Deberry v. Sherman Hosp. Ass'n

Decision Date15 June 1990
Docket NumberNo. 90 C 1173.,90 C 1173.
Citation741 F. Supp. 1302
PartiesVeronica DEBERRY, as mother and next friend of Shauntia Marae Deberry, Plaintiffs, v. SHERMAN HOSPITAL ASSOCIATION, an Illinois corporation, Defendant.
CourtU.S. District Court — Northern District of Illinois

Kenneth C. Chessick, Stephen F. Gray, John W. Fisk, Law Office of Kenneth C. Chessnick, Schaumburg, Ill., for plaintiffs.

John G. Langhenry, Jr., Robert H. Smith, Hinshaw, Culbertson, Moelmann, Hoban & Fuller, Chicago, Ill., for defendant.

MEMORANDUM OPINION

KOCORAS, District Judge:

This matter is before the court on Defendant Sherman Hospital Association's motion to dismiss Count I of Plaintiff Veronica Deberry's two-count complaint as failing to state a claim upon which relief can be granted. As Count II of the complaint is in this court solely on the basis of pendent jurisdiction, the defendant also asks that we dismiss it without prejudice so that the plaintiff can refile this single state-law claim in state court. For the following reasons, the defendant's motion is denied.

BACKGROUND

At the heart of this case lies an alleged medical misdiagnosis of tragic proportions. The complaint, which we take as true for purposes of this motion to dismiss, states that on January 10, 1988, the plaintiff took her daughter, Shauntia Deberry, into Defendant Sherman Hospital's emergency room with a fever, rash, stiff neck with her head tilted to the left, and dispositional aberrations including irritability and lethargy. Plaintiff asserts that although her daughter received treatment at Sherman, she was discharged without her condition having been stabilized. Two days later, when her condition had not only failed to improve but had worsened, the plaintiff's daughter was finally admitted to Sherman where she was ultimately diagnosed as suffering from spinal meningitis. As a result of the disease, she, in addition to other sufferings, is now deaf.

Plaintiff has responded with the instant lawsuit. It consists of two counts. In Count I, the plaintiff claims that by discharging Shauntia without stabilizing her condition, Sherman violated the federal Emergency Medical Treatment and Active Labor Act, 42 U.S.C. § 1395dd (1988). Section 1395dd is also, and more commonly, referred to as "COBRA", the acronym for the Consolidated Omnibus Budget Reconciliation Act of 1986 of which § 1395dd is one small part.1 Count II, on the other hand, is a straightforward state law medical malpractice claim brought pursuant to this court's pendent jurisdiction. It asserts that Sherman's agent, Dr. Douglas Jackson, was negligent in failing to suspect meningitis under the circumstances and in failing to run a blood test or spinal tap which would have detected the disease on January 10th.

Sherman has now moved to dismiss Count I pursuant to Federal Rule of Civil Procedure 12(b)(6) as failing to state a claim upon which relief can be granted. Sherman takes the position that Count I states nothing more than a state malpractice claim of misdiagnosis and thus cannot violate COBRA, which is concerned with prohibiting the refusal by hospitals to treat indigent patients with medical emergencies. Of course if Count I is dismissed, the foundation for federal jurisdiction over Count II evaporates; so Sherman also asks that we dismiss Count II as well so that the plaintiff may bring her suit in the appropriate forum: the Circuit Court of Cook County, Illinois.

DISCUSSION

In order to have a claim dismissed under Rule 12(b)(6), the moving party must meet a high standard. The purpose of a motion to dismiss is to test the sufficiency of the complaint, not to decide the merits of the case. Under the "simplified notice pleading" of the Federal Rules of Civil Procedure, the allegations of a complaint should be construed liberally and "the complaint should not be dismissed for failure to state a claim unless it appears beyond doubt that the plaintiff can prove no set of facts in support of his claim which would entitle him to relief." Conley v. Gibson, 355 U.S. 41, 46, 78 S.Ct. 99, 102, 2 L.Ed.2d 80 (1957); see also Hishon v. King & Spaulding, 467 U.S. 69, 73, 104 S.Ct. 2229, 2232, 81 L.Ed.2d 59 (1984). Generally, "mere vagueness or lack of detail does not constitute sufficient grounds for a motion to dismiss." Strauss v. City of Chicago, 760 F.2d 765 (7th Cir. 1985).

When considering a defendant's motion to dismiss the Court must view the complaint's allegations in the light most favorable to the plaintiff. Scheuer v. Rhodes, 416 U.S. 232, 236, 94 S.Ct. 1683, 1686, 40 L.Ed.2d 90 (1974); Conley, 355 U.S. at 45, 78 S.Ct. at 101. All well-pleaded facts and allegations in the plaintiff's complaint must be taken as true, Ed Miniat, Inc. v. Globe Life Ins. Group, Inc., 805 F.2d 732, 733 (7th Cir.1986), and the plaintiff is entitled to all reasonable inferences that can be drawn therefrom. "Furthermore, a complaint is not required to allege all, or any, of the facts logically entailed by the claim.... A complaint does not fail to state a claim merely because it does not set forth a complete and convincing picture of the alleged wrongdoing." American Nurses Ass'n v. State of Illinois, 783 F.2d 716, 727 (7th Cir.1986).

Since Count I asserts a statutory cause of action, we begin with the statute in question: 42 U.S.C. § 1395dd. The text of § 1395dd becomes all the more important because of the very few cases which addressed it, none of which has come from the Seventh Circuit Court of Appeals. Section 1395dd, as modified in 1986 by the Emergency Treatment and Active Labor Act, Pub.L. 99-272, 100 Stat. 82 (1986), was enacted to alleviate the problem of "patient dumping." This term refers to a hospital's refusal to treat an emergency patient, even though the hospital is physically capable of doing so, simply because the patient may be unable to pay. Congress' response to this perceived problem, § 1395dd, states, in relevant part, as follows:

(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 ... exists....
(b) Necessary stabilizing treatment for emergency medical conditions ...
(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 ..., 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
(B) for transfer of the individual to another medical facility in accordance with subsection (c) of this section.

Subsection (e) of § 1395dd then goes on to define some key terms, three of which are relevant here:

(1) The term "emergency medical condition" means 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 —
(A) placing the patient's health in serious jeopardy,
(B) serious impairment to bodily functions, or
(C) serious dysfunction of any bodily organ or part.
(4) (A) The term "to stabilize" means, with respect to an emergency medical condition, to provide such medical treatment of the condition as may be necessary to assure, within reasonable medical probability, that no material deterioration of the condition is likely to result from the transfer of the individual from a facility.
(5) The term "transfer" means the movement (including the discharge) of a patient outside the hospital's facilities at the direction of any person employed by ... the hospital....

Basic textual analysis of these provisions yields two primary ways in which a hospital can violate § 1395dd through the operation of its emergency room. But a prerequisite to both is that the patient in question must have had an emergency medical condition. Once it is established that the plaintiff showed up at the hospital's emergency room with an emergency medical condition, the hospital can violate § 1395dd either (1) by failing to detect the nature of the emergency condition through inadequate screening procedures under subsection (a), or, (2) under subsection (b), if the emergency nature of the patient's condition is detected, by failing to stabilize the condition before releasing the plaintiff. Whether either of these failures has occurred is essentially a fact-based reasonableness inquiry. This straightforward exegesis of § 1395dd's language is supported by two of four cases which have addressed the elements of a cause of action under the statute. See Thornton v. Southwest Detroit Hosp., 895 F.2d 1131, 1133-35 (6th Cir.1990); Thompson v. St. Anne's Hosp., 716 F.Supp. 8, 9-10 (N.D.Ill.1989) (Bua, J.).

Fashioning these elements into a pleading standard poses no grave difficulty, although it is something which no court has to date addressed. Combining the legal elements with the liberal federal rule of notice pleading, we conclude that the would-be COBRA plaintiff must allege that he (1) went to the defendant's emergency room (2) with an emergency medical condition, and that the hospital either (3) did not adequately screen him to determine whether he had such a condition, or (4) discharged or transferred him before the emergency condition had been stabilized.

Plaintiff Deberry has met this standard. First, she claims she brought her daughter to Sherman's emergency room and requested emergency medical care on her daughter's behalf. Second, she claims that her...

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