Baber v. Hospital Corp. of America

Decision Date09 November 1992
Docket NumberNo. 91-2395,91-2395
Citation977 F.2d 872
Parties, 39 Soc.Sec.Rep.Ser. 161, Medicare & Medicaid Guide P 40,816 Barry BABER, Administrator of the Estate of Brenda Baber, Plaintiff-Appellant, v. HOSPITAL CORPORATION OF AMERICA, a West Virginia Corporation; Hospital Corporation of America, d/b/a HCA Group, Incorporated, Tennessee Corporation; Raleigh General Hospital, a West Virginia Corporation; Appalachian Regional Healthcare, Incorporated, d/b/a Beckley Appalachian Regional Hospital, a Kentucky Corporation, Beckley Appalachian Regional Hospital; Richard B. Kline; Joseph Whelan, Defendants-Appellees.
CourtU.S. Court of Appeals — Fourth Circuit

Barbara H. Lupton, Masters & Taylor, Charleston, W.Va., argued (Marvin W. Masters, Kathleen T. Pettigrew, Lee H. Adler, Ithaca, N.Y., on the brief), for plaintiff-appellant.

William H. File, Jr., File, Payne, Scherer & Brown, Beckley, W.Va., Karen Speidel Rodgers, Kay, Casto, Chaney, Love & Wise, Geraldine M. Guerin, Shuman, Annand & Poe, Charleston, W.Va., Charlotte Ann Hoffman, Jenkins, Fenstermaker, Krieger, Kayes & Farrell, Huntington, W.Va., argued (Ann L. Haight, Michael J. Farrell, on the brief), for defendants-appellees.

Before ERVIN, Chief Judge, WILLIAMS, Circuit Judge, and MERHIGE, Senior United States District Judge for the Eastern District of Virginia, sitting by designation.


WILLIAMS, Circuit Judge:

Barry Baber, Administrator of the Estate of Brenda Baber, instituted this suit against Dr. Richard Kline, Dr. Joseph Whelan, Raleigh General Hospital (RGH), Beckley Appalachian Regional Hospital (BARH), and the parent corporations of both hospitals. Mr. Baber alleged that the Defendants violated the Emergency Medical Treatment and Active Labor Act (EMTALA), 1 42 U.S.C.A. § 1395dd (West 1992). The Defendants moved to dismiss the EMTALA claim under Rule 12(b)(6) of the Federal Rules of Civil Procedure. Because the parties submitted affidavits and depositions, the district court treated the motion as one for summary judgment. See Fed.R.Civ.P. 12(b).

Mr. Baber's complaint charged the various defendants with violating EMTALA in several ways. Specifically, Mr. Baber contends that Dr. Kline, RGH, and its parent corporation violated EMTALA by:

(a) failing to provide his sister with an "appropriate medical screening examination;"

(b) failing to stabilize his sister's "emergency medical condition;" and

(c) transferring his sister to BARH without first providing stabilizing treatment.

Mr. Baber also charged Dr. Whelan, BARH, and its parent corporation with failing to provide his sister with an "appropriate medical screening" upon her admission to BARH.

After reviewing the parties' submissions, the district court granted summary judgment for the Defendants. The court concluded that patients may not sue their physicians for EMTALA violations and therefore granted Dr. Kline and Dr. Whelan summary judgment. The district court further concluded that Mr. Baber failed to submit evidence tending to show either that RGH failed to provide "an appropriate medical screening," 42 U.S.C.A. § 1395dd(a), or that RGH knew Ms. Baber had an "emergency medical condition" that required stabilization before transfer to another hospital, id. §§ 1395dd(b) & (c). Finally, the district court found that BARH was not required to perform an "appropriate medical screening" on Ms. Baber upon her admission to that hospital because the screening requirement applies only to a patient who seeks treatment from an emergency department. Accordingly, the district court granted summary judgment in favor of the hospitals and their parent corporations. 2 Finding no error, we affirm.


We review a grant of summary judgment de novo, applying the same standard as the district court. Temkin v. Frederick County Comm'rs, 945 F.2d 716, 718 (4th Cir.1991), cert. denied, --- U.S. ----, 112 S.Ct. 1172, 117 L.Ed.2d 417 (1992). Specifically, summary judgment is only appropriate if "the pleadings, depositions, answers to interrogatories, and admissions on file, together with the affidavits, if any, show that there is no genuine issue as to any material fact and that the moving party is entitled to a judgment as a matter of law." Fed.R.Civ.P. 56(c); see also Anderson v. Liberty Lobby, Inc., 477 U.S. 242, 247, 106 S.Ct. 2505, 2510, 91 L.Ed.2d 202 (1986) (quoting Fed.R.Civ.P. 56(c)). A district court must grant summary judgment if, after an adequate time for discovery, a party fails to make a showing sufficient to establish the existence of an essential element of that party's case. Celotex Corp. v. Catrett, 477 U.S. 317, 322, 106 S.Ct. 2548, 2552, 91 L.Ed.2d 265 (1986).

In summary judgment proceedings, the moving party must demonstrate the absence of a genuine issue of material fact. Temkin, 945 F.2d at 718. Once the moving party has met his burden, the nonmoving party must come forward with some evidence beyond the mere allegations contained in the pleadings to show that there is a genuine issue for trial. Richmond, F. & P. R.R. v. United States, 945 F.2d 765, 768 (4th Cir.1991), cert. denied, --- U.S. ----, 112 S.Ct. 1667, 118 L.Ed.2d 388 (1992). While this does not require the non-moving party to submit evidence in a form that would be admissible at trial, Celotex, 477 U.S. at 324, 106 S.Ct. at 2553, "[u]nsupported speculation is not sufficient to defeat a summary judgment motion," Felty v. Graves-Humphreys Co., 818 F.2d 1126, 1128 (4th Cir.1987).

In reviewing the evidence submitted by the parties on appeal, we must view all evidence in the light most favorable to the non-moving party. Anderson, 477 U.S. at 255, 106 S.Ct. at 2514.


In the present case, the material facts regarding EMTALA liability are undisputed. Brenda Baber, accompanied by her brother, Barry, sought treatment at RGH's emergency department at 10:40 p.m. on August 5, 1987. When she entered the hospital, Ms. Baber was nauseated, agitated, and thought she might be pregnant. She was also tremulous and did not appear to have orderly thought patterns. She had stopped taking her anti-psychosis medications, Haldol and Cogentin, and had been drinking heavily. Dr. Kline, the attending physician, described her behavior and condition in the RGH Encounter Record as follows:

Patient refuses to remain on stretcher and cannot be restrained verbally despite repeated requests by staff and by me. Brother has not assisted either verbally or physically in keeping patient from pacing throughout the Emergency Room. Restraints would place patient and staff at risk by increasing her agitation.

(J.A. at 53.)

In response to Ms. Baber's initial complaints, Dr. Kline examined her central nervous system, lungs, cardiovascular system, and abdomen. He also ordered several laboratory tests, including a pregnancy test.

While awaiting the results of her laboratory tests, Ms. Baber began pacing about the emergency department. In an effort to calm Ms. Baber, Dr. Kline gave her five milligrams of Haldol. When this failed to relieve Ms. Baber's hyperactivity and agitation, he administered 100 milligrams of Thorazine. He also gave Ms. Baber 100 milligrams of Thiamine and two ounces of magnesium citrate because of her earlier alcohol consumption. The medication did not immediately control her agitation. Mr. Baber described his sister as becoming restless, "worse and more disoriented after she was given the medication," and wandering around the emergency department. (J.A. at 45.)

While roaming in the emergency department around midnight, Ms. Baber, without warning, convulsed and fell, striking her head upon a table and lacerating her scalp. The seizure lasted three minutes, but she quickly regained consciousness and emergency department personnel carried her by stretcher to the suturing room. Once in the suturing room, Dr. Kline examined her again. He obtained a blood gas study which did not reveal any oxygen deprivation or acidosis. Ms. Baber was verbal and could move her head, eyes, and limbs without discomfort. With attendants restraining her limbs, Dr. Kline closed the one-inch laceration with a couple of sutures. Although she became calmer and drowsy after the wound was sutured, Ms. Baber was easily arousable and easily disturbed. Ms. Baber experienced some anxiety, disorientation, restlessness, and some speech problems, which Dr. Kline concluded were caused by her pre-existing psychiatric problems of psychosis with paranoia and alcohol withdrawal.

Dr. Kline discussed Ms. Baber's condition with Dr. Whelan, the psychiatrist who had treated Ms. Baber for two years. Dr. Whelan believed she suffered from undifferentiated schizophrenia and noted that her mental illness was associated with periods of extreme alcohol abuse. 3 Dr. Whelan concluded that Ms. Baber's hyperactive and uncontrollable behavior during her evening at RGH was compatible with her behavior during a relapse of her serious psychotic and chronic mental illness. Both Dr. Whelan and Dr. Kline were concerned about the seizure she had while at RGH's emergency department because it was the first one she had experienced. They believed the seizure might be linked to Ms. Baber's psychosis. They also agreed Ms. Baber needed further treatment for what they believed to be her recurring psychiatric problems and decided to transfer her to the psychiatric unit at BARH because RGH did not have a psychiatric ward, and both doctors believed it would be beneficial for her to be treated in a familiar setting. The decision to transfer Ms. Baber was further supported by the doctors' belief that any tests to diagnose the cause of her initial seizure, such as a computerized tomography scan (CT scan), could be performed at BARH once her psychiatric condition was under control. The transfer to BARH was discussed with Mr. Baber who neither expressly consented nor objected. His only request was that his sister be x-rayed because of the blow to her...

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