Grages v. Geisinger Health

• Decision Date: 09 March 2021
• Docket Number: CIVIL ACTION NO. 4:19-cv-01141
• Parties: JANE EMILIA GRAGES, Administrator for the Estate of Kimberly Jane Donovan, Deceased, et al., Plaintiffs, v. GEISINGER HEALTH (a/k/a Geisinger Health System), et al., Defendants.
• Court: U.S. District Court — Middle District of Pennsylvania

JANE EMILIA GRAGES, Administrator for the Estate ofKimberly Jane Donovan, Deceased, et al., Plaintiffs, v. GEISINGER HEALTH (a/k/a

Geisinger Health System), et al., Defendants.

CIVIL ACTION NO. 4:19-cv-01141

UNITED STATES DISTRICT COURT MIDDLE DISTRICT OF PENNSYLVANIA

March 9, 2021

(SAPORITO, M.J.)

MEMORANDUM

In this pro se civil action, the plaintiffs¹ have asserted a federal claim for damages against defendant Geisinger Medical Center ("GMC"), under the Emergency Medical Treatment and Active Labor Act ("EMTALA"), 42 U.S.C. § 1395dd. See generally Mala v. Crown Bay Marina, Inc., 704 F.3d 239, 244-46 (3d Cir. 2013) (discussing a federal court's obligation to liberally construe the filings of pro se litigants);Grages v. Geisinger Health, Civil. No. 4:19-CV-1141, 2020 WL 1151452, at *2-*3 (M.D. Pa. Mar. 10, 2020) (Doc. 26) (construing the complaint in this action to include an EMTALA stabilization claim). In addition, the plaintiffs have asserted state-law tort claims against GMC and the other defendants: Geisinger Health; Susan Baro, D.O.; Jaewon Ryu, M.D.; David Feinburg, M.D.; and Jennifer Roy, P.A.²

The defendants have jointly moved for judgment on the pleadings, pursuant to Rule 12(c) of the Federal Rules of Civil Procedure. (Doc. 41.) This Rule 12(c) motion is fully briefed and ripe for disposition. (Doc. 42; Doc. 44.)³

I. ALLEGATIONS OF THE COMPLAINT

At the time of her death, the decedent, Kimberly Jane Donovan ("Kimberly"), was a 25-year-old first-year law student. On June 27, 2017, she was transported by "life flight" helicopter to the trauma center at GMC for emergency medical treatment. Kimberly was subsequently admitted as an inpatient and underwent surgery to repair orbital fractures caused by blunt force trauma to the head.⁴

Eight days later, at about noon on July 5, 2017, Kimberly was discharged from GMC. At the time of her discharge, she was prescribed several medications, including methadone (Dolophine), fluoxetine (Prozac), and gabapentin (Neurontin). Kimberly was transported homeby her mother, Grages.

Upon returning home, Grages noticed swelling in Kimberly's head around the surgical area, and Kimberly complained to Grages about throbbing pain in her head. Kimberly went to sleep at approximately 12:30 a.m. on July 6, 2017. Grages slept beside her in the same bed and checked on Kimberly periodically throughout the evening. At approximately 3:00 a.m., Grages checked on Kimberly, who appeared to be fine.

At approximately 7:00 a.m. on July 6, 2017, Grages found Kimberly lying in bed with no pulse. Grages began to perform CPR and called 911. Kimberly was pronounced dead by paramedics at 7:50 a.m. on July 6, 2017. The county coroner subsequently found the cause of Kimberly's death to be an accidental overdose and respiratory depression due to multiple toxicities. A postmortem drug analysis confirmed the presence of therapeutic levels of methadone, fluoxetine, and gabapentin in Kimberly's bloodstream.

The plaintiffs claim that the lethal combination of methadone, fluoxetine, and gabapentin prescribed to Kimberly upon discharge from GMC was the proximate cause of her death. In particular, they allegethat defendant Roy, a physician assistant supervised by physician-defendant Baro, prescribed methadone to Kimberly "without an associated diagnosis." Based on this, the plaintiffs claim that GMC failed to stabilize Kimberly's medical condition following emergency medical treatment, in violation of EMTALA, 42 U.S.C. § 1395dd.

II. LEGAL STANDARD

The defendants have answered the complaint and moved for judgment on the pleadings under Rule 12(c) of the Federal Rules of Civil Procedure. Rule 12(c) provides that "[a]fter the pleadings are closed—but early enough not to delay trial—a party may move for judgment on the pleadings." Fed. R. Civ. P. 12(c). "Under Rule 12(c), a court must accept all factual averments as true and draw all reasonable inferences in favor of the non-moving party." U.S. Fid. & Guar. Co. v. Tierney Assoc., Inc., 213 F. Supp. 2d 468, 469 (M.D. Pa. 2002) (citing Soc'y Hill Civic Ass'n v. Harris, 632 F.2d 1045, 1054 (3d Cir. 1980)); see also Westport Ins. Corp. v. Black, Davis & Shue Agency, Inc., 513 F. Supp. 2d 157, 163 (M.D. Pa. 2007) ("When deciding a motion for judgment on the pleadings, the court is directed to view 'the facts presented in the pleadings and the inferences drawn therefrom in the light most favorable to the nonmoving party.'")(quoting Hayes v. Cmty. Gen. Osteopathic Hosp., 940 F.2d 54, 56 (3d Cir. 1991)). In deciding a Rule 12(c) motion, we may also consider "matters of public record, and authentic documents upon which the complaint is based if attached to the complaint or as an exhibit to the motion." Chemi SpA v. GlaxoSmithKline, 356 F. Supp. 2d 495, 496-97 (E.D. Pa. 2005); see also Kilvitis v. Cty. of Luzerne, 52 F. Supp. 2d 403, 406 (M.D. Pa. 1999) ("In deciding a Rule 12(c) motion, however, a court may take judicial notice of any matter of public record."). Ultimately, "[a] party moving for judgment on the pleadings under Rule 12(c) must demonstrate that there are no disputed material facts and that judgment should be entered as a matter of law." U.S. Fid. & Guar., 213 F. Supp. 2d at 469-70 (citing Jablonski v. Pan Am. World Airways, Inc., 863 F.2d 289, 290-91 (3d Cir. 1988), and Inst. for Sci. Info., Inc. v. Gordon & Breach, Sci. Publishers, Inc., 931 F.2d 1002, 1005 (3d Cir. 1991)).

III. DISCUSSION

A. Federal EMTALA Stabilization Claim

The plaintiffs assert an EMTALA stabilization claim against GMC, alleging that the hospital failed to stabilize Kimberly's emergency medical condition prior to discharging her on July 5, 2017, eight daysafter she presented at the hospital's trauma center for emergency medical treatment. The defendants move for judgment on the pleadings, arguing that the hospital's statutory obligation to stabilize Kimberly's emergency medical condition ended upon her good-faith admission to the hospital as an inpatient.

"Congress passed EMTALA to curb the problem of patient dumping by creating a statutory duty for hospitals to examine and treat individuals who come to them for emergency care." Torretti v. Main Line Hosps., Inc., 580 F.3d 168, 177 (3d Cir. 2009), as amended by 586 F.3d 1011 (3d Cir. 2009). "EMTALA imposes two duties on hospital emergency rooms: a duty to screen a patient for an emergency medical condition,⁵ and, once an emergency condition is found, a duty to stabilize the patient before transferring or discharging him." Baker v. Adventist Health, Inc., 260 F.3d 987, 992 (9th Cir. 2001). To state a "stabilization" claim, "EMTALA requires that [a plaintiff] (1) had an emergency medical condition; (2) the hospital actually knew of that condition; and (3) the patient was not stabilized before being transferred [or discharged]." Torretti, 580 F.3d at 178 (internal quotation marks omitted).

"Critically, EMTALA defines 'to stabilize' as 'to provide such medical treatment of the [emergency medical condition] as may be necessary to assure, within reasonable medical probability, that no material deterioration of the condition is likely to result from or occur during the transfer of the individual from a facility . . . ." Williams v. Dimensions Health Corp., 952 F.3d 531, 535 (4th Cir. 2020) (quoting 42 U.S.C. § 1395dd(e)(3)) (emphasis and alterations in original).⁶ "Thus, under the statute itself, 'the stabilization requirement only sets forth standards for transferring a patient in either a stabilized or unstabilized condition. By its own terms, the statute does not set forth guidelines for the care and treatment of patients who are not transferred.'" Id. (quoting Harry v. Marchant, 291 F.3d 767, 771 (11th Cir. 2002)).

"[T]he stabilization requirement was intended to regulate the hospital's care of the patient only in the immediate aftermath of the act of admitting her for emergency treatment and while it considered whether it would undertake longer-term full treatment or insteadtransfer the patient to a hospital that could and would undertake that treatment." Bryan v. Rectors & Visitors of Univ. of Va., 95 F.3d 349, 352 (4th Cir. 1996). Thus, "[a]fter an individual is admitted for inpatient care, state tort law provides a remedy for negligent care. If EMTALA liability extended to inpatient care, EMTALA would be converted into a federal malpractice statute, something it was never intended to be." Bryant v. Adventist Health Sys./West, 289 F.3d 1162, 1169 (9th Cir. 2002) (internal quotation marks and alterations omitted); see also Baker, 260 F.3d at 993 ("The statute is not intended to create a national standard of care for hospitals or to provide a federal cause of action akin to a state law claim for medical malpractice.").

Subsequent regulations from the Centers for Medicare & Medicaid Services ("CMS"), promulgated in 2003, confirm the limited scope of the stabilization requirement:

If a hospital has screened an individual . . . and found the individual to have an emergency medical condition, and admits that individual as an inpatient in good faith in order to stabilize the emergency medical condition, the hospital has satisfied its special responsibilities under this section with respect to that individual.

42 C.F.R. § 489.24(d)(2)(i).⁷ "[I]mportantly, the regulations refer to an admission that is 'in good faith.' Thus, while the CMS clarified that admission is a defense to a stabilization claim, it, at the same time, imposed a good faith requirement to that admission." Williams, 952 F.3d at 536. Thus, "a hospital cannot escape liability under EMTALA by ostensibly 'admitting' a patient, with no intention of treating the patient, and then inappropriately transferring or discharging the patient without having met the stabilization requirement." EMTALA Final Rule, 68 Fed. Reg. 53,222, 53,245 (Sept. 9, 2003);⁸ see also Williams, 952 F.3d at 537 ("The good faith requirement simply clarifies that any admission must be legitimate and not in name...