Jones v. Wake County Hosp. System, Inc.

• Decision Date: 04 November 1991
• Docket Number: No. 90-523-CIV-5.,90-523-CIV-5.
• Court: U.S. District Court — Eastern District of North Carolina
• Parties: Vastine JONES, Administratrix of the Estate of Philip Jones, Plaintiff, v. WAKE COUNTY HOSPITAL SYSTEM, INC., etc., et al., Defendants.

786 F. Supp. 538

Vastine JONES, Administratrix of the Estate of Philip Jones, Plaintiff, v. WAKE COUNTY HOSPITAL SYSTEM, INC., etc., et al., Defendants.

No. 90-523-CIV-5.

United States District Court, E.D. North Carolina, Raleigh Division.

November 4, 1991.

COPYRIGHT MATERIAL OMITTED

Robert J. Burford, Raleigh, N.C., for Jones.

Alene M. Mercer, Theodore B. Smyth, Susan K. Burkhart, Patterson, Dilthey, Clay, Cranfill, Sumner & Hartzog, Raleigh, N.C., for Wake County Hosp. System, Inc.

Samuel G. Thompson, William H. Moss, Smith, Anderson, Blount, Dorsett, Mitchell & Jernigan, Raleigh, N.C., for Solovieff.

Jean Walker Tucker, Bruce W. Berger, Yates, Fleishman, McLamb & Weyher, Raleigh, N.C., for Nolan.

ORDER

DUPREE, District Judge.

Vastine Jones, Administratrix of the estate of Philip Jones, brings this action pursuant to the Federal Examination and Treatment for Emergency Medical Conditions and Women in Labor Act, part of the Consolidated Omnibus Budget Reconciliation Act, 42 U.S.C. § 1395dd (Supp.1991) (known as COBRA) along with a pendent state law claim of medical malpractice and negligence. Wake Medical Center, Gregory Solovieff, M.D. and Kevin Nolan, M.D. are named as defendants. As relief, she seeks compensatory damages, punitive damages, attorneys' fees, and injunctive relief. The matter is presently before the court on defendants' motion to dismiss, pursuant to Rules 12(b)(1) and 12(b)(6) of the Federal Rules of Civil Procedure, defendants' motion to strike allegations in plaintiff's amended complaint, and defendants' motion for sanctions against the plaintiff pursuant to Rule 11 of the Federal Rules of Civil Procedure.¹

On or about September 6, 1988, at approximately 5:30 p.m., plaintiff's intestate, Philip Jones, was admitted to the emergency room of Wake Medical Center complaining of pain and weakness stemming from bodily burns received on September 4, 1988. He was examined by defendant Solovieff, an emergency room physician on duty that day. Jones' vital signs were checked, blood work was performed, and a dressing was applied. Defendant Solovieff, apparently concerned about the possibility of an infection, consulted defendant Nolan, another physician on duty in the emergency room. After consultation, they decided that further treatment was not necessary and discharged Jones at approximately 10:30 p.m. that same night. Within hours of his discharge, Jones began complaining of severe pain, paralysis, and a sense of disorientation. Plaintiff took Jones back to Wake Medical Center at approximately 5:30 p.m. on September 7, 1988. Shortly afterward, Jones suffered septic shock, respiratory arrest, and renal failure. He died at approximately 2:15 a.m. on September 8, 1988 from cardiac arrest. Plaintiff alleges that Jones was suffering from a potentially fatal systemic infection known as sepsis at the time of his visit to the emergency room on September 6 and that if defendants had exercised reasonable care and performed additional tests on Jones instead of discharging him, Jones' condition could have been diagnosed and treated.

Plaintiff filed her original complaint on September 5, 1990, which charged simply that the treatment of Jones violated COBRA. The original complaint did not include any allegations that plaintiff's treatment at the hospital was due to indigency, lack of medical insurance, or race. Over the next few months, each of the defendants filed motions with this court to dismiss plaintiff's action pursuant to Rules 12(b)(1) and 12(b)(6). In the memoranda supporting their motions, defendants argued that this court was without subject matter jurisdiction since plaintiff had failed to state a cause of action under COBRA, and that, in reality, plaintiff's claim amounted to nothing more than a gardenvariety malpractice claim controlled by state law. It was the position of the defendants that COBRA applied only to instances in which a hospital refused to treat a patient because of indigency or other economic considerations.

However, on April 19, 1991, just as these motions became ripe for adjudication by this court, plaintiff was granted leave to file an amended complaint. Her amended complaint rehashed the allegations in her original complaint but included the additional allegations that Jones had received unfavorable treatment by the defendants because of his race and socioeconomic status.

By an order filed on May 28, 1991, this court denied defendant's motion to dismiss the original complaint as moot. Defendants then filed motions to dismiss the amended complaint on the same grounds as in their previous motions. Additionally, defendants motioned to strike those allegations in plaintiff's amended complaint pertaining to racism, arguing that plaintiff inserted these charges merely as a last minute attempt to survive the motion to dismiss.

COBRA was enacted by Congress primarily in response to concerns about the practice of "patient dumping", the refusal of a hospital emergency room to treat a person who does not have medical insurance. Note, Preventing Patient Dumping: Sharpening the COBRA's Fangs, N.Y.U.L.Rev. 1186 (1986). COBRA in pertinent part, imposes the following duties on hospitals that receive Medicare funds:

(a) In the case of a hospital that has a hospital emergency department, if any individual (whether or not eligible for benefits under this subchapter) comes to the emergency department and a request is made on the individual's behalf for examination or treatment for a medical condition, the hospital must provide for an appropriate medical screening examination within the capability of the hospital's emergency department to determine whether or not an emergency medical condition ... exists....

(b)(1) If any individual ... comes to a hospital and the hospital determines that the individual has an emergency medical condition ... the hospital must provide either—

(A) within the staff and facilities available at the hospital, for such further medical examination and such treatment as may be required to stabilize the medical condition, or ...

(B) for transfer of the individual to another medical facility in accordance with subsection (c) of this section.

COBRA authorizes a private cause of action for any individual who suffers personal harm from the violation of the statute against the violating hospital. 42 U.S.C. § 1395dd(d)(2)(A). In addition, civil monetary penalties may be levied against the hospital and the responsible physicians. 42 U.S.C. § 1395dd(d)(1)(A) and (B).

I. 12(b)(1) MOTION

Defendants argue that this court is without subject matter jurisdiction to hear plaintiff's claim. They claim that Jones was not in an "emergency medical condition", within the meaning of the statute and that therefore COBRA is inapplicable to the facts giving rise to this suit.

Federal district courts have subject matter jurisdiction in "all civil actions arising under the Constitution, laws, or treaties of the United States." 28 U.S.C. § 1331 (Supp.1991). The United States Supreme Court has interpreted this language to mean that federal courts have jurisdiction in all cases where a well-pleaded complaint shows that "federal law creates the cause of action" or where the "plaintiff's right to relief necessarily depends on resolution of a substantial question of federal law." Franchise Tax Board v. Construction Laborers Vacation Trust, 463 U.S. 1, 27-28, 103 S.Ct. 2841, 2856, 77 L.Ed.2d 420 (1983).

Furthermore, the legislative history of COBRA clearly demonstrates Congress's intention for federal courts to have subject matter jurisdiction over actions brought pursuant to COBRA. See Thornton v. Southwest Detroit Hospital, 895 F.2d 1131, 1133 (6th Cir.1990); Bryant v. Riddle Memorial Hospital, 689 F.Supp. 490, 493 (E.D.Pa.1988).

The court concludes that it has subject matter jurisdiction over the suit and that defendant's objections to the court's jurisdiction go more to the question of whether plaintiff has stated a valid claim for relief under COBRA. Therefore, the court will now address defendant's motion to dismiss pursuant to Rule 12(b)(6).

II. 12(b)(6) MOTION

A motion to dismiss under Rule 12(b)(6) must be viewed in the light most favorable to the plaintiff. Revene v. Charles County Commissioners, 882 F.2d 870, 872 (4th Cir. 1989). However, dismissal is properly granted when it is clear as a matter of law that no relief could be granted under any set of facts that could be proved consistent with plaintiff's allegations. Hishon v. King & Spalding, 467 U.S. 69, 104 S.Ct. 2229, 81 L.Ed.2d 59 (1984). On a motion to dismiss, the court examines the sufficiency of the complaint without consideration of the affidavits, exhibits or admissions. Scheuer v. Rhodes, 416 U.S. 232, 94 S.Ct. 1683, 40 L.Ed.2d 90 (1974).

(a) Scope of COBRA

The few courts that have interpreted COBRA have split as to the scope of the act. The legislative history of the statute is predominated by concern over "patient dumping". See H.R.Rep. No. 241(1), 99th Cong., 1st Sess. 27, reprinted in 1986 U.S.Code Cong. & Admin.News 579, 605. This has led several courts to hold that COBRA applies only to instances where a plaintiff can show he was refused treatment due to indigency. See Evitt v. University Heights Hospital, 727 F.Supp. 495 (S.D.Ind.1989); Stewart v. Myrick, 731 F.Supp. 433 (D.Kan.1990). However, the fact that the plain language of the statute does not limit COBRA to only situations where patients are denied treatment for economic reasons has led other courts to rule that no such showing is necessary. See Brooker v. Desert Hospital Corporation, 947 F.2d 412 (9th Cir.1991); Gatewood v. Washington Healthcare Corporation, 933 F.2d 1037 (D.C.Cir.1991); Delaney v. Cade, 756 F.Supp. 1476 (D.Kan. 1991); Deberry v. Sherman Hospital Association, 741 F.Supp. 1302 (N.D.Ill.1990). The Sixth Circuit has adopted a middle approach, holding in Cleland v. Bronson Health Care Group, Inc., 917 F.2d 266 (6th Cir.1990),...