Casey v. Amarillo Hosp. Dist., 07-96-0037-CV

• Citation: 947 S.W.2d 301
• Decision Date: 05 June 1997
• Docket Number: No. 07-96-0037-CV,07-96-0037-CV
• Parties: Robert Dean CASEY and Judy Carol Phelps, (f/k/a Judy Carol Wilson), Appellants, v. AMARILLO HOSPITAL DISTRICT, Appellee.
• Court: Court of Appeals of Texas

Page 301

947 S.W.2d 301

53 Soc.Sec.Rep.Ser. 707

Robert Dean CASEY and Judy Carol Phelps, (f/k/a Judy Carol

Wilson), Appellants, v. AMARILLO HOSPITAL DISTRICT, Appellee.

No. 07-96-0037-CV.

Court of Appeals of Texas,

Amarillo.

June 5, 1997.

Rehearing Overruled July 14, 1997.

Templeton, Smithee, Hayes & Fields, Joe W. Hayes, Amarillo, for appellants.

Gibson, Ochsner & Adkins, L.L.P., Thomas C. Riney, Tod Mayfield, Amarillo, for appellee.

Before DODSON and QUINN, JJ., and REYNOLDS, Senior Justice. ^*

DODSON, Justice.

Robert Dean Casey and Judy Carol Phelps (the Parents), as parents of Justin Dean Casey, deceased, (Justin), appeal from the trial court's summary judgment rendered in favor of the Amarillo Hospital District (the Hospital) and challenges that portion of the judgment which disposed of their claim under the federal Emergency Medical Treatment and Active Labor Act (EMTALA), codified at 42 U.S.C. § 1395dd. By their sole point of error, the Parents contend that the trial court erred in granting the Hospital's motion which asserted that the Hospital's treatment of Justin was within the acceptable parameters of EMTALA. Concluding that the summary judgment evidence conclusively negated essential elements of the Parents' EMTALA claim, we affirm.

The record shows the following facts. On May 2, 1991, at 6:30 p.m., the Hospital admitted Justin to the emergency room with a fever of 106.5 degrees. Dr. R.D. Hubbird, who was Justin's pediatrician, then examined Justin. Dr. Hubbird ordered that lab tests be performed and a chest x-ray be taken. These were taken and performed by Hospital personnel. By 8:30 p.m., Justin's temperature dropped to 103.2 degrees. At this point, Dr. Hubbird consulted with Dr. Steve O'Grady, who was a pediatric intern at the Hospital. Dr. Hubbird concluded that Justin suffered from constipation and recommended that Justin be taken home. On May 3, 1991, at approximately 4:45 a.m., Justin started convulsing and stopped breathing. An ambulance took Justin back to the Hospital, where he died at approximately 6:15 a.m. The cause of Justin's death was determined to be meningococcemia.

By one point of error, the Parents claim that the trial court erred in rendering summary judgment as to their EMTALA claim because: 1) genuine issues of material fact exist as to whether the Hospital provided an appropriate medical screening examination and whether the Hospital actually knew of an emergency medical condition, and 2) the EMTALA does not require that a motive on the part of the Hospital be plead or proved.

When a defendant moves for summary judgment, that party must conclusively negate at least one essential element of each cause of action brought by the plaintiff. Lear Siegler, Inc. v. Perez, 819 S.W.2d 470, 471 (Tex.1991). The question on appeal, as well as in the trial court, is not whether the summary judgment proof raises fact issues with reference to the essential elements of a plaintiff's claim. Gibbs v. General Motors Corp., 450 S.W.2d 827, 828 (Tex.1970). Rather, when reviewing the summary judgment record, we apply the following standards:

1. The movant for summary judgment has the burden of showing that there is no genuine issue of material fact and that it is entitled to judgment as a matter of law.

2. In deciding whether there is a disputed material fact issue precluding summary judgment, evidence favorable to the non-movant will be taken as true.

3. Every reasonable inference must be indulged in favor of the non-movant and any doubts resolved in its favor.

Nixon v. Mr. Property Management Co., 690 S.W.2d 546, 548-49 (Tex.1985).

When a summary judgment order does not specify the basis upon which it is granted, the summary judgment will be upheld on any theories asserted by the movant that are supported by the evidence. Rogers v. Ricane Enterprises, Inc., 772 S.W.2d 76, 79 (Tex.1989). Evidence favoring the movant's position will not be considered on review of a summary judgment unless it is uncontradicted. Great American R. Ins. Co. v. San Antonio Pl. Sup. Co., 391 S.W.2d 41, 47 (Tex.1965). Finally, where a movant's evidence is uncontradicted, it will be taken as true. Railroad Commission v. Sample, 405 S.W.2d 338 (Tex.1966).

Before we consider the Parents' point of error and its sub-points, it is necessary to discuss the EMTALA and the relevant case law interpreting the EMTALA. The EMTALA was enacted by Congress to address a growing concern that hospitals were either "dumping" patients who could not pay or transferring patients to another hospital before their emergency conditions were stabilized. Miller v. Medical Ctr. of Southwest La., 22 F.3d 626, 628 (5th Cir.1994). The EMTALA was not intended to duplicate or preempt state law protections that already existed, but was intended to create a new cause of action not available under state law for "failure to treat." Summers v. Baptist Medical Ctr. Arkadelphia, 91 F.3d 1132, 1137 (8th Cir.1996).

There are two requirements placed upon hospitals by the EMTALA. First, "the Hospital must provide for an appropriate medical screening examination ... to determine whether or not an emergency medical condition exists." 42 U.S.C. § 1395dd(a). Second, if the hospital determines that an emergency medical condition exists, the hospital must either stabilize the medical condition, or transfer the individual to another medical facility. 42 U.S.C. § 1395dd(b). A cause of action under the EMTALA, then, may be established in one of two ways. First, the claimant may establish that the hospital did not meet these requirements because the hospital's screening examination was not appropriate. Second, the claimant may establish that the hospital determined that an emergency medical condition existed and failed to stabilize the condition or transfer the patient to another hospital.

In general, it is established that an EMTALA violation is vastly different from medical negligence, and the appropriateness of a screening examination is not to be judged against a negligence standard. Summers v. Baptist Medical Ctr. Arkadelphia, 91 F.3d at 1137; Baber v. Hospital Corp. of America, 977 F.2d 872, 880 (4th Cir.1992). "EMTALA is not a substitute for state law malpractice actions, and was not intended to guarantee proper diagnosis or to provide a federal remedy for misdiagnosis or medical negligence." Power v. Arlington Hosp. Ass'n., 42 F.3d 851, 856 (4th Cir.1994).

The EMTALA requirement that the screening examination be "appropriate" requires that hospitals determine what their screening procedures will be, and then apply them uniformly to all individuals who come into the emergency room. Summers v. Baptist Medical Ctr. Arkadelphia, 91 F.3d at 1138. The EMTALA was not created "to ensure each emergency room patient a correct diagnosis, but rather to ensure that each is accorded the same level of treatment regularly provided to patients in similar medical circumstances." Gatewood v. Washington Healthcare Corp., 933 F.2d 1037, 1041 (D.C.Cir.1991). In that connection, for the claimant to establish that the hospital's screening procedures are not appropriate, the claimant must establish that he did not receive the same screening examination as every other person who enters the emergency room with the same or similar condition.

If the claimant fails to establish that the screening examination is not appropriate, a cause of action may still lie under the EMTALA upon a showing that the hospital, after determining that an emergency medical condition existed, failed to either stabilize the medical condition or transfer the patient to another medical facility. 42 U.S.C. § 1395dd(b). To satisfy this second requirement, a claimant must show that the emergency medical condition was "within the actual knowledge of the doctors on duty." Cleland v. Bronson Health Care Group, Inc., 917 F.2d 266, 269 (6th Cir.1990). Therefore, the hospital's actions are to be viewed in terms of the actual diagnosis, not in terms of what the diagnosis should have been. Vickers v. Nash General Hospital, Inc., 78 F.3d 139, 145 (4th Cir.1996). Accordingly, in order for a hospital to be liable for failing to stabilize or transfer a patient, it must be shown that an emergency condition existed and that the hospital, through the doctors on duty, had actual knowledge of the emergency condition. Cleland v. Bronson Health Care Group, Inc., 917 F.2d at 269.

Some courts have required claimants to satisfy a second element, in addition to one of the two discussed above, in order to state any EMTALA cause of action. These courts have required that the claimant show an improper motive for "dumping" the claimant on the part of the hospital. See, Cleland v. Bronson Health Care Group, Inc., 917 F.2d at 266. As stated above, the legislative history of the EMTALA shows that Congress passed it in order to protect indigent and uninsured patients from being "dumped" by hospitals who did not want to treat them. Summers v. Baptist Medical Ctr. Arkadelphia, 91 F.3d at 1136.

The express language of the statute, however, provides in clear and unambiguous language that "any individual" coming to an emergency room must be afforded an appropriate medical screening examination. 42 U.S.C. § 1395dd(a). This express statutory language has lead every Federal Circuit Court of Appeals who has considered this issue, save the Sixth Circuit in Cleland, to conclude that no improper motive for disparate treatment need be shown on the part of the hospital in order to state a cause of action under the EMTALA. See, Burditt v. U.S. Dept. of Health and Human Servs., 934 F.2d 1362, 1363 (5th Cir.1991); Gatewood v. Washington Healthcare Corp., 933 F.2d at 1041; Power v. Arlington Hosp. Ass'n., 42 F.3d at 851; Summers v. Baptist Medical Ctr. Arkadelphia, 91 F.3d at 1132.

We conclude, as have the Fourth, Fifth, Eighth, and D.C. Circuit Courts of Appeal, that "we are bound by statutory language this clear, at least where, as here, it is...