Barris v. County of Los Angeles

• Decision Date: 24 December 1997
• Docket Number: No. B105216,B105216
• Court: California Court of Appeals Court of Appeals
• Parties: Previously published at 60 Cal.App.4th 471 60 Cal.App.4th 471, 97 Cal. Daily Op. Serv. 9725, 97 Daily Journal D.A.R. 15,454 Dawnelle BARRIS, Plaintiff and Appellant, v. COUNTY OF LOS ANGELES, Defendant and Respondent.

Page 281

70 Cal.Rptr.2d 281

Previously published at 60 Cal.App.4th 471

60 Cal.App.4th 471, 97 Cal. Daily Op. Serv. 9725,

97 Daily Journal D.A.R. 15,454

Dawnelle BARRIS, Plaintiff and Appellant, v. COUNTY OF LOS ANGELES, Defendant and Respondent.

No. B105216.

Court of Appeal, Second District, Division 4, California.

Dec. 24, 1997.

As Modified on Denial of Rehearing Jan. 14, 1998.

Review Granted March 18, 1998.

Kenneth M. Sigelman & Associates, Kenneth M. Sigelman, San Diego, and Penelope A. Phillips, Sherman Oaks, for Plaintiff and Appellant.

Drivon & Tabak, Laurence E. Drivon, Stockton, and Richard Massa, Lakeport, as Amici Curiae on behalf of Plaintiff and Appellant.

Veatch, Carlson, Grogan & Nelson, William G. Lieb, Los Angeles, Greines, Martin, Stein, & Richland LLP, Timothy T. Coates and Alison M. Turner, Beverly Hills, for Defendant and Respondent.

Thelen, Marrin, Johnson & Bridges, Curtis A. Cole, Matthew S. Levinson, Los Angeles, Horvitz & Levy and Mitchell C. Tilner, Encino, as Amici Curiae on behalf of Defendant and Respondent.

EPSTEIN, Acting Presiding Justice.

This appeal concerns the interrelationship of the Emergency Medical Treatment and Active Labor Act (EMTALA; 42 U.S.C. § 1395dd), a federal statute enacted to prevent patient dumping, and the California Medical Injury Compensation Reform Act (MICRA), which includes a provision limiting non-economic damages in medical malpractice cases to $250,000. (Civ.Code, § 3333.2.) We conclude that in this case the MICRA cap on damages applies to the EMTALA claim for failure to stabilize prior to transfer because the conduct underlying that claim is "based on professional negligence." That is the conclusion reached by the trial court, which we affirm.

FACTUAL AND PROCEDURAL SUMMARY

Dawnelle Barris appeals the trial court's application of the MICRA cap on damages to her EMTALA cause of action against the County of Los Angeles (County). The essential facts pertinent to this issue are not disputed.

On May 6, 1993 at approximately 5:30 p.m., Mychelle Barris, appellant's daughter, was brought to King Drew Medical Center Emergency Room by paramedics. King Drew Medical Center is a facility operated by the County. Mychelle had a temperature of 106.6 degrees, her pulse was 134, and her respiratory rate was 42. Her symptoms included Mychelle was transferred from the emergency room to the facility's Pediatric Outpatient Clinic. Shortly after her arrival, she was examined by a staff physician, Dr. Trach Phoung Dang. Dr. Dang's examination revealed several abnormalities including an elevated temperature of 105.4 degrees, slight lethargy, an ear infection, bilateral rhonchi, wheezing, suprasternal retractions, a pulse rate of 86 indicating a respiratory problem, acute gastroenteritis, five percent dehydration, and asthma exacerbation. At 8 p.m. Mychelle had a seizure. Dr. Dang testified that he believed at the time that Mychelle was suffering from a viral infection, not sepsis.

diarrhea, five episodes of vomiting, shortness of breath, and lethargy. Later tests revealed she was suffering from septicemia (sepsis), a life-threatening bacterial infection which requires antibiotics for treatment.

Dr. Dang treated Mychelle's symptoms. She was given Tylenol and ibuprofen for her fever and intravenous fluids for her dehydration. Her breathing problem was treated with albuterol and her seizure with Ativan.

Based on his examination, Dr. Dang believed a complete blood count and blood culture needed to be done. He spoke several times to Dr. Thompson at Kaiser Permanente Hospital. Mychelle was covered under a Kaiser health plan. Dr. Dang told Dr. Thompson that he wanted to do the blood work. Dr. Thompson responded that the blood work would be done at Kaiser, not at King.

At approximately 9 p.m., Mychelle was transferred to Kaiser by ambulance. At that time she was slightly lethargic and her temperature was 101 degrees. Dr. Dang testified that when Mychelle was transferred, he thought that her condition had stabilized.

Mychelle arrived at Kaiser at 9:35 p.m., suffered cardiac arrest at 9:50 p.m., and died shortly afterwards.

Mychelle's parents filed a complaint alleging causes of action for wrongful death and for violations of EMTALA. ¹ The EMTALA claims alleged violations for failure to provide an appropriate medical screening examination and for transferring Mychelle without stabilizing her emergency medical condition. The trial court granted the County's motion for nonsuit on the failure to screen allegation under EMTALA. (The correctness of that order is not questioned on appeal.)

The jury found both Dr. Dang and Dr. Thompson negligent, and found that their negligence was a legal cause of Mychelle's death. It apportioned fault 75 percent to Dr. Dang and 25 percent to Dr. Thompson. The jury assessed economic damages at $3,000 and non-economic damages at $1,350,000. ² The jury also found that County violated EMTALA by failing to stabilize Mychelle before her transfer.

The trial court granted the County's motion to reduce the non-economic damages to $250,000 pursuant to the MICRA cap. Appellant contends that the MICRA cap does not apply to her EMTALA claim. ³

DISCUSSION

Because no reported California case has discussed EMTALA, we begin with a review of that statute. We next examine the purpose of the MICRA statute. We then address the critical issue in this case: whether the MICRA cap on non-economic damages applies to the EMTALA action for failure to stabilize prior to transfer.

I

EMTALA was enacted amid concern that hospitals were "refusing to provide emergency medical treatment to patients unable EMTALA imposes two requirements on hospitals that have emergency departments. First, if a request is made, the hospital must conduct an "appropriate medical screening." (42 U.S.C. § 1395dd, subd. (a).) To meet EMTALA's screening requirements, the hospital is obligated to apply its "standard screening procedure for identification of an emergency medical condition uniformly to all patients...." (Baber v. Hospital Corporation of America (4th Cir.1992) 977 F.2d 872, 878.) This provision of EMTALA is implicated when individuals ⁴ who are perceived to have the same medical condition receive disparate treatment. (Vickers v. Nash General Hospital (4th Cir.1995) 78 F.3d 139, 142, 143.)

                to pay, or transferring them before emergency conditions were stabilized."  (Power v. Arlington Hospital Association (4th Cir.1994) 42 F.3d 851, 856 ("Power ").)   The purpose of the statute is to prevent "patient dumping."  (Ibid.) "Congress enacted the EMTALA not to improve the overall standard of medical care, but to ensure that hospitals do not refuse essential emergency care because of a patient's inability to pay."  (Eberhardt v. City of Los Angeles (9th Cir.1995) 62 F.3d [60 Cal.App.4th 476] 1253, 1258.)   EMTALA does not substitute for state law malpractice actions, but is a distinct cause of action.  (Power, supra, 42 F.3d at p. 856.)
                

EMTALA's second requirement is that a hospital stabilize a patient with an emergency medical condition. (42 U.S.C. § 1395dd, subd. (b)(1).) If the hospital knows that a patient's condition is unstable and does not stabilize it, the hospital may transfer the patient only with the patient's consent or after completing a certificate showing that the transfer will benefit the patient. (Baber v. Hospital Corporation of America, supra, 977 F.2d 872, 882.) A hospital violates this provision of EMTALA if it has "actual knowledge of the individual's unstabilized emergency medical condition," fails to stabilize the condition, and nevertheless transfers the patient. (Summers v. Baptist Medical Center Arkadelphia (8th Cir.1996) 91 F.3d 1132, 1140.)

It has been held that a hospital is strictly liable for a violation of EMTALA. (Abercrombie v. Osteopathic Hospital Founders Association (10th Cir.1991) 950 F.2d 676, 681.) This strict liability characterization describes the lack of any intent requirement, not the standard of care. (See Repp v. Anadarko Municipal Hospital (10th Cir.1994) 43 F.3d 519, 522, fn. 5; see also Dowdy, Friend & Rangel, The Anatomy of EMTALA: A Litigator's Guide (1996) 27 Saint Mary's L.J. 463, 489, fn. omitted ["Although courts sometimes refer to EMTALA as a strict liability statute, this reference is incorrect. Strict liability automatically imposes responsibility for an activity regardless of the care utilized in the act, whereas EMTALA requires hospitals to adhere to a certain level of care."].)

A hospital or physician that violates any EMTALA requirement is liable for specified penalties. (42 U.S.C. § 1395dd(d)(1)(A) and (d)(1)(B).) In addition, "[a]ny 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 equitable relief as is appropriate." (42 U.S.C. § 1395dd(d)(2)(A).) The language we have emphasized in this passage is critical to the parties' claims.

Section 1395dd(d)(2)(A) was enacted because "Congress 'was clearly aware of a growing concern in some states that excessive damage awards were fueling a medical malpractice "crisis," ' and that Congress apparently wished to preserve state enacted ceilings on the amount of damages that could be recovered in EMTALA through the incorporation

of § 1395dd(d)(2)(A)." (Power, supra, 42 F.3d 851, 862, quoting Reid v. Indianapolis Osteopathic Medical Hospital Inc. (S.D.Ind.1989) 709 F.Supp. 853, 855.) Section 1395dd(d)(2)(A) is "an attempt on the part of Congress to balance the deterrence and compensatory goals of EMTALA with deference to the ability of states to determine what damages are appropriate in personal injury actions against hospitals." (Power, supra, 42 F.3d at p. 863.)

II

MICRA serves a different purpose. "[T]he Legislatu...