Mikeska v. Las Cruces Reg'l Med. Ctr., LLC

• Citation: 388 P.3d 266
• Decision Date: 21 April 2016
• Docket Number: No. 33,836.,33,836.
• Parties: Samantha MIKESKA, Plaintiff–Appellant, v. LAS CRUCES REGIONAL MEDICAL CENTER, LLC d/b/a Mountain View Regional Medical Center, Defendant–Appellee.
• Court: Court of Appeals of New Mexico

388 P.3d 266

Samantha MIKESKA, Plaintiff–Appellant,

v.LAS CRUCES REGIONAL MEDICAL CENTER, LLC d/b/a Mountain View Regional Medical Center, Defendant–Appellee.

No. 33,836.

Court of Appeals of New Mexico.

April 21, 2016.

Certiorari Denied, July 20, 2016, No. S-1-SC-35903.

The Pickett Law Firm, Mark L. Pickett, Las Cruces, NM, for Appellant.

Madison & Mroz, P.A., Ada B. Priest, M. Eliza Stewart, Rebecca S. Kenny, Albuquerque, NM, for Appellee.

OPINION

ZAMORA, Judge.

{1} Plaintiff Samantha Mikeska (Plaintiff) appeals a judgment entered in favor of Las Cruces Regional Medical Center, d/b/a Mountain View Medical Center (Defendant) after a jury trial on Plaintiff's claim under the Emergency Medical Treatment and Active Labor Act, 42 U.S.C. § 1395dd (2011) (EMTALA). Plaintiff argues that the district court erred in allowing expert witness testimony concerning the purpose and scope of the EMTALA, and the corresponding jury instructions. Plaintiff also argues that the district court erred in instructing the jury to disregard certain evidence, particularly evidence that Plaintiff was misdiagnosed. We hold that the district court erred in allowing an expert witness to testify concerning questions of law. We further hold that the district court erred in allowing testimony and giving instructions that misstated the law and interjected a false issue into the trial. Last, we hold that the district court erred in instructing the jury to disregard evidence that Plaintiff was misdiagnosed. We reverse and remand.

I. FACTUAL AND PROCEDURAL BACKGROUND

{2} Plaintiff initially visited Defendant's emergency room twice on the same day, and was discharged on both occasions after being misdiagnosed with a ruptured ovarian cyst

. Four days later she once again returned to Defendant's emergency room at which point she was accurately diagnosed with a bowel obstruction. Emergency surgery to remove a portion of her bowel was ultimately required.

{3} Plaintiff filed suit against Defendant alleging that Defendant provided inadequate screening and inappropriately discharged her in an unstable condition after each of her first two visits to the emergency room, in violation of EMTALA. Plaintiff's EMTALA claim proceeded to trial. In anticipation of Dr. Paul Bronston's testifying on behalf of Defendant, Plaintiff filed a motion to exclude his testimony, but later withdrew it. Plaintiff subsequently filed a motion in limine to exclude as irrelevant, any evidence or argument concerning the purpose of the EMTALA. The district court heard the parties' arguments on the motion during a pre-trial hearing.

{4} At the pre-trial hearing, Plaintiff's counsel argued that the initial purpose of the EMTALA is not relevant in determining whether a violation has occurred, because under the statute all patients must be appropriately screened and discharged in a stable condition regardless of the patients' ability to pay. Defendant's counsel argued that the statute's purpose was relevant to its theory that Plaintiff did not receive disparate screening or treatment. The following exchange took place between the district court and Plaintiff's counsel:

Court: [T]he [c]ourt's ruling is that the statute stands for itself, and any interpretation of it, the meaning, goes to the evidence to be presented by the parties or the experts as to how they interpret the statute.

Counsel for Plaintiff: And why would the [c]ourt allow an expert to come in and interpret the law? Isn't that the position and function of the [j]udge? I've never been in a trial, ever, in which someone came in and said, [t]his is what the law is, and explained to the jury what the law is. The jury is there to answer questions.

Court: Right.

....

Court: I like my ruling. All right. Next.

Counsel for Plaintiff: Judge, the fourth point is that [D]efendant[ ] listed two witnesses, expert witnesses, who we believe will come in and discuss [the] EMTALA and what [the] EMTALA requires[.]

Court: I thought your co-counsel said that wasn't the responsibility of the experts; it was the responsibility of the [c]ourt.

Counsel for Plaintiff: Well, I think that's true.

Court: Are you changing your tune?

Counsel for Plaintiff: No.

Ultimately, Plaintiff's motion in limine was denied. The district court informed counsel that Dr. Bronston would be allowed to testify. Defendant presented the expert testimony of Dr. Paul Bronston concerning the purpose and scope of the EMTALA.

{5} In the course of trial, Plaintiff's counsel reiterated her objection to any evidence of the patient's ability to pay or the prohibition of discrimination and questioned the relevancy of this information in an EMTALA claim. Specifically, at Defendant's request and over Plaintiff's objection, the district court instructed the proposed jury, as well as the empaneled jury, on the issue of discrimination based on Plaintiff's ability to pay. The district court also instructed the jury, over Plaintiff's objection, that medical negligence was not an issue in this case, stating "[y]ou are not to concern yourselves with [evidence that Plaintiff was misdiagnosed], nor should it have any bearing on your verdict in this case." The jury found that Defendant did not violate the EMTALA in screening or treating Plaintiff during her first two visits to its emergency room. Plaintiff filed a motion for new trial contending that Dr. Bronston's testimony on the history and purpose of EMTALA regarding the ability to pay was irrelevant. She also argued that Dr. Bronston misled the jury when he testified that the emergency room doctors' medical negligence was not to be relied upon in determining an EMTALA claim. The motion was denied. This appeal followed.

II. DISCUSSION

{6} On appeal, Plaintiff argues that the district court erred in allowing Dr. Bronston to express his legal opinions to the jury about the purpose and scope of the EMTALA, and the legal significance of insurance coverage under the EMTALA. Defendant argues that Plaintiff either failed to object to Dr. Bronston's testimony or waived any objection to the evidence of payment or ability to pay, thereby failing to preserve this first issue on appeal. While it may have been best practices to raise her objection again during Dr. Bronston's testimony, we find that Plaintiff properly preserved this issue on appeal and invoked a ruling by the trial court by filing her second motion in limine to exclude any evidence of the purpose of the EMTALA; objecting to Defendant's contentions in the statement of the case instruction about ability to pay; objecting to Defendant's proposed instruction on the purpose of EMTALA; and by filing a motion for new trial. See Benz v. Town Ctr. Land, LLC, 2013–NMCA–111, ¶ 24, 314 P.3d 688 ("To preserve an issue for review on appeal, it must appear that appellant fairly invoked a ruling of the trial court on the same grounds argued in the appellate court." (internal quotation marks and citation omitted)). Plaintiff also contends that the district court erred in instructing the jury on the elements of an EMTALA claim and by giving erroneous and misleading instructions on the significance of evidence that was admitted at trial. We discuss the purpose and scope of the EMTALA, and then each of Plaintiffs' contentions in turn.

A. The EMTALA

{7} The EMTALA was enacted to prevent hospitals from patient "dumping," that is "refusing to treat patients who do not have health insurance or are otherwise unable to pay for services." Godwin v. Mem'l Med. Ctr., 2001–NMCA–033, ¶ 17, 130 N.M. 434, 25 P.3d 273. It applies to hospitals receiving federal funding from Medicare and that operate an emergency care department. See § 1395dd(e)(2) and 42 U.S.C. § 1395cc (2015). Under the EMTALA, participating hospitals have two primary obligations. See Ingram v. Muskogee Reg'l Med. Ctr., 235 F.3d 550, 551 (10th Cir.2000). The hospital must first conduct a medical screening examination "to determine whether the patient is suffering from an emergency medical condition." Phillips v. Hillcrest Med. Ctr., 244 F.3d 790, 796 (10th Cir.2001) ; see § 1395dd(a). When an emergency medical condition exists, the hospital must "stabilize the patient before transporting him or her elsewhere." Phillips, 244 F.3d at 796 ; see § 1395dd(b)(1)(A), (B). "[A t]ransfer includes [a] discharge." See Godwin, 2001–NMCA–033, ¶ 20, 130 N.M. 434, 25 P.3d 273 (internal quotation marks and citation omitted); see also § 1395dd(e)(4).

{8} The EMTALA's private right of action permits recovery in damages where hospitals fail to comply with these obligations. See § 1395dd(d)(2)(A). Although the EMTALA was "originally intended to cure the evil of dumping patients who could not pay for services, the rights guaranteed under EMTALA apply equally to all individuals whether or not they are insured." Phillips, 244 F.3d at 796 ; see Collins v. DePaul Hosp., 963 F.2d 303, 308 (10th Cir.1992) (stating that the plaintiff's ability to pay did not preclude his action under the EMTALA); see also Summers v. Baptist Med. Ctr. Arkadelphia, 91 F.3d 1132, 1137 (8th Cir.1996) (en banc) ("The [EMTALA] clearly applies to ‘any individual,’ whether insured or not, and, therefore, the fact that [the defendant's] motivation in this particular case was obviously not to dump an uninsured or indigent patient does not defeat the plaintiff's action." (citation omitted)).

{9} The goal of the medical screening examination required by § 1395dd(a)"is to determine whether a patient with acute or severe symptoms has a life threatening or serious medical condition." Godwin, 2001–NMCA–033, ¶ 47, 130 N.M. 434, 25 P.3d 273 (internal quotation marks and citation omitted). "[T]he hospital must develop a screening procedure designed to identify such critical conditions that exist in symptomatic patients and to apply that screening procedure uniformly to all patients with similar complaints." Id. (internal quotation marks and citation omitted). In Godwin, this Court rejected the defendant's argument that in order to prove a §...