 (1986), reprinted in 1986 U.S.C.C.A.N. 42, 605), cert. denied, --- U.S. ----, 116 S.Ct. 1423, 134 L.Ed.2d 547 (1996); Eberhardt v. City of Los Angeles, 62 F.3d 1253, 1255 (9th Cir.1995) (Congress enacted EMTALA "in response to 'a growing concern about the provision of adequate emergency room medical services to individuals who seek care ....' ") (quoting H.R.Rep. No. 241(III), 99th Cong., 1st Sess. 5 (1986), reprinted in 1986 U.S.C.C.A.N. 42, 726); Cleland v. Bronson Health Care Group, Inc., 917 F.2d 266, 268 (6th Cir.1990) ("It is undisputed that the impetus to [EMTALA] came from highly publicized incidents where hospital emergency rooms allegedly ... failed to provide a medical screening that would have been provided a paying patient, or transferred or discharged a patient without taking steps that would have been taken for a paying patient."); see also 131 Cong.Rec. S13,892-01 (1985) (remarks of Sens. Durenberger, Kennedy, Dole, Baucus, Heinz, and Proxmire, emphasizing that the source of...