Gillispie v. Regionalcare Hosp. Partners Inc.
| Decision Date | 12 June 2018 |
| Docket Number | No. 16-4307,16-4307 |
| Citation | 892 F.3d 585 |
| Parties | Marie GILLISPIE, Appellant v. REGIONALCARE HOSPITAL PARTNERS INC; Essent Healthcare Waynesburg LLC, d/b/a Southwest Regional Medical Center; Essent Healthcare Pennsylvania Inc; Essent Healthcare Inc; Essent Healthcare; Southwest Regional Medical Center |
| Court | U.S. Court of Appeals — Third Circuit |
Noah Geary (Argued), Suite 225, Washington Trust Building, Washington, PA 15301, Counsel for Appellant
Marla N. Presley (Argued), Bethany S. Wagner, Jackson Lewis, 1001 Liberty Avenue, Suite 1000, Pittsburgh, PA 15222, Counsel for Appellee
Before: SMITH, Chief Judge, McKEE and RESTREPO, Circuit Judges
We are asked to determine whether the District Court erred in dismissing a claim under the "whistleblower" protection provision of the Emergency Medical Treatment and Active Labor Act ("EMTALA"), 42 U.S.C. § 1395dd. The dispute here arises from Marie Gillispie’s allegations that the Southwest Regional Medical Center (the "Medical Center") terminated her employment because she reported the Medical Center’s allegedly improper discharge of an unstable patient and because she reported its alleged substandard care of an admitted patient.
The District Court granted summary judgment in favor of the Medical Center based upon its conclusion that Gillispie had not established a prima facie case for retaliation under EMTALA and because various common law claims that Gillispie included in her complaint were preempted by state statutes. For the reasons that follow, we will affirm.
Although hospital emergency rooms were once used primarily to treat life-threatening injuries and serious medical conditions, they have since morphed into little more than primary care facilities for those who cannot afford routine medical care.1
This shift from medical emergency management to primary care treatment has resulted in a "grave financial challenge" for hospital administrators.2 Many of them responded to this economic pressure by engaging in a practice known as "patient dumping." That term refers to the practice of refusing to offer emergency room treatment to indigent patients who lack medical insurance, or transferring them to other medical facilities before their emergency medical condition has been stabilized.3 Congress attempted to address this situation by enacting EMTALA.4 EMTALA imposes certain mandates on hospitals regardless of whether a patient who presents to an emergency room has the ability to pay for treatment.5
EMTALA requires hospitals to first examine each patient to determine whether an emergency medical condition exists.6 "[I]f the examination reveals the patient is suffering from an emergency medical condition, the hospital usually must stabilize the patient before getting into the business of trying to [discharge or] transfer him [or her] elsewhere."7 A hospital that either (1) fails to properly screen a patient, or (2) releases a patient without first stabilizing his or her emergency medical condition thereby violates EMTALA.8
Congress included a whistleblower provision in EMTALA to maximize the likelihood that violations would be reported, and that employees who reported them would not be punished by the employer hospital. That provision states in relevant part: "A participating hospital may not penalize or take adverse action ... against any hospital employee because the employee reports a violation of a requirement of this section."9
Marie Gillispie, a registered nurse, worked for the Southwest Regional Medical Center10 for 13 years and held the position of Quality Project Coordinator when she was terminated in November 2012. Her responsibilities as Quality Project Coordinator included evaluating patient care as well as addressing patient care issues involving possible medical errors.
On October 23, 2012, a pregnant patient, whom we will call "E.R.," went to the Medical Center’s emergency room complaining of discomfort, pain and vaginal bleeding. After examining E.R., the Medical Center’s emergency room personnel discharged her and instructed her to "[g]o directly to Uniontown Hospital" to see a gynecologist. The Medical Center did not have a gynecologist on staff.11 The Medical Center’s personnel did not transport E.R. to Uniontown Hospital, and they were unable to contact Uniontown to confirm whether E.R. got there.
The next day, October 24, 2012, Cynthia Cowie, who was the Medical Center’s Chief Executive Officer, organized a telephone conference to discuss what had happened to E.R. the night before. Gillispie participated in that call in her role as Quality Project Coordinator.
On October 25th, the day after the conference call, a root cause analysis (RCA) meeting was called to investigate whether E.R.’s discharge violated EMTALA and to determine whether the circumstances surrounding E.R.’s discharge triggered any reporting requirements under EMTALA.
Gillispie contends that she insisted that EMTALA required the appropriate personnel at the Medical Center to report the circumstances surrounding E.R.’s discharge to the Pennsylvania Department of Health and/or the Pennsylvania Patient Safety Authority.12 Despite Gillispie’s alleged insistence that EMTALA required the Medical Center to self-report, Cowie instructed the meeting attendees not to report the incident.13 Nevertheless, at the conclusion of the RCA meeting, Cowie did instruct two of the Medical Center’s directors to visit Uniontown Hospital to follow-up on E.R.’s treatment.
Cowie convened a second meeting on October 25, 2012. According to Gillispie’s deposition, everyone in that meeting agreed that the Medical Center’s discharge of E.R. failed to comply with EMTALA.14 Gillispie claimed that she and two other attendees argued that the Medical Center therefore had a legal obligation to report the circumstances of E.R.’s discharge to the appropriate agency or authority.15 According to her deposition, Gillispie told the group "I think it’s better to be on the safe side of safety and report it because they're gonna find out anyway...."16 Gillispie also claims that she "protested with [Cowie] several times, or protested with the group several times that [they] better let them know because it would come out."17 Despite Gillispie’s alleged insistence, Cowie steadfastly maintained that the incident did not have to be reported. Consequently, no one at the Medical Center reported E.R.’s discharge to any regulatory authority or agency.
Representatives of the Pennsylvania Department of Health did arrive at the Medical Center the next day, but they did not come to investigate E.R.’s discharge. Rather, they came to investigate a complaint regarding a patient with the initials L.S. L.S.’s family had complained that, despite Cowie’s contrary representations to them, the Medical Center had failed to discipline nurses for the poor care L.S. had received at the Medical Center. L.S.’s family had complained that L.S. was given all of his medications at once despite his inability to swallow the pills simultaneously. The family also complained that L.S. had not received certain medications on two separate occasions.
During an interview related to that investigation, Gillispie told the investigators about her involvement in the Medical Center’s internal review of L.S.’s treatment. She informed them that only one of the two nurses who had been assigned to L.S. had been disciplined for errors in his treatment. According to Gillispie, Cowie had falsely told L.S.’s family that both nurses had been disciplined.
That same day, Cowie learned of a letter that Gillispie had prepared to aid the Department of Health with its inquiry into L.S.’s treatment. According to Cowie, Gillispie claimed that the letter had previously been drafted in connection with the Medical Center’s July 2012 investigation into L.S.’s care. The document was, in fact, dated July 2012, but the Medical Center’s information technology personnel determined that the letter had not been created until the day of the Department of Health’s investigation into L.S.’s treatment and that it had been backdated. At the conclusion of the Department of Health’s visit, Cowie met with Gillispie and told her to leave the Medical Center’s premises for the day.
Gillispie complied, but, at Cowie’s request, she returned to the Medical Center on November 1, 2012—six days after the Department of Health’s visit. Upon her return, Gillispie met with Cowie and gave her a letter that included the following text:
I am also concerned about the EMTALA violation that occurred last week regarding the pregnant female and transfer of her from our ER to Uniontown Hospital’s ER. This is a serious EMTALA violation. As you know, you informed us that you decided to not report this incident to the Department of Health. As I stated to you at the meeting last week, I believe we must self-report this incident. Pam Carroll spoke up as well and agreed with me. I struggle to understand your reasons for deciding to not report this incident. I again suggest that you do so, immediately, as it would be in the Hospital’s best interest.18
Cowie terminated Gillispie’s employment at the conclusion of that meeting.
Although Gillispie had not reported the Medical Center’s discharge of E.R. to any agency prior to her termination, she did subsequently report it.19 She also filed this suit alleging that her termination violated EMTALA’s whistleblower protection.
Gillispie’s original five-count complaint alleged that her discharge violated EMTALA as well as Pennsylvania’s public policy. She subsequently amended the complaint by adding four counts under the Pennsylvania Medical Care Availability and Reduction of Error (MCARE) Act.20 The District Court subsequently dismissed those counts because the applicable statute of limitations had passed.
Thereafter, a Magistrate Judge filed a Report and Recommendation...
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