Freedman v. Fisher

• Decision Date: 02 February 2015
• Docket Number: Civil Action No. 13–3145.
• Parties: Gary FREEDMAN, et al., Plaintiffs v. Steven FISHER, M.D., et al., Defendants.
• Court: U.S. District Court — Eastern District of Pennsylvania

89 F.Supp.3d 716

Gary FREEDMAN, et al., Plaintiffs

v.Steven FISHER, M.D., et al., Defendants.

Civil Action No. 13–3145.

United States District Court, E.D. Pennsylvania.

Signed Feb. 2, 2015.

James Edward Hockenberry, H. Leon Aussprung, III, Law Office of Leon Aussprung, M.D., Philadelphia, PA, for Plaintiffs.

Donald N. Camhi, Post & Schell, P.C., James A. Young, Heather A. Tereshko, Christie Pabarue and Young, John P. Shusted, Zachary J. Duffy, German Gallagher & Murtagh, Philadelphia, PA, for Defendants.

MEMORANDUM

J. WILLIAM DITTER, JR., District Judge.

An appropriate federal law addresses the problem of “patient dumping,” a practice of some hospitals that, for economic and other reasons, sent prospective patients to another institution without first evaluating that patient's needs. In brief, the law known as the Emergency Treatment and Labor Act (“EMTALA”), provides that whatever the hospital's protocol may be for a given condition, every patient must receive the same tests, evaluation, care, and treatment as every other patient with the same condition. In addition, the hospital must stabilize any known emergency medical condition prior to transfer of a patient to another facility. Notwithstanding, EMTALA does not create a federal cause of action for malpractice. Presently before me are cross motions for summary judgment along with responses and sur-replies related to Plaintiffs' claim under that law.

Defendant Abington Memorial Hospital (“AMH”) argues that summary judgment should be entered in its favor on the plaintiffs' claims brought under EMTALA, 42 U.S.C. § 1395dd(a), as pled by plaintiffs in Count XI of the Amended Complaint. In support thereof, AMH contends that the plaintiffs' EMTALA claim is time-barred by the statute of limitations and that undisputed material facts demonstrate that the plaintiffs' EMTALA claim is legally insufficient.

In their cross-motion, the plaintiffs also move for summary judgment on the EMTALA claim. Plaintiffs argue that judgment should be entered in their favor as there is no genuine dispute as to the material facts which establish an EMTALA violation.

For the reasons that follow, the plaintiffs motion for summary judgment is denied and AMH's motion is partially denied and partially granted.

I. FACTUAL BACKGROUND

I will review the facts once again for clarity's sake. Abraham Strimber presented to the emergency department at Abington Memorial Hospital at approximately 11:40 a.m. with multiple complaints, including chest and abdominal pain. Within minutes, Mr. Strimber was evaluated by an emergency department nurse and then assigned to a primary nurse. Both nurses documented his complaints, their examinations, and their observations of Mr. Strimber.

At 12:23 p.m., Mr. Strimber was examined by an emergency department physician, Steven Fisher, M.D., who made a differential diagnosis and ordered extensive laboratory tests. At 2:27 p.m., Dr. Fisher discharged Mr. Strimber from the emergency department and transferred him within the hospital for further observation.

Margo Turner, M.D., who specializes in internal medicine, next observed, examined, and ordered further testing. Mr. Strimber was then seen by Dr. Muttreja, a cardiologist, at 6:30 p.m. Dr. Muttreja noted that he doubted Mr. Strimber suffered from acute coronary syndrome

based upon cardiac markers and an EKG, but recommended an echocardiogram.¹

At 8:30 p.m., the floor nurse alerted Dr. Turner to a dangerous change in Mr. Strimber's cardiac condition. Shortly thereafter he was taken to the catheterization

lab where testing revealed pericardial hemorrhage. Mr. Strimber rapidly deteriorated and despite a series of emergency measures, he died at 10:49 p.m. of a dissecting aorta.²

II. STANDARD OF REVIEW

A reviewing court may enter summary judgment where there are no genuine issues as to any material fact and a party is entitled to judgment as a matter of law. See Fed.R.Civ.P. 56(c). The evidence presented must be viewed in the light most favorable to the non-moving party. Matsushita Elec. Indus. Co., Ltd. v. Zenith Radio Corp., 475 U.S. 574, 587, 106 S.Ct. 1348, 89 L.Ed.2d 538 (1986). The inquiry is “whether the evidence presents a sufficient disagreement to require submission to a jury or whether it is so one-sided that one party must prevail as a matter of law.” Anderson v. Liberty Lobby, Inc., 477 U.S. 242, 251–52, 106 S.Ct. 2505, 91 L.Ed.2d 202 (1986). In deciding the motion for summary judgment, it is not the function of the court to decide disputed questions of fact, but only to determine whether genuine issues of fact exist. Id. at 248–49, 106 S.Ct. 2505.

The moving party has the initial burden of identifying relevant evidence which it believes shows an absence of a genuine issue of material fact and supports its claim.

Celotex Corp. v. Catrett, 477 U.S. 317, 324, 106 S.Ct. 2548, 91 L.Ed.2d 265 (1986). The moving party's burden may be discharged by demonstrating that there is an absence of evidence to support the nonmoving party's case. Celotex, 477 U.S. at 325, 106 S.Ct. 2548. Once the moving party satisfies its burden, the burden shifts to the nonmoving party, who must go beyond its pleadings and designate specific facts, by use of affidavits, depositions, admissions, or answers to interrogatories, showing that there is a genuine issue for trial. Id. at 324, 106 S.Ct. 2548. Moreover, when the nonmoving party bears the burden of proof, it must “make a showing sufficient to establish the existence of [every] element essential to that party's case.” Equimark Commercial Fin. Co. v. C.I.T. Fin. Servs. Corp., 812 F.2d 141, 144 (3d Cir.1987) (quoting Celotex, 477 U.S. at 322, 106 S.Ct. 2548 ). Summary judgment must be granted “against a party who fails to make a showing sufficient to establish the existence of an element essential to that party's case, and on which that party will bear the burden of proof at trial.” Celotex, 477 U.S. at 322, 106 S.Ct. 2548.

III. DISCUSSION

A. EMTALA

The cross-motions before me both address the plaintiffs' EMTALA claim. As I have previously noted, EMTALA was enacted based on concerns over “patient dumping”—a practice where hospitals, usually because of economic concerns, either refused to treat certain emergency room patients or transferred them to other facilities. See Torretti v. Main Line Hospitals, 580 F.3d 168, 173 (3d Cir.2009). The Act contains several requirements, however, and is not limited to a prohibition against refusing to treat individuals with emergency conditions based on insurance coverage. “EMTALA requires hospitals to give certain types of medical care to individuals presented for emergency treatment: (a) appropriate medical screening, (b) stabilization of known emergency medical conditions and labor, and (c) restrictions on transfer of unstabilized individuals to outside facilities.”³ Torretti, 580 F.3d at 172 (citing 42 U.S.C. § 1395dd(a) -(c) ). Because EMTALA does not create a federal cause of action for malpractice, “[l]iability is determined independently of whether any deficiencies in the screening or treatment provided by the hospital may be actionable as negligence or malpractice, as the statute was aimed at disparate patient treatment.” Id. at 174 (internal citations omitted).

1. Statute of Limitations

AMH first argues that the EMTALA claim is barred by the statute of limitations while the plaintiffs contend it “relates back” to the original complaint and therefore may st proceed.⁴ As it relates to the instant case, Rule 15(c) sets forth one relevant prerequisite for an amendment to relate back to the original complaint: “the claims in the amended complaint must arise out of the same occurrences set forth in the original complaint.” Arthur v. Maersk, Inc., 434 F.3d 196, 203 (3d Cir.2006) (citing Fed.R.Civ.P. 15(c) ). “Relation back is structured ‘to balance the interests of the defendant protected by the statute of limitations with the preference expressed in the Federal Rules of Civil Procedure in general, and Rule 15 in particular, for resolving disputes on their merits.’ ” Glover, 698 F.3d at 145 (citing Krupski v. Costa Crociere S.p.A., 560 U.S. 538, 130 S.Ct. 2485, 177 L.Ed.2d 48 (2010) ). “[A]pplication of Rule 15(c)(1)(B) normally entails a ‘search for a common core of operative facts in the two pleadings' ” Id. (citations omitted). “[I]t is well-established that the touchstone for relation back is fair notice, because Rule 15(c) is premised on the theory that a ‘party who has been notified of litigation concerning a particular occurrence has been given all the notice that statutes of limitations were intended to provide.’ ” Id. (citations omitted). “Thus, only where the opposing party is given ‘fair notice of the general fact situation and the legal theory upon which the amending party proceeds' will relation back be allowed.” Id. (citation omitted).

AMH contends that there is “nothing pleaded [in the original complaint] that should have alerted AMH that it might have direct statutory liability for failure to comply with a federal statutory requirement of performance [EMTALA] of an appropriate screening examination.” Def's. Mot. for Partial Summ. J. (Doc. # 77), at 20. The facts underpinning an EMTALA claim were pled in the original complaint, i.e., the failure to adequately screen, examine and treat Mr. Strimber. This gave AMH “fair notice” that an EMTALA claim was possible. See Glover, 698 F.3d at 146. In their original pleading, the plaintiffs alleged that on AMH had a duty to “adopt and enforce adequate rules and policies to ensure quality care for patients” as well as to ensure medical staff perform “timely and proper patient assessments and/or evaluations.” Pls.' Compl. ¶ 87. Similarly, in their amended complaint, the plaintiffs claimed that AMH failed in its duty to “conduct a full and complete medical screening examination” and failed to “timely determine whether or not an emergency medical condition existed.” Pls.' Am. Compl. ¶ 84. Moreover, the plaintiffs'...