Lopez-Soto v. Hawayek

• Citation: 988 F.Supp. 41
• Decision Date: 31 December 1997
• Docket Number: No. Civ. 94-1808 (SEC).,Civ. 94-1808 (SEC).
• Parties: Mayda LOPEZ-SOTO, et al., Plaintiffs, v. Jose HAWAYEK, et al., Defendants.
• Court: U.S. District Court — District of Puerto Rico

988 F.Supp. 41

Mayda LOPEZ-SOTO, et al., Plaintiffs, v. Jose HAWAYEK, et al., Defendants.

No. Civ. 94-1808 (SEC).

United States District Court, D. Puerto Rico.

December 31, 1997.

Harry Anduze-Montano, Hato Rey, PR, Guillermo Ramos-Luina, Hato Rey, PR, for Plaintiffs.

Luis F. Montijo, Hato Rey, PR, Jose A. Rivera-Cordero, San Juan, PR, Pedro J. Cordova-Pelegrina, San Juan, PR, Angel R. De Corral-Julia, De Corral & De Mier, San Juan, PR, for Defendants.

OPINION AND ORDER

CASELLAS, District Judge.

This case is before the Court on defendant Hospital Auxilio Mutuo's motion for summary judgment (Docket # 70),¹ which was duly opposed (Docket # 80, 87). Defendant essentially contends that the Court should grant summary judgment in its favor because plaintiffs have failed to assert a cause of action under the Emergency Medical Treatment and Active Labor Act ("EMTALA"), 42 U.S.C. § 1395dd (1994). Upon careful examination of the facts, the applicable law and the arguments advanced by both parties, the Court finds that defendant's motion should be GRANTED.

Procedural Background

The unfortunate incidents which gave rise to this action took place on June 12, 1993, a few hours after plaintiff Mayda López-Soto arrived at the Auxilio Mutuo Hospital pursuant to her obstetrician's instructions, to give birth to her first child. When she arrived at the hospital shortly after midnight, she was evaluated by hospital personnel and admitted to her doctor's care. At the time, plaintiff did not appear to be suffering from an emergency medical condition, and she was experiencing normal labor pains. When her obstetrician, Dr. José Hawayek, arrived at the hospital later that morning, he examined her and ruptured the membranes of her amniotic sack, identifying the presence of thick "pea soup meconium." At 11:00 a.m., Dr. Hawayek ordered a caesarean section, and plaintiff went into the operating room at 1:30 p.m. Upon delivering the baby at 1:50 p.m., Dr. Hawayek noticed that the newborn was experiencing severe respiratory distress as a result of having inhaled meconium. Given the delicate situation, he promptly ordered the attending nurse to call the pediatrician on duty at the hospital. In response to this call, Dr. Martin Garrido showed up at the hospital about forty minutes later.²

As soon as Dr. Garrido examined the baby, he determined that the baby's condition required specialized treatment only available at a neonatal intensive care unit and he made arrangements to have the child transferred to the Damas Hospital in Ponce which, unlike the Auxilio Mutuo, had a neonatal intensive care unit.³ Upon learning of the hospital's intentions to transfer the baby to a hospital which was located more than an hour away, the baby's father, plaintiff Raúl Mariani-Franco, called a relative of his who, as a physician, had privileges at the San Juan-based Pediatric Hospital and managed to secure a vacancy at its Neonatal Intensive Care Unit. As soon as the baby arrived at the Pediatric Hospital, he received treatment for a pneumothorax which he had developed at the Auxilio Mutuo, and his condition improved markedly. Nevertheless, additional complications ensued shortly thereafter, and the baby died at approximately 8:30 p.m. on June 13, 1993.

There are various contested issues of material fact regarding the treatment which the baby received prior to being transferred, and whether defendant, the Auxilio Mutuo hospital, followed the proceedings established by EMTALA for the transferring of emergency room patients from one hospital to another. Yet, for reasons which will be explained below, these facts are not relevant to the determination of whether plaintiffs have indeed asserted a cause of action under EMTALA.

Summary Judgment Standard

The First Circuit has recently noted that:

[s]ummary judgment is a means of determining whether a trial is actually required. It is appropriately granted when the record shows that no genuine issue of material fact exists and that the moving party is entitled to judgment as a matter of law. Thus, in order to defeat a properly crafted summary judgment motion, the party opposing it must demonstrate that a trialworthy issue looms as to a fact which could potentially affect the outcome of the suit.

Serapion v. Martinez, 119 F.3d 982 (1st Cir. 1997). See also McCarthy v. Northwest Airlines, Inc., 56 F.3d 313, 315 (1st Cir.1995).

For a dispute to be "genuine", "the factual controversy `must be sufficiently open-ended to permit a rational factfinder to resolve the issue in favor of either side'." Lynne Woods-Leber v. Hyatt Hotels of Puerto Rico, Inc., 124 F.3d 47 (1st Cir.1997). See also U.S. v. One Parcel of Real Property, 960 F.2d 200, 204 (1st Cir.1992); Boston Athletic Assn. v. Sullivan, 867 F.2d 22, 24 (1st Cir. 1989). By like token, "material" means that the fact is one that might affect the outcome of the suit under the governing law. Morris v. Government Development Bank of Puerto Rico, 27 F.3d 746, 748 (1st Cir.1994).

In determining whether to grant a summary judgment, the Court may not, however, weigh the evidence. Casas Office Machines, Inc. v. Mita Copystar America, Inc., 42 F.3d 668 (1st Cir.1994). Summary judgment "admits of no room for credibility determinations, no room for the measured weighing of conflicting evidence such as the trial process entails." Id. citing Greenburg v. Puerto Rico Maritime Shipping Authority, 835 F.2d 932, 936 (1st Cir.1987). Accordingly, if the facts permit more than one reasonable inference, the court on summary judgment may not adopt the inference least favorable to the non-moving party. Casas Office Machines, 42 F.3d at 684.

Given the foregoing, we must examine the facts, as presented by the parties, to determine whether there is any genuine issue of material fact involved. There is none.

Applicable Law

It is undisputed that Congress enacted the Emergency Medical Treatment and Active Labor Act ("EMTALA") — or the Anti-Dumping Act, as it is otherwise commonly known — with a clear and specific purpose in mind: to allay concerns "about the increasing number of reports that hospital emergency rooms [were] refusing to accept or treat patients with emergency conditions if the patient [did] not have medical insurance." Correa v. Hospital San Francisco, 69 F.3d 1184, 1189 (1st Cir.1995), citing H.R.Rep. No.241(I), 99th Cong., 1st Sess. 27 (1986), reprinted in 1986 U.S.C.C.A.N. 42, 605. See also, generally, Barry R. Furrow, An Overview and Analysis of the Impact of the Emergency Medical Treatment and Active Labor Act, 16 J. Legal Med. 325 (Sept. 1995); Diane S. Mackey, The Emergency Medical Treatment and Active Labor Act: An Act Undergoing Judicial Development, 19 U.Ark. Little Rock L.J. 465 (May 1997).

The Act itself did not limit its coverage to persons without economic resources for emergency care.⁴ Mackey, supra at 466. See also Alicia K. Dowdy, et al., The Anatomy of EMTALA: A Litigator's Guide, 27 St. Mary's L.J. 463, 465 (1996). But neither did it "provide a private cause of action against the hospital and physician for misdiagnosis or improper treatment, areas traditionally governed by state malpractice law." Furrow, supra at 326. See also Correa, 69 F.3d at 1192; Vickers v. Nash General Hospital, 78 F.3d 139, 142 (4th Cir.1996); Baber v. Hospital Corp. of America, 977 F.2d 872, 879 (4th Cir.1992).⁵

Despite the Act's clear and specific purpose, the available case law has failed to agree on a uniform interpretation of its most relevant provisions, 42 U.S.C. § 1395dd(a), (b) and (c). While some cases have opted for a disjunctive interpretation of sections (a) and (b),⁶ others have chosen to interpret them conjunctively, or as an interrelated whole.⁷

Most courts have determined — or at least implied — that the pertinent EMTALA provisions must be analyzed conjunctively, taking into consideration the context of the statute and not isolating its individual provisions. Thus, for instance, in James v. Sunrise Hospital, 86 F.3d 885 (9th Cir.1996), the Ninth Circuit interpreted "the transfer restrictions of 42 U.S.C. § 1395dd(c) to apply only when an individual `comes to the emergency room,' and after `an appropriate medical screening examination,' `the hospital determines that the individual has an emergency medical condition.'" Id. at 889 (emphasis ours).

Similarly, in Miller v. Medical Center of Southwest Louisiana, 22 F.3d 626 (5th Cir. 1994), the Fifth Circuit rendered its interpretation of the Act, and held that its "duties are only triggered when an individual `comes to an emergency department and a request is made on the individual's behalf for examination or treatment ...' These two preconditions are conjunctive requiring both that an individual 1) comes to the emergency department and 2) that a request be made." Id. at 628 (citations omitted).

The Fourth Circuit has also interpreted the Act taking the statute as a whole and within its textual context. For example, in Baber v. Hospital Corp. of America, 977 F.2d 872 (4th Cir.1992), it held that "the hospital's duty to provide an appropriate medical screening arises only if the patient seeks treatment from the emergency department." Id. at 884. Furthermore, in determining that the EMTALA provisions had to be read conjunctively, the Fourth Circuit in Vickers v. Nash General Hospital, 78 F.3d 139 (4th Cir.1996) underscored the fact that "[t]he duty created by EMTALA [was] a `limited' one ..." Id. at 142 (citations omitted); and that it was "not intended to duplicate preexisting legal protections, but rather to create a new cause of action, generally unavailable under state tort law, for what amounts for failure to treat." Id. (citations omitted).

Although the First Circuit has yet to take an explicit stand on this issue, in its only opinion to date interpreting the Act, Judge Bruce Selya appeared to lean toward a conjunctive interpretation of the relevant EMTALA provisions when it summarized them as...