Holcomb v. Humana Medical Corp., Inc.

• Decision Date: 26 August 1993
• Docket Number: Civ. A. No. 92-A-522-N.
• Citation: 831 F. Supp. 829
• Parties: Rosie Nell HOLCOMB, as Administratrix of the Estate of Barbara Jean Smith, Deceased, v. HUMANA MEDICAL CORPORATION, INC., d/b/a Humana Hospital-Montgomery.
• Court: U.S. District Court — Middle District of Alabama

831 F. Supp. 829

Rosie Nell HOLCOMB, as Administratrix of the Estate of Barbara Jean Smith, Deceased, v. HUMANA MEDICAL CORPORATION, INC., d/b/a Humana Hospital-Montgomery.

Civ. A. No. 92-A-522-N.

United States District Court, M.D. Alabama, N.D.

August 26, 1993.

Tom Dutton, Pittman, Hooks, Marsh, Dutton & Hollis, Birmingham, AL, for plaintiff.

Armstead Lester Hayes, III, Melton, Espy, Williams & Hayes, P.C., Montgomery, AL, for defendant.

MEMORANDUM OPINION

ALBRITTON, District Judge.

I. INTRODUCTION

This cause is now before the court on the Motion for Summary Judgment filed by the Defendant, Humana Medical Corporation d/b/a Humana Hospital-Montgomery ("Humana") on June 9, 1993.¹

Rosie Nell Holcomb ("Holcomb"), administratrix of the estate of Barbara Jean Smith, deceased, filed this action on April 27, 1992 against Humana and Paul P. Monahan, M.D.² alleging violation of the Emergency Medical Treatment and Active Labor Act ("EMTALA"), 42 U.S.C. § 1395dd, et seq. EMTALA commonly known as the Anti-Patient Dumping Act, was enacted as part of the Consolidated Budget Omnibus Reconciliation Act of 1985 ("COBRA").

Holcomb alleges that Humana failed to provide Ms. Smith with an "appropriate medical screening examination" and discharged her in an "unstabilized condition." Holcomb further alleges that as a result of Humana's conduct plaintiff's decedent died on May 9, 1990.

Humana denies all of the allegations and contends that it satisfied the requirements under EMTALA.

For the reasons stated below, Humana's Motion for Summary Judgment is due to be granted.

II. FACTS

On May 4, 1990, at approximately 11:00 p.m., Barbara Jean Smith entered the emergency room of Humana Hospital in Montgomery, Alabama. She informed the admitting nurse that she had given birth within the last week and complained of fever, aching all over, a sore throat, and coughing. Her temperature was 104.3, pulse 146, respiration 32, and blood pressure 112/64. Nevertheless, she was alert and oriented. Moreover, her vaginal bleeding was normal given a recent delivery.

Ms. Smith was first examined by Larry Abrams, a physician's assistant, who took her medical history and gave her a physical examination. Next, she was seen by Dr. Paul P. Monahan, the doctor on call in the emergency room ("ER") that night. Dr. Monahan also gave her a physical. It included listening to her lungs, and examining her abdomen and back. He immediately ordered Tylenol and IV fluids as treatment.

After discussing Ms. Smith's condition with her, Dr. Monahan ordered several tests to determine whether she suffered from a bacterial infection or a viral infection. The tests consisted of a urine analysis and a White Blood Count Test (WBC). The WBC test indicated that Barbara Smith was suffering from a viral infection. Furthermore, because Ms. Smith had a cough, a chest x-ray was taken to determine whether she had pneumonia. After reviewing the results of the tests, the physical examinations, and her medical history, Dr. Monahan diagnosed Ms. Smith as having acute viral syndrome (flu). Thereafter, she was kept in the ER overnight and was given Tylenol and IV fluids.

Dr. Monahan saw Ms. Smith twice more that night. During the first visit, he performed another physical exam. During the second, he asked how she was feeling and whether anything had developed with her condition. After Ms. Smith told him that she felt better and after noting that her vital signs had returned to normal, Dr. Monahan determined that she was medically stable and ordered that she be discharged. He instructed her to stay in bed, drink lots of fluids, and return to the ER immediately if she felt that she was getting worse. Ms. Smith was discharged from Humana at 6:00 a.m. on May 5, 1990.

After returning home, Ms. Smith initially informed Rosie Holcomb that she was feeling better; however, later that day she began to feel worse. On May 6, 1990, at approximately 9:00 p.m., Ms. Smith was admitted to Jackson Hospital. While at Jackson, she was diagnosed as suffering from endometritis.³ Subsequently, on May 9, 1990, Barbara Jean Smith died.

III. SUMMARY JUDGMENT STANDARD

Rule 56(c) of the Federal Rules of Civil Procedure provides that summary judgment is appropriate where "there is no genuine issue as to any material fact and ... the moving party is entitled to judgment as a matter of law." This standard can be met by the movant, in a case in which the ultimate burden of persuasion at trial rests on the nonmovant, either by submitting affirmative evidence negating an essential element of the nonmovant's claim, or by demonstrating that the nonmovant's evidence itself is insufficient to establish an essential element of his or her claim. Celotex Corp. v. Catrett, 477 U.S. 317, 322, 106 S.Ct. 2548, 2552, 91 L.Ed.2d 265 (1986).

The burden then shifts to the nonmovant to make a showing sufficient to establish the existence of an essential element to his claims, and on which he bears the burden of proof at trial. Id. To satisfy this burden, the nonmovant cannot rest on the pleadings, but must by affidavit or other appropriate means, set forth specific facts showing that there is a genuine issue for trial. Rule 56(e), Fed.R.Civ.P.

The court's function in deciding a motion for summary judgment is to determine whether there exists genuine, material issues of fact to be tried, and if not, whether the movant is entitled to a judgment as a matter of law. See Dominick v. Dixie National Life Insurance Company, 809 F.2d 1559 (11th Cir.1987). It is the substantive law that identifies those facts which are material on motions for summary judgment. Anderson v. Liberty Lobby, Inc., 477 U.S. 242, 258, 106 S.Ct. 2505, 2515, 91 L.Ed.2d 202 (1986). See also De Long Equipment Co. v. Washington Mills Abrasive Co., 887 F.2d 1499 (11th Cir. 1989).

When the court considers a motion for summary judgment it must refrain from deciding any material factual issues. All the evidence and the inferences from the underlying facts must be viewed in the light most favorable to the nonmovant. Earley v. Champion International Corp., 907 F.2d 1077, 1080 (11th Cir.1990). See also Matsushita Electric Industrial Co. v. Zenith Radio Corp., 475 U.S. 574, 587, 106 S.Ct. 1348, 1356, 89 L.Ed.2d 538 (1986). The movant bears "the exacting burden of demonstrating that there is no dispute as the any material fact in the case." Warrior Tombigbee Transp. Co. v. M/V Nan Fung, 695 F.2d 1294, 1296 (11th Cir.1983). See also Adickes v. S.H. Kress & Co., 398 U.S. 144, 157, 90 S.Ct. 1598, 1608, 26 L.Ed.2d 142 (1970).

With these rules and principles of law in mind, the court will determine whether summary judgment is appropriate or whether there exist genuine issues of material fact that should properly proceed to trial for resolution. Although this cause is before the court for consideration of defendant's motion, in order to survive summary judgment plaintiff must at least establish the necessary elements of her cause of action and demonstrate the presence of a genuine issue of material fact. Lowe v. Aldridge, 958 F.2d 1565, 1569 (11th Cir.1992).

IV. LIABILITY STANDARD UNDER § 1395dd

Congress enacted EMTALA to address its concern with preventing "patient dumping."⁴ H.R.Rep. No. 241, 99th Cong., 1st Sess., pt. 3, at 5, (1986) reprinted in 1986 U.S.C.C.A.N. 42, 579, 726; 131 Cong. Rec. H9503 (Oct. 31, 1985); 131 Cong. Rec. S13903 (Oct. 23, 1985). The purpose of EMTALA was not to guarantee all patients a proper diagnosis or even to ensure that they receive adequate care, but rather to provide an "adequate first response to a medical crisis" for all patients and "send a clear signal to the hospital community ... that all Americans, regardless of wealth or status, should know that a hospital will provide what services it can when they are truly in physical distress." 131 Cong. Rec. S13904 (Oct. 23, 1985) (statement of Sen. Durenberger).

The starting point of our analysis is, of course, the statutory language. Section 1395dd(a)⁵ requires hospitals to provide any person requesting treatment for a medical condition with "an appropriate medical screening examination within the capability of the hospital's emergency department." In addition, should the hospital determine that the individual suffers from an "emergency medical condition,"⁶ it must provide whatever treatment (within its capabilities) is needed to stabilize the condition prior to transferring or discharging the patient. 42 U.S.C. § 1395dd(b)(1).⁷ If a hospital fails to satisfy either of these requirements, it may be subjected to two types of sanctions. First, under § 1395dd(d)(1), a hospital that "negligently" violates the statute may, at the initiative of the Secretary of Health and Human Services, be subject to a civil money penalty of not more than $50,000 for each violation and termination or suspension of its medicare provider agreement. Second, under § 1395dd(d)(2), a hospital that violates the statute may be liable for damages in a civil action brought by the patient harmed by the violation. Holcomb's claim arises under this second, subsection (d)(2), cause of action.

With regard to the alleged violation of § 1395dd(a), a party can prove a violation of that provision only by showing that the hospital failed to provide an "appropriate medical screening examination." This term is not defined in the statute and the Eleventh Circuit has not addressed the term. The three circuits which have considered the meaning of the term, the Sixth, D.C., and Fourth, however, have provided consistent definitions. In Cleland v. Bronson Health Care Group, Inc., 917 F.2d 266, 271 (6th Cir.1990), the Sixth Circuit defined "appropriate" as meaning "care similar to care that would have been provided to any other patient, or at least not known by the providers to be insufficient or below their own standards." The D.C. Circuit has held that what is "appropriate" can be determined "not by reference to particular...