Collins v. DePaul Hosp., 91-8010

• Decision Date: 28 April 1992
• Docket Number: No. 91-8010,91-8010
• Citation: 963 F.2d 303
• Parties: , 37 Soc.Sec.Rep.Ser. 268, Medicare & Medicaid Guide P 40,379 Charles J. COLLINS and Christina A. Collins, Plaintiffs-Appellants, v. DePAUL HOSPITAL, a Wyoming corporation, Defendant-Appellee. and Wyoming Hospital Association, a Wyoming non-profit corporation, Amicus Curiae in support of the Appellee. American Hospital Association, Amicus Curiae in support of the Appellee.
• Court: U.S. Court of Appeals — Tenth Circuit

Page 303

963 F.2d 303

60 USLW 2706, 37 Soc.Sec.Rep.Ser. 268,

Medicare & Medicaid Guide P 40,379

Charles J. COLLINS and Christina A. Collins, Plaintiffs-Appellants, v. DePAUL HOSPITAL, a Wyoming corporation, Defendant-Appellee and Wyoming Hospital Association, a Wyoming non-profit corporation, Amicus Curiae in support of the Appellee American Hospital Association, Amicus Curiae in support of the Appellee.

No. 91-8010.

United States Court of Appeals Tenth Circuit.

April 28, 1992.

Nicholas Vassallo (Harold F. Buck of Buck Law Offices with him on the brief), Cheyenne, Wyo., for plaintiffs-appellants.

Richard B. Caschette (and Douglas J. Cox of Cooper & Kelley, P.C., Denver Colo., and James L. Applegate of Hirst & Applegate, Cheyenne, Wyo., with him on the brief), for defendant-appellee.

J. Kent Rutledge of Lathrop & Rutledge, P.C., Cheyenne, Wyo., for Wyoming Hosp. Ass'n, amicus curiae.

Fredric J. Entin, Jeffrey M. Teske, and Tracey L. Fletcher, Chicago, Ill., for American Hosp. Ass'n, amicus curiae.

Before HOLLOWAY and McWILLIAMS, Circuit Judges, and CAUTHRON, District Judge. ^*

McWILLIAMS, Circuit Judge.

By amended complaint, Charles J. Collins and his wife, Christina A. Collins, brought suit in the United States District Court for the District of Wyoming against DePaul Hospital, a Wyoming corporation which maintains and operates a hospital in Cheyenne, Wyoming, alleging a violation of the Emergency Medical Treatment and Active Labor Act, sometimes referred to as COBRA. 42 U.S.C. § 1395dd, et seq. ¹

From the amended complaint we learn that Charles Collins was involved in an accident on April 3, 1988, and sustained serious injuries therein, including a fractured skull, a collapsed lung and a fractured acetabulum (hip). On that same day, Collins was taken to the DePaul Hospital, which had an emergency department, where he received emergency medical examination and treatment.

The gist of the amended complaint is that although the hospital and its staff may have appropriately diagnosed and treated his other injuries, they failed to take an X-ray of his right hip until April 28, 1988, which X-ray revealed for the first time a fractured hip. Collins further alleged that notwithstanding the discovery of his hip injury on April 28, 1988, he was discharged from the hospital the same day at a time when he was in an unstabilized condition and was simply told to see another physician on an outpatient basis. As a direct result of the hospital's failure to detect on or about April 3, 1988, his fractured hip and to then provide treatment therefor, Collins alleged that he has sustained permanent loss of length in his right leg, and further that, because of the delay in detecting the hip injury, he lost the opportunity to have his hip reconstructed and now has a fused hip. By amended answer, the hospital denied liability and later, after discovery, moved for summary judgment, to which no response was filed. After hearing, the district court granted the hospital's motion for summary judgment and later, after hearing, denied a motion to alter or amend. Collins appeals.

On appeal, Collins in his brief frames the one issue to be resolved on appeal as follows:

Whether 42 U.S.C. § 1395dd requires a hospital to provide all patients who come to its emergency room with an adequate medical screening to determine whether the patient has an emergency medical condition.

Collins argues that the issue he poses should be answered in the affirmative and that summary judgment for the hospital should be reversed and the case remanded and that his COBRA claim should be resolved by a jury. As we understand it, the hospital agrees that the issue, as framed by Collins, should be answered "yes," but asserts that it did comply with COBRA, and that Collins' proceeding in federal court is in reality a federal medical malpractice suit which is not contemplated by COBRA. ²

The COBRA statutes with which we are here concerned are 42 U.S.C. § 1395dd(a), (b) and (c), as in effect on April 3, 1988, which read as follows:

§ 1395dd. Examination and treatment for emergency medical conditions and women in active labor

(a) Medical screening requirement

In the case of a hospital that has a hospital emergency department, if any individual (whether or not eligible for benefits under this subchapter) comes to the emergency department and a request is made on the individual's behalf for examination or treatment for a medical condition, the hospital must provide for an appropriate medical screening examination within the capability of the hospital's emergency department to determine whether or not an emergency medical condition (within the meaning of subsection (e)(1) of this section) exists or to determine if the individual is in active labor (within the meaning of subsection (e)(2) of this section) (emphasis added).

(b) Necessary stabilizing treatment for emergency medical conditions and active labor

(1) In general

If any individual (whether or not eligible for benefits under this subchapter) comes to a hospital and the hospital determines that the individual has an emergency medical condition, or is in active labor, the hospital must provide either--

(A) within the staff and facilities available at the hospital, for such further medical examination and such treatment as may be required to stabilize the medical condition, or to provide for treatment of the labor, or

(B) for transfer of the individual to another medical facility in accordance with subsection (c) of this section (emphasis added).

* * * * * *

(c) Restricting transfers until patient stabilized

(1) Rule

If a patient at a hospital has an emergency medical condition which has not been stabilized (within the meaning of subsection (e)(4)(B) of this section), the hospital may not transfer the patient unless--

Paraphrasing the above-referenced statute, we read it to require that when a participating hospital has an emergency department, if "any individual" comes, or is brought, to such emergency department and requests, or a request is made on his or her behalf, for an examination or treatment of a medical condition, the hospital "must provide for an appropriate medical screening examination ... to determine whether or not an emergency medical condition ... exists" and if the hospital determines that the individual has an "emergency medical condition" it must provide either (1) within its staff and facilities for such further medical examination and treatment as is required "to stabilize the medical condition," and if the medical condition has not been stabilized, the hospital, subject to certain exceptions not applicable in the instant case, may not transfer the individual elsewhere, or (2) transfer the individual to another medical facility in accordance with another provision of the statute.

As indicated earlier, on appeal Collins states in his brief that the only issue in the case is whether 42 U.S.C. § 1395dd requires a hospital to provide any person who comes to its emergency room with an adequate medical screening to determine whether the person has an "emergency medical condition." Accordingly, we are not here concerned with the COBRA provision requiring that a person whom the hospital determines does have "an emergency medical condition" be further examined and treated and his, or her, condition "stabilized" before transfer or discharge. This latter situation was suggested in Collins' amended complaint, but that particular claim has apparently been abandoned along the way. The district court in its order did not address that particular matter, and, as stated, the issue on appeal does not include the "discharge before stabilization" issue. Accordingly, the only matter argued on appeal concerns 42 U.S.C. § 1395dd(a), i.e the requirement that there be an "appropriate medical screening" when a person presents himself to a hospital's emergency department for the purpose of determining "whether or not an emergency medical condition exists."

The background facts out of which this dispute arises, as set forth in the amended complaint and as expanded upon in the several depositions, discloses that on April 3, 1988, Collins was thrown from an all-terrain vehicle and sustained life threatening injuries. He was brought by ambulance to DePaul Hospital in an unconscious condition and immediately admitted to the emergency room. His injuries were diagnosed as including numerous abrasions and lacerations, a shoulder injury, pulmonary problems, chest and head injury, including a severe brain injury. A neurosurgeon treated and evaluated Collins' brain injury. Collins was then admitted to the hospital's Intensive Care Unit (ICU) on the same day and surgery was performed. Collins' life hung in the balance on April 3, 1988. He remained in ICU until April 18, 1988. During this period of time, Collins received continuous care and treatment for his injuries. Eventually Collins regained consciousness and on April 18, 1988, he was transferred out of ICU to the general surgery floor of the hospital where he remained until his discharge from the hospital on April 29, 1988.

During the first part of his hospitalization, Collins did not communicate in any meaningful way with the attending doctors. However, as his brain injury slowly improved and he began to move around, he began to complain about his right hip. On April 28, 1988, a hip X-ray was taken and revealed a fracture of the right acetabulum (hip). ³ Although in his brief Collins alleged that he was discharged on April 28, 1988, the day the hip X-ray was taken, it appears that actually on April 28, 1988, he was sent home on an overnight pass and that he in fact returned to DePaul Hospital on the morning of April 29, 1988, when a CAT scan was taken of his hip, and the attending doctor discussed Collins' hip injury with a local Cheyenne orthopedic surgeon. After reviewing Collins' medical condition, Collins was then discharged on April 29,...