Lopez v. Contra Costa Reg'l Med. Ctr.

• Decision Date: 10 October 2012
• Docket Number: No. C 12–03726 LB.,C 12–03726 LB.
• Citation: 903 F.Supp.2d 835
• Court: U.S. District Court — Eastern District of California
• Parties: Jesus LOPEZ, for himself and as the Guardian ad Litem for Edgar Lopez, Alexandra Lopez, and Gretsandy Lopez, his minor children, Plaintiff, v. CONTRA COSTA REGIONAL MEDICAL CENTER and County of Contra Costa, Defendants.

903 F.Supp.2d 835

Jesus LOPEZ, for himself and as the Guardian ad Litem for Edgar Lopez, Alexandra Lopez, and Gretsandy Lopez, his minor children, Plaintiff,

v.CONTRA COSTA REGIONAL MEDICAL CENTER and County of Contra Costa, Defendants.

No. C 12–03726 LB.

United States District Court,

N.D. California,

San Francisco Division.

Oct. 10, 2012.

Geoffrey Becker, Becker & Becker, Lafayette, CA, for Plaintiff.

W. David Walker, Craddick Candland & Conti, A Professional Corporation, San Ramon, CA, for Defendants.

ORDER GRANTING DEFENDANTS' MOTION TO DISMISS

LAUREL BEELER, United States Magistrate Judge.

I. INTRODUCTION

Plaintiff Jesus Lopez in his individual capacity, and as the Guardian ad Litem for his three minor children Edgar, Alexandra, and Gretsandy Lopez, is suing Defendants Contra Costa Regional Medical Center and County of Contra Costa (together, “CCRMC” ¹) for medical malpractice and for violating the Emergency Medical Treatment and Active Labor Act (“EMTALA”), 42 U.S.C. § 1395dd, following the death of Mr. Lopez's wife from complications after she gave birth at Contra Costa Regional Medical Center. For the reasons discussed below, the court GRANTS Defendants' motion to dismiss Plaintiffs' EMTALA claim and declines to exercise supplemental jurisdiction over their state law medical malpractice claim.

II. BACKGROUND

Plaintiff Jesus Lopez is the surviving spouse of Sandra Lopez, and Plaintiffs Edgar, Alexandra, and Gretsandy Lopez are their children. Compl., ECF No. 1, ¶ 2.² Plaintiffs allege that on or around September 29, 2011, Sandra Lopez was admitted to CCRMC to deliver her third child, Gretsandy Lopez. Id. ¶ 3. CCRMC allegedly diagnosed Mrs. Lopez with several serious complications, including pre-eclampsia, eclampsia and HELLP syndrome. Id. ¶ 4. Mrs. Lopez previously had been diagnosed with pre-eclampsia when she delivered her second child. See id. ¶ 11.After the diagnosis this time, CCRMC ordered Mrs. Lopez to be transferred to the Intensive Care Unit (“ICU”). Id. ¶ 5. CCRMC did not transfer Mrs. Lopez, however, because its ICU was full. Id. CCRMC did not stabilize Mrs. Lopez within the meaning of the EMTALA. Id. Plaintiffs allege that CCRMC did not transfer Mrs. Lopez to another hospital as required under EMTALA and, as a result, Mrs. Lopez died. Id. ¶¶ 5–8. Plaintiffs also allege that CCRMC employees were negligent in that they failed to inform Mr. and Mrs. Lopez about Mrs. Lopez's previous pre-eclampsia diagnosis, failed to monitor Mrs. Lopez's pregnancy for pre-eclampsia, and provided treatment that did not meet the applicable standard of care. Id.

Plaintiffs filed this suit on July 16, 2012, claiming CCRMC violated EMTALA and also bringing a state law claim for medical malpractice. Id. Plaintiffs seek damages in excess of $5,000,000 for the EMTALA violation and over $750,000 for medical malpractice. Id. ¶¶ 9, 12. On July 25, 2012, the court appointed Mr. Lopez as the guardian ad litem for his three minor children. Id. ¶ 7; see also Order, ECF No. 7. Defendants filed a motion to dismiss Plaintiffs' complaint on August 6, 2012.³See ECF No. 8.

III. LEGAL STANDARD

A court may dismiss a complaint under Federal Rule of Civil Procedure 12(b)(6) when it does not contain enough facts to state a claim to relief that is plausible on its face. See Bell Atlantic Corp. v. Twombly, 550 U.S. 544, 570, 127 S.Ct. 1955, 167 L.Ed.2d 929 (2007). “A claim has facial plausibility when the plaintiff pleads factual content that allows the court to draw the reasonable inference that the defendant is liable for the misconduct alleged.” Ashcroft v. Iqbal, 556 U.S. 662, 678, 129 S.Ct. 1937, 173 L.Ed.2d 868 (2009). “The plausibility standard is not akin to a ‘probability requirement,’ but it asks for more than a sheer possibility that a defendant has acted unlawfully.” Id. (quoting Twombly, 550 U.S. at 557, 127 S.Ct. 1955). “While a complaint attacked by a Rule 12(b)(6) motion to dismiss does not need detailed factual allegations, a plaintiff's obligation to provide the ‘grounds' of his ‘entitle[ment] to relief’ requires more than labels and conclusions, and a formulaic recitation of the elements of a cause of action will not do. Factual allegations must be enough to raise a right to relief above the speculative level.” Twombly, 550 U.S. at 555, 127 S.Ct. 1955 (internal citations and parenthetical omitted).

In considering a motion to dismiss, a court must accept all of the plaintiff's allegations as true and construe them in the light most favorable to the plaintiff. See id. at 550, 127 S.Ct. 1955;Erickson v. Pardus, 551 U.S. 89, 93–94, 127 S.Ct. 2197, 167 L.Ed.2d 1081 (2007); Vasquez v. Los Angeles County, 487 F.3d 1246, 1249 (9th Cir.2007).

If the court dismisses the complaint, it should grant leave to amend even if no request to amend is made “unless it determines that the pleading could not possibly be cured by the allegation of other facts.” Lopez v. Smith, 203 F.3d 1122, 1127 (9th Cir.2000) (quoting Cook, Perkiss and Liehe, Inc. v. Northern California Collection Serv. Inc., 911 F.2d 242, 247 (9th Cir.1990)).

IV. DISCUSSION

CCRMC argues that Plaintiffs fail to state a claim because EMTALA does not apply to a patient—like Mrs. Lopez—who is admitted for care. Motion, ECF No. 8 at 4–6. It then argues that the court should not assert supplemental jurisdiction over Plaintiffs' state law medical malpractice claim.

A. EMTALA Claim

Congress passed EMTALA, also known as the “Patient Anti Dumping Act,” to prohibit hospital emergency rooms from refusing to treat indigent and uninsured patients or transferring patients to other hospitals without first stabilizing their condition. See Jackson v. E. Bay Hosp., 246 F.3d 1248, 1254 (9th Cir.2001). When a individual requests treatment in a hospital emergency department, EMTALA requires the hospital to “provide for an appropriate medical screening examination within the capability of the hospital's emergency department, including available ancillary services routinely available to the emergency department, to determine whether or not an emergency medical condition [as defined in the statute] exists.” 42 U.S.C. § 1395dd(a). If 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 ⁴ the medical condition, or

(B) for transfer ⁵ of the individual patient to another medical facility in accordance with subsection (c) of this section.

42 U.S.C. § 1395dd(b)(1). Subsection (c) is titled “Restricting transfers until individual is stabilized,” and it sets forth the conditions that must be met before a hospital may transfer an unstabilized patient:

(1) Rule

If an individual at a hospital has an emergency medical condition which has not been stabilized (within the meaning of subsection (e)(3)(B) of this section), the hospital may not transfer the individual unless—

(A)(i) the individual (or a legally responsible person acting on the individual's behalf) after being informed of the hospital's obligations under this section and of the risk of transfer, in writing requests transfer to another medical facility;

(ii) a physician ... has signed a certification that based on the information available at the time of the transfer, the medical benefits reasonably expected from the provision of appropriatemedical treatment at another medical facility outweigh the increased risks to the individual, and in the case of labor, to the unborn child from effecting the transfer; ⁶ or

(iii) if a physician is not present in the emergency department at the time the individual is transferred, a qualified medical person .... has signed a certification [as described in section ii] ... after a physician ..., in consultation with the [qualified medical] person, has made the determination [described in section ii] ... and subsequently countersigns the certification; and

(B) the transfer is an appropriate transfer ....

42 U.S.C. § 1395dd(c)(1). An “appropriate transfer to a medical facility is a transfer—

(A) in which the transferring hospital provides the medical treatment within its capacity which minimizes the risks to the individual's health and, in the case of a woman in labor, the health of the unborn child;

(B) in which the receiving facility—

(i) has available space and qualified personnel for the treatment of the individual; and

(ii) has agreed to accept transfer of the individual and to provide appropriate medical treatment;

(C) in which the transferring hospital sends to the receiving hospital all medical records ... relating to the emergency condition [including records of the medical condition, observations of signs or symptoms, diagnosis, and test results] ... and the informed written consent ...;

(D) in which the transfer is effected through qualified personnel and transportation equipment [including the use of life support measures during the transfer] ...; and

(E) which meets other such requirements as the Secretary may find necessary in the health and safety of individuals transferred.

42 U.S.C. § 1395dd(c)(2).

In 2003, the Centers for Medicare & Medicaid Services of the Department of Health and Human Services promulgated regulations interpreting key EMTALA provisions. See42 C.F.R. § 489.24 (2012) (the “CMS Regulations”). The CMS Regulations explain that EMTALA does not apply to patients who have been admitted for treatment:

(1) [I]f an individual ... “comes to an emergency department”, as defined in paragraph (b) of this section, the hospital must—

(I) Provide an appropriate medical screening examination within the capability of the hospital's emergency department, including ancillary services routinely available to the emergency department, to determine whether or not an emergency medical condition exists. The examination must be conducted by an individual(s) ... qualified under hospital...