Heimlicher v. Steele, No. C05-4054-PAZ.

CourtUnited States District Courts. 8th Circuit. Northern District of Iowa
Writing for the CourtPaul A. Zoss
Citation615 F.Supp.2d 884
PartiesLaura A. HEIMLICHER and Lawrence W. Heimlicher, Plaintiffs, v. James O. STEELE, M.D., and Dickinson County Memorial Hospital, an Iowa non-profit corporation, dba Lakes Regional Healthcare, Defendants.
Docket NumberNo. C05-4054-PAZ.
Decision Date14 May 2009
615 F.Supp.2d 884
Laura A. HEIMLICHER and Lawrence W. Heimlicher, Plaintiffs,
v.
James O. STEELE, M.D., and Dickinson County Memorial Hospital, an Iowa non-profit corporation, dba Lakes Regional Healthcare, Defendants.
No. C05-4054-PAZ.
United States District Court, N.D. Iowa, Western Division.
May 14, 2009.

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Brian J. McKeen, McKeen & Associates, PC, Detroit, MI, James H. Cook, Dutton Braun Staack Hellman, Waterloo, IA, for Plaintiffs.

Jim D. Dekoster, Stephen J. Powell, Swisher & Cohrt, PLC, Waterloo, IA, Joseph L. Fitzgibbons, Ned A. Stockdale, Fitzgibbons Law Office, Estherville, IA, for Defendants.

MEMORANDUM OPINION AND ORDER ON DEFENDANTS' POST-TRIAL MOTIONS

PAUL A. ZOSS, United States Magistrate Judge.


 I. BACKGROUND ........................................................................ 894
                 II. DESCRIPTION OF ISSUES RAISED IN THE MOTIONS ....................................... 896
                III. STANDARDS FOR CONSIDERING POST-TRIAL MOTIONS ...................................... 897
                 A. Motions for Judgment as a Matter of Law ........................................ 897
                 B. Motions for New Trial .......................................................... 898
                 C. Motions to Amend Judgment ...................................................... 899
                 IV. ANALYSIS OF ISSUES RAISED IN THE MOTIONS ........................................... 900
                 A. Does a Physician's Certification Absolve a Hospital from Liability
                 under EMTALA for Transferring a Patient to Another Hospital? ................... 900
                 1. Was Ms. Heimlicher's emergency medical condition stabilized
                 before she was transferred to Sioux Valley Hospital? ....................... 903
                 2. Did Ms. Heimlicher make a written request to be transferred to
                 Sioux Valley Hospital? ..................................................... 904
                 3. Did Dr. Steele properly certify that the benefits from the transfer
                 outweighed the risks? ...................................................... 905
                 B. Did the Court Err in Placing the Burden of Proof on the Certification
                 Defense on Lakes Hospital? .................................................... 909
                 C. Did the Court Err in Instructing the Jury on Dr. Steele's Negligence? ........... 910
                 D. Did the Court Err in Instructing the Jury on Lakes Hospital's
                 Negligence? ................................................................... 911
                 E. Were the State-Law Negligence Claims against Lakes Hospital
                 Preempted by EMTALA? .......................................................... 912
                 F. Did the Court Err in Refusing to Submit Ms. Heimlicher's
                 Comparative Fault to the Jury? ................................................ 915
                 G. Did the Court Mislead the Jury into Assigning Lakes Hospital Double
                 Liability? ..................................................................... 918
                 H. Did the Court Err in Allowing Plaintiffs' Counsel to Ask Expert
                 Witnesses Questions Based on the Jury Instructions? ........................... 920
                 I. Did the Court Err in Permitting the Jury to Treat Dr. Low as an
                 Agent of Lakes Hospital? ...................................................... 921
                 J. Did the Court Erroneously Allow Evidence of Grief into The Record? .............. 922
                 K. Did the Court Err in Allowing Photographs of the Fetus into
                 Evidence? ..................................................................... 927
                

Page 894

 L. Did the Court Err in Allowing Dr. Leavy to Testify to Matters Outside
                 of His Expert Witness Designation? ............................................ 928
                 M. Did the Plaintiffs Waive Their EMTALA Claim by Not Submitting to
                 the Court Timely Requested Jury Instructions on the Claim? .................... 931
                 N. Did the Court Err in Submitting Revised Damages Instructions to the
                 Jury? ......................................................................... 931
                 O. Did the Court Err in Reading the Instructions to the Jury Before Any
                 Evidence Was Received? ........................................................ 932
                 P. Did the Court Err in Not Granting the Various Motions for Mistrial
                 Asserted by the Defendants Throughout the Trial? .............................. 933
                 Q. Was the Verdict Irrational, Arbitrary, Excessive, or Unjust? .................... 937
                 V. CONCLUSION ......................................................................... 942
                APPENDIX ................................................................................. 942
                DEFENDANTS' JOINT EXHIBIT H .............................................................. 943
                PLAINTIFFS' EXHIBIT 5 .................................................................... 944
                JOINT EXHIBIT 50, PAGE 15 ................................................................ 945
                INSTRUCTION NO. 13 ....................................................................... 946
                INSTRUCTION NO. 15 ....................................................................... 946
                INSTRUCTION NO. 16 ....................................................................... 946
                INSTRUCTION NO. 17 ....................................................................... 947
                INSTRUCTION NO. 18 ....................................................................... 947
                INSTRUCTION NO. 19 ....................................................................... 948
                INSTRUCTION NO. 20 ....................................................................... 949
                INSTRUCTION NO. 22 ....................................................................... 949
                
I. BACKGROUND

The plaintiffs in this case are Laura A. Heimlicher and Lawrence W. Heimlicher. The defendants are Dickinson County Memorial Hospital, a hospital in Spirit Lake, Iowa ("Lakes Hospital" or "the Hospital"); and James O. Steele, M.D., a specialist in emergency medicine working at Lakes Hospital.

On February 11, 2004, Ms. Heimlicher began experiencing vaginal bleeding, pain in her abdomen, and contractions. Joint Ex. 50, pp. 1-3. She was 34 weeks pregnant. She called "911" from her home, and was taken by ambulance to the Lakes Hospital emergency room, where she was examined by Dr. Steele. Id., p. 6. He conducted a vaginal examination, and then ordered an ultrasound. Id., p. 8. The ultrasound was performed by Tracy Evans, an ultrasound technician employed by Lakes Hospital. As Ms. Evans was performing the ultrasound examination, she described to Dr. Steele what she was seeing. Based on Ms. Evans's comments, Dr. Steele wrote in his notes that the ultrasound examination ruled out the possibility of a "placental abruption," a serious condition where the placental lining separates from the uterine wall. Id., pp. 7-9. Dr. Steele made this notation even though he was not qualified to read ultrasound images,

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and he knew Ms. Evans was not qualified to read ultrasound images. He also knew that an ultrasound examination could never rule out a placental abruption.1

No radiologist was available at Lakes Hospital to read the ultrasound images, so Ms. Evans transmitted the images electronically to "Dr. Low," a radiologist in Minnesota who was on call that night. Dr. Low and Ms. Evans then spoke on the telephone, and he told her his diagnosis was "mass vs. hemorrhage vs. fibroid." See Def. Joint Ex. H, the "ultrasound worksheet," a copy of which is attached to this ruling. Ms. Evans testified that she relayed this information to Dr. Steele. Dr. Steele testified he did not recall receiving this information, and he did not even know a radiologist had looked at the ultrasound images that evening. In fact, he testified he was not aware that Lakes Hospital had the capability of electronically sending ultrasound images to a radiologist for review. Dr. Steele testified that if he had been advised the images showed "mass vs. hemorrhage vs. fibroid," he would have ordered an immediate C—section.

Dr. Steele consulted by telephone with Dr. Michael M. Fiegen, an obstetrician in Sioux Falls, South Dakota, about Ms. Heimlicher's care and about transferring her to Dr. Fiegen's care at Sioux Valley Hospital in Sioux Falls. Sioux Valley Hospital is a larger hospital, with better facilities and a more specialized staff, about 100 miles away. Dr. Steele confirmed to Dr. Fiegen that Ms. Heimlicher's placenta was not abrupting and her uterus was not ruptured, and told him her condition was stable. Based on these representations, Dr. Fiegen agreed to accept the transfer. Dr. Fiegen had Dr. Steele administer medication to Ms. Heimlicher to slow her contractions.

The plaintiffs offered evidence that Dr. Steele failed to perform a proper differential diagnosis of Ms. Heimlicher's condition, and if he had done so, he would have diagnosed an abrupting placenta. There is no dispute that if Dr. Steele had known Ms. Heimlicher's placenta was abrupting, the applicable standard of care would have required him to order an immediate C— section. There also is no dispute that the Lakes Hospital staff was capable of performing C—sections, and could have performed one that evening.

Inclement weather did not permit the use of a helicopter or an airplane, so Ms. Heimlicher was placed in a ground ambulance for transport to Sioux Valley Hospital. She was accompanied in the ambulance by Jennifer Helle, the nurse who had been caring for her at Lakes Hospital. After leaving Lakes Hospital in the ambulance, Ms. Heimlicher almost immediately began experiencing too-rapid contractions, profuse vaginal bleeding, and severe pain in her abdomen. At the same time, a fetal monitor was showing that the baby was in distress. Joint Ex. 50, p. 12. These symptoms were strong evidence of an abrupting placenta or a rupturing uterus. Nevertheless, Nurse Helle did not report the...

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10 practice notes
  • Dutton v. Rando, DOCKET NO. A-1049-16T1
    • United States
    • New Jersey Superior Court – Appellate Division
    • February 26, 2019
    ...first names. We intend no disrespect.2 See Mass. Gen. Laws Ann. ch. 229, § 2 ; N.C. Gen. Stat. § 28A-18-2(b) ; Heimlicher v. Steele, 615 F.Supp.2d 884, 924 (N.D. Iowa 2009) ; Keller v. Feasterville Family Health Care Ctr., 557 F.Supp.2d 671, 687 (E.D. Pa. 2008) ; Canavin v. Pac. Sw. Airline......
  • Guzman v. Memorial Hermann Hospital System, Civil Action No. H-07-3973.
    • United States
    • United States District Courts. 5th Circuit. United States District Courts. 5th Circuit. Southern District of Texas
    • June 16, 2009
    ...whether the transfer was at the patient's request was a fact question, precluding summary judgment. Id.; see also Heimlicher v. Steele, 615 F.Supp.2d 884, 905 (N.D.Iowa 2009) ("Under subsection (c)(1)(A)(i) of the Act, a written request for transfer authorizes a hospital to transfer a patie......
  • Thornhill v. Jackson Parish Hosp., CIVIL ACTION NO. 15-01867
    • United States
    • United States District Courts. 5th Circuit. United States District Courts. 5th Circuit. Western District of Louisiana
    • May 4, 2016
    ...‘dumping’ of uninsured, underinsured, or indigent patients by hospitals who did not want to treat them." See Heimlicher v. Steele , 615 F.Supp.2d 884, 900–01 (N.D.Iowa 2009) (quoting Summers , 91 F.3d at 1136 ). Once a hospital admits a patient in good faith, that concern has been addressed......
  • Bansal v. Univ. of Tex. M.D. Anderson Cancer Ctr., NO. 14-15-00986-CV
    • United States
    • Court of Appeals of Texas
    • August 25, 2016
    ...See, e.g. , Root v. New Liberty Hosp. Dist. , 209 F.3d 1068, 1069 (8th Cir.2000) (hospital district); Heimlicher v. Steele , 615 F.Supp.2d 884, 894 (N.D.Iowa 2009) (county hospital); Williams v. County of Cook , No. 97 C 1069, 1997 WL 428534 (N.D.Ill. July 24, 1997) (unpublished) (county th......
  • Request a trial to view additional results
10 cases
  • Dutton v. Rando, DOCKET NO. A-1049-16T1
    • United States
    • New Jersey Superior Court – Appellate Division
    • February 26, 2019
    ...first names. We intend no disrespect.2 See Mass. Gen. Laws Ann. ch. 229, § 2 ; N.C. Gen. Stat. § 28A-18-2(b) ; Heimlicher v. Steele, 615 F.Supp.2d 884, 924 (N.D. Iowa 2009) ; Keller v. Feasterville Family Health Care Ctr., 557 F.Supp.2d 671, 687 (E.D. Pa. 2008) ; Canavin v. Pac. Sw. Airline......
  • Guzman v. Memorial Hermann Hospital System, Civil Action No. H-07-3973.
    • United States
    • United States District Courts. 5th Circuit. United States District Courts. 5th Circuit. Southern District of Texas
    • June 16, 2009
    ...whether the transfer was at the patient's request was a fact question, precluding summary judgment. Id.; see also Heimlicher v. Steele, 615 F.Supp.2d 884, 905 (N.D.Iowa 2009) ("Under subsection (c)(1)(A)(i) of the Act, a written request for transfer authorizes a hospital to transfer a patie......
  • Thornhill v. Jackson Parish Hosp., CIVIL ACTION NO. 15-01867
    • United States
    • United States District Courts. 5th Circuit. United States District Courts. 5th Circuit. Western District of Louisiana
    • May 4, 2016
    ...‘dumping’ of uninsured, underinsured, or indigent patients by hospitals who did not want to treat them." See Heimlicher v. Steele , 615 F.Supp.2d 884, 900–01 (N.D.Iowa 2009) (quoting Summers , 91 F.3d at 1136 ). Once a hospital admits a patient in good faith, that concern has been addressed......
  • Bansal v. Univ. of Tex. M.D. Anderson Cancer Ctr., NO. 14-15-00986-CV
    • United States
    • Court of Appeals of Texas
    • August 25, 2016
    ...See, e.g. , Root v. New Liberty Hosp. Dist. , 209 F.3d 1068, 1069 (8th Cir.2000) (hospital district); Heimlicher v. Steele , 615 F.Supp.2d 884, 894 (N.D.Iowa 2009) (county hospital); Williams v. County of Cook , No. 97 C 1069, 1997 WL 428534 (N.D.Ill. July 24, 1997) (unpublished) (county th......
  • Request a trial to view additional results

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