Cleland v. Bronson Health Care Group, Inc.

Decision Date06 December 1990
Docket NumberNo. 89-1627,89-1627
Citation917 F.2d 266
Parties, Medicare&Medicaid Gu 39,030 Clair D. CLELAND, Jr. and Janet Cleland, Co-Personal Representatives of the Estate of Clair Devern Cleland, III, Plaintiffs-Appellants, v. BRONSON HEALTH CARE GROUP, INC., a Michigan Corporation, Bronson Methodist Hospital, a Michigan Corporation, Individually and Doing Business as South-Western Michigan Trauma and Emergency Center of Bronson and Expresscare, and Southwestern Michigan Emergency Service, P.C., a Michigan Professional Corporation, Defendants-Appellees.
CourtU.S. Court of Appeals — Sixth Circuit

Paul L. Nelson (argued), Tolley, Fisher & Verwys, Grand Rapids, Mich., for plaintiffs-appellants.

Jon D. Vander Ploeg (argued), Lance R. Mather, William W. Jack, Smith, Haughey, Rice & Roegge, F. William McKee, Joel S. Huyser, Rhoades, McKee, Boer, Goodrich & Titta, Grand Rapids, Mich., for defendants-appellees.

Before: KENNEDY and BOGGS, Circuit Judges; and HULL, Chief District Judge. *

BOGGS, Circuit Judge.

The Clelands took their 15-year-old son to the Bronson Methodist Hospital emergency room in Kalamazoo, Michigan, complaining of cramps and vomiting. He was examined by a doctor of the defendant Bronson Health Care Group, who diagnosed influenza and, four hours later, discharged the patient. Unfortunately, this diagnosis was incorrect. Young Cleland was actually suffering from intussusception, where a part of the intestine telescopes within itself. Less than 24 hours later, he suffered cardiac arrest and died. Instead of limiting themselves to the perhaps expected medical malpractice action, the parents of the deceased creatively also looked to a 1986 Congressional enactment, the Emergency Medical Treatment and Active Labor Act, ("the Act") 42 U.S.C. Sec. 1395dd. The Act imposes on hospitals such as this one the following duties:

(1) To provide "an appropriate medical screening examination within the capability of the hospital's emergency department" to "any individual [who] comes to the emergency department" and seeks examination or treatment. 42 U.S.C. Sec. 1395dd(a).

(2) If the "hospital determines that the individual has an emergency medical condition," to stabilize the medical condition before transferring (or discharging) a patient. 42 U.S.C. Sec. 1395dd(b)(1) and (c)(1).

It is undisputed that the impetus to this legislation came from highly publicized incidents where hospital emergency rooms allegedly, based only on a patient's financial inadequacy, failed to provide a medical screening that would have been provided a paying patient, or transferred or discharged a patient without taking steps that would have been taken for a paying patient. Apparently dissatisfied with the effect of laws that had been limited to hospitals that received funds from the government under the Hill-Burton Act, 42 U.S.C. Secs. 291 to 291 o -1, Congress chose to attempt to meet the perceived evil by enacting the quoted language. See 1986 U.S.Code Cong. & Admin.News 42, 579, 605; Note, Preventing Patient Dumping, 61 N.Y.U.L.Rev. 1186, 1187-88 and nn. 11-12 (1986).

The district court noted this legislative history and found that it was unlikely that Congress intended for Sec. 1395dd to be used as a general malpractice action, because this statute addresses concerns about indigent patients rather than bringing within its ambit all unfortunate consequences that occurred to any and all patients. The district court therefore dismissed the complaint under Rule 12(b)(6), Federal Rules of Civil Procedure, based on its interpretation that the Act applied only to indigent and uninsured patients. We affirm the district court, though on different grounds. Russ' Kwik Car Wash, Inc. v. Marathon Petroleum Co., 772 F.2d 214, 216 (6th Cir.1985).

We hold Congress to its words, that this statute applies to any and all patients. However, we interpret the vague phrase "appropriate medical screening" to mean a screening that the hospital would have offered to any paying patient, and the vague phrase "emergency medical condition" to mean a condition within the actual knowledge of the doctors on duty or those doctors that would have been provided to any paying patient. Since the plaintiffs make no allegations that would allow a finding that either of the statutory duties was breached, we affirm the district court's dismissal of this case.


At 11:30 p.m. on October 28, 1986, Clair Cleland Jr. and Janet Cleland took their fifteen-year-old son, Clair III, to the Southwestern Michigan Trauma and Emergency Center 1 complaining of lower abdominal cramps and vomiting. He was examined by Dr. Beth Armstrong, who diagnosed Clair as suffering from gastroenteritis (influenza) with dehydration and hypoglycemia. Approximately four hours after his arrival, in the early morning of October 29, Clair was discharged to his parents with instructions for his care.

At approximately 10:30 p.m. that same night, Clair was returned to the Trauma Center experiencing cardiopulmonary arrest. He was pronounced dead at approximately 11:45 p.m.

The Clelands filed this action on May 16, 1988, alleging that defendants failed to provide for an appropriate medical screening, failed to treat Clair's emergency medical condition, and discharged Clair without stabilizing his condition, all in violation of the Act. The trial court dismissed their suit for failure to state a claim under the Act because Clair was not indigent and was not uninsured. This appeal followed.


There was no indication or allegation that the care provided to young Cleland, and the decision to discharge him were based on anything other than the best medical judgment of those employed by the hospital. There is no allegation that the screening was in any way different than would have been offered to any other patient, or was deficient in any way peculiar to the patient's characteristics. The allegation of "failure to stabilize" before discharge is similarly based only on the outcome. Appellants point to nothing that indicates that the patient's condition at discharge would not have been considered stable for any other patient, nor is there any allegation of any facts known to the doctors at the time to imply that the patient was not stabilized.

As noted above, there is nothing in the legislative history showing that Congress had any concern about the treatment accorded any patients other than the indigent and uninsured. Thus, defendants argue that Congress could not have intended to allow anyone else to sue under the Act. Unfortunately for this theory, Congress wrote a statute that plainly has no such limitation on its coverage. Just as the Supreme Court has frequently held that the existence of a widespread evil does not mean that Congress must address all of it at once, but it may address it piecemeal, see Williamson v. Lee Optical of Oklahoma, 348 U.S. 483, 489, 75 S.Ct. 461, 465, 99 L.Ed. 563 (1955), there is no principle of construction that Congress may not similarly write a statute that is far broader than any area of concern that it has conceived of or has had brought to its attention. "[T]he law need not be in every respect logically consistent with its aims to be constitutional." Id. at 487-88, 75 S.Ct. at 464-65.

While the legislative history might be of assistance in interpreting ambiguous words or phrases of limitation, there are simply none in this language. The benefits and rights of the statutes extend "to any individual" who arrives at the hospital. The ambiguous words that do exist: ("appropriate" and "stabilize") do not serve to exclude completely any person from the coverage of the Act. Thus, we must reject the grounds chosen by the district court, and argued by the defendants, for dismissing the plaintiffs' claim.

We note that a number of courts have, in dicta, indicated that the Act was meant to apply only to the indigent and uninsured: Thornton v. Southwest Detroit Hosp., 895 F.2d 1131, 1132 (6th Cir.1990) ("The Act requires hospitals to give emergency aid to indigent patients"); Thompson v. St. Anne's Hosp., 716 F.Supp. 8, 10 (N.D.Ill.1989) (statute aimed at preventing hospitals both from transferring and simply rejecting indigent patients); Reid v. Indianapolis Osteopathic Medical Hosp., 709 F.Supp. 853 (S.D.Ind.1989) (statute designed to prevent hospitals turning patients away because of inability to pay); Bryant v. Riddle Memorial Hosp., 689 F.Supp. 490, 492 (E.D.Pa.1988) (Act intended to address the problem of patient dumping). However, in none of those cases was a claimant excluded simply because the claimant was not indigent or uninsured, so our issue was not faced directly.

Three district courts, however, have ruled squarely on the issue before us. Stewart v. Myrick, 731 F.Supp. 433 (D.Kan.1990), and Evitt v. University Heights Hosp., 727 F.Supp. 495 (S.D.Ind.1989), on which Stewart relied heavily, hold that the Act does not cover a situation that "does not represent a case of patient dumping, in which the plaintiff was turned away from medical care for economic reasons." Stewart, 731 F.Supp. at 436. Evitt holds that "[c]laims regarding diagnosis and treatment lie in the area of medical malpractice, an area traditionally regulated by state law." Evitt, 727 F.Supp. at 497.

In the very recent case of DeBerry v. Sherman Hosp. Assoc., 741 F.Supp. 1302 (N.D.Ill.1990), the court explicitly considered the same type of arguments as those presented in our case, and held that a claim could be stated under the Act where the patient did not allege that the denial of treatment was based on inability to pay. We find the reasoning in this case to be persuasive. It specifically takes account of the Stewart and Evitt cases, but holds that the text must control over the legislative history. In addition, Evitt and Myrick argue that 42 U.S.C. Sec. 1395dd has a very strong...

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