Cervantes v. Tenet Hosps. Ltd.
| Citation | 372 F.Supp.3d 486 |
| Decision Date | 26 March 2019 |
| Docket Number | EP-18-CV-00110-KC |
| Parties | Consuelo CERVANTES, Plaintiff, v. TENET HOSPITALS LIMITED, a Texas Limited Partnership, d/b/a the Hospitals of Providence East Campus, Defendants. |
| Court | U.S. District Court — Western District of Texas |
Felix Valenzuela, Valenzuela Law Firm, John Joseph Grost, Attorney at Law, El Paso, TX, for Plaintiff.
Daphne Marie Andritsos, Yvonne K. Puig, Norton Rose Fulbright US LLP, Austin, TX, for Defendants
On this day, the Court considered Defendant Tenet Hospitals' Motion to Dismiss Plaintiff's Second Amended Complaint. ECF No. 22. For the reasons below, the Motion is DENIED .
The following facts are alleged in Plaintiff Consuelo Cervantes' Second Amended Complaint ("SAC"), ECF No. 25, and, at this stage, are accepted by the Court as true. See Ashcroft v. Iqbal , 556 U.S. 662, 678, 129 S.Ct. 1937, 173 L.Ed.2d 868 (2009). Plaintiff alleges she arrived at Defendant Providence Hospital at 6:59 a.m. on April 10, 2016, after Del Sol Hospital detected loops of bowel in a hernia
but then told her "to go to another hospital." SAC 2–3. Plaintiff alleges her blood pressure was low at 97/49 and her pulse rapid at 125 beats per minute, which are symptoms associated with shock. Id. at 3. A nurse categorized Plaintiff as a "2" on the Emergency Severity Index, meaning she had a "high risk of deterioration, or a time-critical problem." Id. Given this categorization, Plaintiff asserts, Defendant's policy is to examine the patient on a frequent basis, and order several tests, including blood count, metabolic panel, blood sugar, and a CT scan, "instantly or immediately." Id. at 5. Plaintiff claims a physician began an examination at 7:23 a.m. and never examined her again. Id. Further, even though Defendant possessed the capability to complete the tests within an hour, it did not. Id.
At 12:36 p.m., about five and a half hours after Plaintiff arrived at the hospital, the physician ordered a CT scan
. Id. The physician reviewed the results of the scan three hours later, at 3:41 p.m., which revealed "air in the abdominal cavity and outside the intestines, fluid in the abdominal cavity outside the intestines, and a ventral hernia above the umbilical area containing loops of bowel." Id. at 5–6. Plaintiff then underwent surgery at 7:00 p.m. Id. at 6. She was admitted to intensive care for septic shock caused by necrotic and perforated bowel, and remained hospitalized from April 10, 2016, until May 19, 2016, when she was transferred to a rehabilitation center. Id. at 6–7.
Plaintiff filed suit in April 2018, and Defendant successfully moved to dismiss the first amended complaint. Order Granting Motion to Dismiss, October 29, 2018, ECF No. 20. This Court granted Defendant's motion to dismiss and allowed Plaintiff to file an amended complaint. Id. at 11. Plaintiff did so and claims Defendant's conduct violated the Emergency Medical Treatment and Active Labor Act ("EMTALA"), 42 U.S.C. § 1395dd (2017), by failing to "appropriately screen Plaintiff to timely determine whether Plaintiff had an emergency medical condition" because the hospital did not follow its own screening procedures. SAC 7. Defendant subsequently filed the instant Rule 12(b)(6) motion to dismiss for failure to state a claim, arguing that Plaintiff's EMTALA claim cannot succeed because, despite any alleged deviations from its screening procedure, she was admitted to the hospital and her emergency condition was identified. Mot. 7.
A motion to dismiss pursuant to Rule 12(b)(6) challenges a complaint for failing to state a claim upon which relief may be granted. Fed. R. Civ. P. 12(b)(6). In ruling on a Rule 12(b)(6) motion, the court must accept well-pleaded facts as true and view them in a light most favorable to the plaintiff. Calhoun v. Hargrove , 312 F.3d 730, 733 (5th Cir. 2002) ; Collins v. Morgan Stanley Dean Witter , 224 F.3d 496, 498 (5th Cir. 2000). Though a complaint need not contain "detailed" factual allegations, a plaintiff's complaint must allege sufficient facts "to state a claim to relief that is plausible on its face." Bell Atl. Corp. v. Twombly , 550 U.S. 544, 555, 570, 127 S.Ct. 1955, 167 L.Ed.2d 929 (2007) (internal quotation marks omitted) (quoting Papasan v. Allain , 478 U.S. 265, 286, 106 S.Ct. 2932, 92 L.Ed.2d 209 (1986) ); Colony Ins. Co. v. Peachtree Constr., Ltd. , 647 F.3d 248, 252 (5th Cir. 2011). "A claim has facial plausibility when the plaintiff pleads factual content that allows the court to draw the reasonable inference that the defendant is liable for the misconduct alleged." Ashcroft , 556 U.S. at 678, 129 S.Ct. 1937.
"[A] plaintiff's obligation to provide the grounds of his entitlement to relief requires more than labels and conclusions, and a formulaic recitation of the elements of a cause of action will not do." Twombly , 550 U.S. at 555, 127 S.Ct. 1955 ; Colony Ins. Co. , 647 F.3d at 252. Ultimately, the "[f]actual allegations [in the complaint] must be enough to raise a right to relief above the speculative level." Twombly , 550 U.S. at 555, 127 S.Ct. 1955 (internal citation omitted). Nevertheless, "a well-pleaded complaint may proceed even if it strikes a savvy judge that actual proof of those facts is improbable, and ‘that a recovery is very remote and unlikely.’ " Id. at 556, 127 S.Ct. 1955 (quoting Scheuer v. Rhodes , 416 U.S. 232, 236, 94 S.Ct. 1683, 40 L.Ed.2d 90 (1974) ).
Defendant argues that because it eventually identified Plaintiff's emergency medical condition and admitted her, it satisfied its EMTALA obligations.1 Mot. 7. However, because Defendant's assertion, if accepted, would permit disparate medical screening examinations, the Court disagrees.2
To prevent hospitals from rejecting, or "dumping," indigent patients, Congress passed EMTALA and created specific duties for participating hospitals with emergency rooms. 42 U.S.C. § 1395dd ; Battle v. Mem'l Hosp. at Gulfport , 228 F.3d 544, 557 (5th Cir. 2000). A hospital must provide any individual that comes to the emergency room an appropriate screening to identify an emergency medical condition and then stabilize the individual before transfer or discharge. 42 U.S.C. § 1395dd(a) – (c). The Act, however, does not create a federal medical malpractice cause of action, and so neither does it set out a nationwide standard of care. Marshall ex rel Marshall v. E. Carroll Par. Hosp. Serv. Dist. , 134 F.3d 319, 322 (5th Cir. 1998). Instead, it largely leaves the contours of care to the hospital's own policies. Fewins v. Granbury Hosp. Corp. , 662 F. App'x 327, 331 (5th Cir. 2016) ; Baker v. Adventist Health, Inc. , 260 F.3d 987, 997 (9th Cir. 2001). "Because hospitals are generally in the best position to assess their own capabilities, a standard screening policy for patients entering the emergency room generally defines which procedures are within a hospital's capabilities." Guzman v. Mem'l Hermann Hosp. Sys. , 637 F.Supp.2d 464, 481 (S.D. Tex. 2009), aff'd , 409 F. App'x 769 (5th Cir. 2011).
The present controversy centers exclusively on EMTALA's screening requirement. The Act requires hospitals with emergency rooms to provide an "appropriate medical screening within the capability of the hospital's emergency department." 42 U.S.C. § 1395dd(a). EMTALA does not define an "appropriate medical screening examination," though it does specify the examination's purpose is to determine "whether or not an emergency medical condition ... exists." 42 U.S.C. § 1395dd(a). What is "appropriate" in a given case depends upon the apparent severity of the symptoms and the capabilities of the hospital; that is, any screening examination must be "reasonably calculated to determine whether or not an emergency condition exists." Correa v. Hosp. San Francisco , 69 F.3d 1184, 1192 (1st Cir. 1995) ; Guzman , 637 F.Supp.2d at 482. "The essence of this requirement" is that hospitals have a screening procedure in place and apply the procedure "uniformly to all those who present substantially similar complaints." Correa , 69 F.3d at 1192 (citing Baber v. Hospital Corp. of Am. , 977 F.2d 872, 879 (4th Cir. 1992) ); see Marshall , 134 F.3d at 323–24 ; Repp v. Andarko Mem'l Hosp. , 43 F.3d 519, 522 (10th Cir. 1994) ; Centers for Medicare and Medicaid Services ("CMS"), State Operations Manual, Interpretive Guidelines, Appendix V—Interpretive Guidelines—Responsibilities of Medicare Participating Hospitals in Emergency Cases 36, https://www.cms.gov/Regulations-and-Guidance/Guidance/Manuals/Downloads/som107ap_v_emerg.pdf ("If a hospital applies in a nondiscriminatory manner (i.e. a different level of care must not exist based on payment status, race, national origin, etc.) a screening process reasonably calculated to determine whether an [emergency] exists, it has met its obligations under EMTALA."). A plaintiff can establish disparate treatment with evidence the hospital did not adhere to its own screening procedures. See Battle , 228 F.3d 544, 558 (5th Cir. 2000) ; see also Romo v. Union Mem'l Hosp. Inc. , 878 F.Supp. 837, 842 (W.D.N.C. 1995) ().
Contrary to Defendant's argument, a correct diagnosis and admission to a hospital does not end an EMTALA screening inquiry. First, particular medical outcomes are not the measure of an appropriate medical screening. Guzman , 637 F.Supp.2d at 482 (citing Gatewood v. Wash. Healthcare Corp. , 933 F.2d 1037, 1039 (D.C. Cir. 1991) ); CMS, State Operations Manual, Interpretive Guidelines, Appendix V—Interpretive Guidelines—Responsibilities of Medicare Participating Hospitals in Emergency Cases 36 ("Regardless of positive or negative individual outcome, a hospital would be in violation of the anti-dumping statute if it fails to meet any of the medical screening requirements under 42 C.F.R. § 489.24.")....
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