Hardy v. New York City Health & Hosp. Corp.

• Decision Date: 15 January 1999
• Docket Number: Docket No. 98-7030
• Citation: 164 F.3d 789
• Parties: Winifred HARDY, Plaintiff-Appellant, v. NEW YORK CITY HEALTH & HOSPITALS CORP. and Queens Hospital Center, Defendants-Appellees.
• Court: U.S. Court of Appeals — Second Circuit

Page 789

164 F.3d 789

Winifred HARDY, Plaintiff-Appellant, v. NEW YORK CITY HEALTH & HOSPITALS CORP. and Queens Hospital Center, Defendants-Appellees.

Docket No. 98-7030

United States Court of Appeals Second Circuit.

Argued Aug. 28, 1998.

Decided Jan. 15, 1999.

Walter Thomas Reardon (with James M. Mimnaugh on brief), Reardon & Sclafani, Yonkers, New York, for Plaintiff-Appellant.

Pamela Seider Dolgow, Jane S. Earle, of Counsel (Michael D. Hess, Corporation Counsel), Office of the Corporation Counsel of the City of New York, New York, New York, for Defendants-Appellees.

Before: WINTER, Chief Judge, WALKER and McLAUGHLIN, Circuit Judges.

BACKGROUND

McLAUGHLIN, Circuit Judge:

Winifred Hardy had been treated for hypertension for many years. On January 27, 1991, she complained of nausea, vomiting, dizziness, diarrhea and elevated blood pressure, and reported that those symptoms had lasted several days. Hardy was treated in the emergency room of Mary Immaculate Hospital in New York and released. Later that day, because her symptoms persisted, an Emergency Medical Service ("EMS") ambulance brought Hardy to the emergency room of Queens Hospital Center (the "Hospital") in New York. The Hospital is operated by the New York City Health and Hospitals Corporation ("HHC").

When Hardy arrived at the Hospital, her blood pressure was 195/143. She was examined and given medication. Seven hours after her arrival, Hardy's condition was described as "improved." She was then discharged, with instructions to have her blood pressure checked daily for one week and to follow-up with her private doctor.

Approximately twenty-four hours later, EMS was called to Hardy's home a second time. Finding Hardy in bed, vomiting, dizzy and hysterical, EMS personnel took her back to the Hospital where she displayed abnormal vital signs, including extremely elevated blood pressure. She was soon diagnosed as having suffered a cerebral hemorrhage or a stroke, and was admitted. She remained under continuous care in the Hospital for eleven months. Partially paralyzed and permanently disabled, Hardy was finally discharged on December 9, 1991.

On November 24, 1993, not quite two years after her release from the Hospital, Hardy filed a complaint, in the United States District Court for the Eastern District of New York (Amon, J.), against the HHC and the Hospital (collectively hereinafter, "the Hospital"). Hardy claimed that the Hospital violated the Emergency Medical Treatment and Active Labor Act ("EMTALA"), 42 U.S.C. § 1395dd. Specifically, Hardy asserted that the Hospital was liable: (1) for failing to give her an appropriate medical screening exam when she first arrived at the Hospital on January 27, 1991; and (2) for discharging her seven hours later without having stabilized her medical condition.

Hardy did not file a notice of claim before bringing suit against the Hospital, within ninety days of the occurrence, as required by New York law. See N.Y. Gen. Mun. Law § 50-e (McKinney's 1986). Nor did she ever apply for leave to file a late notice of claim. See id. § 50-e(5).

In its answer, the Hospital asserted, inter alia, that Hardy's complaint failed to state a claim upon which relief could be granted. Thereafter, the Hospital moved for judgment on the pleadings under Federal Rule of Civil In September 1996, the district court denied the Hospital's motion. Judge Amon concluded that the Hospital had waived both its notice of claim and statute of limitations arguments by failing to plead these affirmative defenses in its answer. The Hospital then moved, under Federal Rule of Civil Procedure 15(a), to amend its answer to include the "waived" defenses. Also, if the motion to amend was granted, the Hospital renewed its motion for judgment on the pleadings or summary judgment under Rule 12(c) and Rule 56.

Procedure 12(c), or alternatively, for summary judgment under Federal Rule of Civil Procedure 56. The Hospital asserted that Hardy's claim was barred because Hardy: (1) failed to file a notice of claim with the Hospital; and (2) failed to commence a timely action within two years of the occurrence, as EMTALA's statute of limitations required.

In an Opinion, Judge Amon expressly declined to rule on whether the Hospital could amend its answer. Instead, the court sua sponte "revisit[ed] the waiver issue" with regard to the notice-of-claim defense. This time, Judge Amon determined that the Hospital's answer containing the objection that the complaint did not state a cause of action was sufficient to preserve that defense.

Judge Amon went on to rule that under EMTALA and applicable New York law, Hardy was indeed required to file a notice of claim as a condition precedent to commencing her EMTALA personal injury action against the Hospital. Because Hardy did not file a notice of claim, she failed to state a claim upon which relief could be granted. Accordingly, Judge Amon granted the Hospital's motion for judgment on the pleadings. Hardy appeals.

DISCUSSION

This is our first opportunity to examine EMTALA. We begin by addressing whether a plaintiff filing an EMTALA claim in federal court must meet New York's notice-of-claim requirement.

I. Standard of Review

Generally, we review a district court's Rule 12(c) dismissal of a complaint de novo. See Sheppard v. Beerman, 94 F.3d 823, 827 (2d Cir.1996). Moreover, because this case turns on an issue of statutory interpretation, we review the district court's disposition de novo. See Perry v. Dowling, 95 F.3d 231, 235 (2d Cir.1996).

II. EMTALA

In 1986, Congress enacted the Emergency Medical Treatment and Active Labor Act ("EMTALA"), 42 U.S.C. § 1395dd. The purpose of EMTALA is to prevent " 'patient dumping,' the practice of refusing to provide emergency medical treatment to patients unable to pay, or transferring them before emergency conditions [are] stabilized." Power v. Arlington Hosp. Ass'n, 42 F.3d 851, 856 (4th Cir.1994); see Bryan v. Rectors and Visitors of the Univ. of Virginia, 95 F.3d 349, 351 (4th Cir.1996); Correa v. Hospital San Francisco, 69 F.3d 1184, 1189 (1st Cir.1995); see also H.R.Rep. No. 241(I), 99th Cong., 2nd Sess. 27 (1986), reprinted in 1986 U.S.C.C.A.N. 42, 605, 726-27.

EMTALA, which applies to all hospitals that participate in the federal Medicare program, imposes two primary obligations on those hospitals. First, when an individual shows up for treatment at a hospital's emergency room, "the hospital must provide for an appropriate medical screening examination ... to determine whether or not an emergency medical condition" exists. 42 U.S.C. § 1395dd(a). Second, if the screening examination indicates that an emergency medical condition does exist, the hospital ordinarily must "stabilize the medical condition" before transferring or discharging the patient. Id. § 1395dd(b)(1)(A).

EMTALA is not a substitute for state law on medical malpractice. See Power, 42 F.3d at 856. It "was not intended to guarantee proper diagnosis or to provide a federal remedy for misdiagnosis or medical negligence." Id. Instead, EMTALA was enacted to fill a lacuna in traditional state tort law by imposing on hospitals a legal duty (that the common law did not recognize) to provide The legislative history of EMTALA demonstrates that "Congress never intended to displace state malpractice law." Brooks, 996 F.2d at 714. This intent to supplement, but not supplant, state tort law is evident in EMTALA's limited preemption provision. See 42 U.S.C. § 1395dd(f); see also Brooks, 996 F.2d at 715. EMTALA provides: "The provisions of this section do not preempt any State or local law requirement, except to the extent that the requirement directly conflicts with a requirement of this section." 42 U.S.C. § 1395dd(f).

emergency care to all. See Brooks v. Maryland Gen. Hosp., Inc., 996 F.2d 708, 714-15 (4th Cir.1993); Bryan, 95 F.3d at 351 ("[EMTALA's] core purpose is to get patients into the system who might otherwise go untreated and be left without a remedy because traditional medical malpractice law affords no claim for failure to treat."); Gatewood v. Washington Heathcare Corp., 933 F.2d 1037, 1041 (D.C.Cir.1991) (finding EMTALA creates "a new cause of action, generally unavailable under state tort law, for what amounts to failure to treat").

EMTALA's deference to state law is also apparent in its express adoption of state law as to the damages recoverable. Id. § 1395dd(d)(2)(A); Brooks, 996 F.2d at 715. EMTALA provides that a plaintiff, in a civil action against a hospital, may "obtain those damages available for personal injury under the law of the State in which the hospital is located, and such equitable relief as is appropriate." 42 U.S.C. § 1395dd(d)(2)(A).

The nettlesome question remains: did Congress intend to incorporate New York's notice-of-claim requirement, as a limit on the "damages available," under § 1395dd(d)(2)(A)?

III. New York's Notice-of-Claim Requirement

We start with the general rule that in a federal court, state notice-of-claim statutes apply to state-law claims. See Felder v. Casey, 487 U.S. 131, 151, 108 S.Ct. 2302, 101 L.Ed.2d 123 (1988) ("federal courts entertaining state-law claims against ... municipalities are obligated to apply the [state] notice-of-claim provision"); Fincher v. County of Westchester, 979 F.Supp. 989, 1002 (S.D.N.Y.1997) (noting that New York's 90-day notice-of-claim requirement applies to state tort claims brought as pendent claims in a federal action).

On the other hand, when a federal action is brought in federal court, the court has discretion to borrow from state law when there are deficiencies in the federal statutory scheme. See Brown v. United States, 742 F.2d 1498, 1503-04 (D.C.Cir.1984); AT & T Co. v. New York City Dep't of Human Resources, 736 F.Supp. 496, 499 (S.D.N.Y.1990). While the absence of a notice-of-claim provision generally does not render a federal statute deficient, see Felder, 487 U.S. at 140, 108 S.Ct. 2302; AT & T, 736...