Cheatwood v. Mwanza
| Decision Date | 03 December 2020 |
| Docket Number | No. 2:19-CV-02088,2:19-CV-02088 |
| Parties | MARK CHEATWOOD PLAINTIFF v. DR. DANIEL MWANZA, et al. DEFENDANTS |
| Court | U.S. District Court — Western District of Arkansas |
Before the Court are three motions for summary judgment. Separate Defendant Dr. Daniel Mwanza filed a motion (Doc. 102) for summary judgment, a brief in support (Doc. 103), and statement of facts (Doc. 104). Plaintiff Mark Cheatwood filed a response (Doc. 142) and brief in opposition (Doc. 143). Mr. Cheatwood also filed a statement of disputed material facts (Doc. 141) responsive to all motions for summary judgment. Separately, Intervener The City of Fort Smith ("the City") filed a response (Doc. 136) and statement of facts (Doc. 140) to Dr. Mwanza's motion. Dr. Mwanza filed a reply (Doc. 152) and Mr. Cheatwood, with leave of Court, filed a surreply (Doc. 163). Separate Defendant Fort Smith HMA, LLC ("Fort Smith HMA") filed a motion (Doc. 109) for summary judgment, brief in support (Doc. 110), and statement of facts (Doc. 111). Mr. Cheatwood filed a response (Doc. 149) and brief in opposition (Doc. 150). Fort Smith HMA filed a reply (Doc. 151). Dr. Michelle Horan also filed a motion (Doc. 112) for summary judgment, brief in support (Doc. 113), and statement of facts (Doc. 114). The City filed a response (Doc. 135) and brief in opposition (Doc. 137). Mr. Cheatwood also filed a response (Doc. 144) and brief in opposition (Doc. 145). Dr. Horan filed a reply (Doc. 154). For the reasons set forth below Fort Smith HMA's motion (Doc. 109) will be GRANTED and Dr. Mwanza and Dr. Horan's motions (Docs. 102, 112) will be DENIED.
On July 10, 2017, Mr. Cheatwood, in the course of his employment for the City, was operating a boom truck to move a water pump from a flatbed trailer into a creek. The boom truck was equipped with outriggers intended to stabilize the boom truck while picking up large items. However, because of the location of the boom truck and the flatbed trailer, Mr. Cheatwood was not able to extend the outriggers to their fullest extent, and instead the outriggers were only extended to the "intermediate position." (Doc. 112-5, p. 4). Although Mr. Cheatwood had previously used the boom truck to lift similar pumps, he was unaware that this pump was heavier than those pumps or that the outriggers were not extended far enough to stabilize the boom truck. As Mr. Cheatwood was lowering the pump into the creek, the boom truck tipped and Mr. Cheatwood fell between thirty and forty feet into the creek. As a result of the fall, Mr. Cheatwood suffered a "right ankle closed fracture, open bimalleolar fracture of the left ankle, broken left wrist, closed burst fracture of the lumbar vertebra[,] and closed sternal fracture." (Doc. 114, p. 1).
Mr. Cheatwood arrived by ambulance at 8:14 a.m. at the Sparks Regional Medical Center ("Sparks") emergency room. Dr. Horan, the emergency room doctor, examined Mr. Cheatwood's injuries at 8:15 a.m. After confirming pedal pulses were present in both the right and left lower extremities, Dr. Horan ordered Nurse Ben Yother to apply wet-to-dry dressings on Mr. Cheatwood's wound. Per Dr. Horan's orders, IV pain medication was administered at 8:26 a.m. Dr. Horan also ordered Ancef and Tdap antibiotics, and additional pain medication, which were administered to Mr. Cheatwood at 8:39 a.m. A lumbar spine CT, x-rays of lower extremities, and an additional CT of Mr. Cheatwood's spine were ordered and completed by 9:13 a.m.
Dr. Horan paged the on-call orthopedic surgeon, Dr. John Harp, three times between 9:01 a.m. and 9:39 a.m. Around 10:00 a.m., Dr. Horan was able to speak to Dr. Harp. After Dr. Harpreviewed the radiology studies, he scheduled Mr. Cheatwood for an irrigation and debridement ("I&D"), a type of wound cleaning performed while the patient is under general anesthesia, and an external fixation of the open fracture for 12:30 p.m. At 10:11 a.m., Dr. Horan, at the direction of Dr. Harp, paged the on-call general surgeon, Dr. Mwanza, to manage Mr. Cheatwood's care. Dr. Mwanza accepted the consult on Mr. Cheatwood at 10:19 a.m. and examined Mr. Cheatwood.
Dr. Horan also paged the on-call neurosurgeon, Dr. Arthur Johnson, at 9:38 a.m., and Dr. Johnson accepted the consult. Dr. Johnson's physician assistant, Janet Canada, APN, examined Mr. Cheatwood. Nurse Canada documented Mr. Cheatwood had a L4 chance fracture on his spine, and Dr. Johnson came to the emergency room to examine Mr. Cheatwood and review his radiology studies.
At 11:28 a.m., Dr. Mwanza admitted Mr. Cheatwood to the hospital. Because Dr. Horan was an emergency room physician, she did not have privileges to admit patients to the hospital. Mr. Cheatwood was transferred to the operating room at 11:55 a.m. and a preoperative assessment was performed by Janis Shephard, R.N. and Dr. Deborah Moss, the anesthesiologist. Dr. Johnson then informed Dr. Moss that Mr. Cheatwood's I&D surgery needed to be put on hold because Mr. Cheatwood's L4 fracture should be surgically stabilized before the I&D procedure. It was Dr. Johnson's opinion that the spinal surgery needed to be performed using a surgical anterior approach. However, no general surgeon on call was trained in performing anterior approaches. Because no general surgeon could perform an anterior approach, Dr. Mwanza entered an order to transfer Mr. Cheatwood to another facility, and Nurse Shephard documented the surgery cancellation at 1:50 p.m.
Dr. Horan was then contacted and asked to assist with Mr. Cheatwood's transfer arrangements. Dr. Horan called the Arkansas Trauma Communications Center to find a hospitalthat could take Mr. Cheatwood as a patient. Caryl Cheatwood requested Mr. Cheatwood be transferred to a Tulsa hospital because of Tulsa's proximity to the Cheatwood home. However, Mr. Cheatwood was not accepted for transfer at any Tulsa, Oklahoma hospital and instead was transferred to University of Arkansas Medical Systems ("UAMS"). Caryl Cheatwood signed a transfer request on behalf of Mr. Cheatwood that included the following language:
I acknowledge that my medical condition has been evaluated and explained to me by the physician. I desire a transfer to another facility. Potential benefits and risks associated with this transfer have been explained and I fully understand them. With this understanding, I choose to be transferred to another facility.
A medical helicopter transport was called at 1:57 p.m. and arrived at Sparks at 2:45 p.m. Mr. Cheatwood departed Sparks by helicopter at 3:04 p.m. and arrived at the UAMS emergency department at 4:28 p.m. At 7:20 p.m. Mr. Cheatwood was admitted as a patient to UAMS. At around 8:00 a.m. the following morning, Mr. Cheatwood underwent the I&D surgical procedure. On July 26, 2017, after undergoing four separate I&D procedures, Mr. Cheatwood's left leg and foot were amputated below the knee.
Plaintiff Mark Cheatwood and his wife Caryl Cheatwood filed this action on July 9, 2019, against Dr. Mwanza, Dr. Horan, Baptist Health FKA Sparks Regional Medical Center, unknown medical doctors 1-10, and unknown hospital staff 1-10. The Cheatwoods alleged claims for medical malpractice, loss of consortium, and violations of the Emergency Medical Treatment and Active Labor Act ("EMTALA"), 42 U.S.C. § 1395dd. Plaintiffs' original complaint lacked sufficient jurisdictional allegations and named the incorrect entity for Sparks. Plaintiffs eventually filed a motion for leave to file a second amended complaint adding Fort Smith HMA, LLC and Community Health Systems Inc. as defendants. Separate Defendants Baptist Health and Community Health Systems, Inc. were dismissed without prejudice pursuant to a joint stipulation(Doc. 55), and Plaintiffs' claims against Unknown Medical Doctors 1-10 and Unknown Hospital Staff 1-10 were also dismissed without prejudice (Doc. 58). On September 30, 2020, Plaintiff Caryl Cheatwood was dismissed as a plaintiff in this action pursuant to Federal Rule of Civil Procedure 41(a)(2).
On a motion for summary judgment, the burden is on the moving party to show that there is no genuine dispute of material fact and that it is entitled to judgment as a matter of law. Fed. R. Civ. P. 56(a). Once the movant has met its burden, the nonmovant must present specific facts showing a genuine dispute of material fact exists for trial. Matsushita Elec. Indus. Co. v. Zenith Radio Corp., 475 U.S. 574, 587 (1986). In order for there to be a genuine dispute of material fact, the evidence must be "such that a reasonable jury could return a verdict for the nonmoving party." Allison v. Flexway Trucking, Inc., 28 F.3d 64, 66-67 (8th Cir. 1994) (quoting Anderson v. Liberty Lobby, Inc., 477 U.S. 242, 248 (1986)).
Mr. Cheatwood's EMTALA claims against Fort Smith HMA will be dismissed. EMTALA applies to hospitals that have executed a provider agreement under the Medicare program. Summers v. Baptist Med. Ctr. Arkadelphia, 91 F.3d 1132, 1136 (8th Cir. 1996). The purpose of EMTALA is to prevent "patient dumping," where hospitals refuse to treat patients in an emergency room if the patients do not have health insurance. Id. at 1136-37. EMTALA requires a hospital to screen patients who come to the hospital's emergency room, and to either provide the treatment required to stabilize the patient or transfer a patient if the hospital determines the patient has an emergency medical condition. Id. at 1140. For purposes of EMTALA, "emergency medicalcondition" is defined as:
(A) a medical condition manifesting itself by acute symptoms of sufficient severity (including severe pain) such that the absence of immediate medical attention could reasonably be expected to result in (i) placing the health of the individual (or, with respect to a pregnant woman, the health of the woman or her unborn child) in serious jeopardy, (ii) serious impairment to bodily functions, or (iii) serious dysfunction of...
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