Miller v. Medical Center of Southwest Louisiana

• Decision Date: 14 June 1994
• Docket Number: No. 93-5123,93-5123
• Citation: 22 F.3d 626
• Parties: , 44 Soc.Sec.Rep.Ser. 343 Roger Dale MILLER, Individually and o/b/o Nick Miller, et al., Plaintiffs-Appellants, v. MEDICAL CENTER OF SOUTHWEST LOUISIANA, et al., Defendants-Appellees.
• Court: U.S. Court of Appeals — Fifth Circuit

Page 626

22 F.3d 626

62 USLW 2792, 44 Soc.Sec.Rep.Ser. 343

Roger Dale MILLER, Individually and o/b/o Nick Miller, et

al., Plaintiffs-Appellants, v. MEDICAL CENTER OF SOUTHWEST LOUISIANA, et al., Defendants-Appellees.

No. 93-5123.

United States Court of Appeals, Fifth Circuit.

June 14, 1994.

Patrick D. McArdle, Laura E. Fahy, New Orleans, LA, for appellants.

Daniel A. Reed, Ronald A. Seale, Seale Smith, Zuber & Barnette, Baton Rouge, LA, for appellees.

Appeal from the United States District Court for the Western District of Louisiana.

Before JOHNSON, BARKSDALE, and DeMOSS, Circuit Judges.

JOHNSON, Circuit Judge:

Roger Dale Miller and Andrea Miller (Plaintiffs), individually and on behalf of their minor son Nick, brought this action against Hamilton Medical Center, Inc., d/b/a Medical Center of Southwest Louisiana (Hamilton), alleging that Hamilton had refused to treat Nick after an automobile accident in violation of the Emergency Medical Treatment and Active Labor Act (EMTALA), 42 U.S.C. Sec. 1395dd. ¹ The district court, however, found that Nick had never "come to" Hamilton within the meaning of the statute. Accordingly, the district court granted Hamilton's Fed.R.Civ.P. 12(b)(6) motion to dismiss for failure to state a claim on which relief could be granted. Plaintiff appeals and we affirm.

FACTS AND PROCEDURAL HISTORY

On March 29, 1992, nine-year-old Nick Miller suffered serious injuries in an automobile accident when his leg became pinned in between two colliding cars. A passerby rushed Nick to nearby Acadia-St. Landry Hospital (Acadia) ² in Church Point, Louisiana. Once there, Dr. Williams, the general practitioner on duty at Acadia, determined that Nick needed the care of an orthopedist and a surgical facility for debridement of the wound. Unable to provide such treatment, Dr. Williams called Dr. Olivier, an orthopedist at Hamilton some thirty minutes away in Lafayette.

Plaintiffs contend that Dr. Olivier agreed to treat Nick and preparations were made to transport Nick to Hamilton. However, before Nick left Acadia, Plaintiffs allege that an administrator from Hamilton called back and, after determining that Nick had no insurance, instructed Dr. Williams not to send Nick to Hamilton.

Following this, Dr. Williams called several other hospitals seeking to find a facility that could treat Nick. Eventually, Charity Hospital in New Orleans agreed to treat Nick and he was flown there by helicopter. Once at Charity, Nick's leg was immediately surgically debrided. The delay caused by this sequence of events was approximately seven hours and Plaintiffs allege that, on account of this delay, Nick's injuries materially worsened.

On March 22, 1993, Plaintiffs filed suit against Hamilton alleging that Hamilton's refusal to treat Nick was in violation of EMTALA, 42 U.S.C. Sec. 1395dd. Hamilton responded with a motion to dismiss pursuant to Fed.R.Civ.P. 12(b)(6) arguing that Plaintiffs

failed to state a claim on which relief could be granted because they did not allege that Nick "came to" the emergency department at Hamilton. Further, Hamilton argued that it was a transferee hospital and, as such, it could only be liable under EMTALA if it had agreed to a transfer which it had not. The district court granted the motion to dismiss, apparently because the court believed that under the facts alleged, Nick never "came to" the emergency department at Hamilton within the meaning of the statute. Plaintiffs now appeal.

1. STANDARD OF REVIEW

In review of a dismissal under Fed.R.Civ.P. 12(b)(6) for failure to state a claim on which relief could be granted, we must accept all well-pleaded facts as true and view them in a light most favorable to the non-movant. McCartney v. First City Bank, 970 F.2d 45, 47 (5th Cir.1992). "We will not go outside the pleadings and we cannot uphold the dismissal 'unless it appears beyond doubt that the plaintiff can prove no set of facts in support of his claim which would entitle him to relief.' " Rankin v. Wichita Falls, 762 F.2d 444, 446 (5th Cir.1985) (quoting Conley v. Gibson, 355 U.S. 41, 44-45, 78 S.Ct. 99, 102, 2 L.Ed.2d 80 (1957).

2. EMTALA

The sole issue before this Court is whether the plaintiffs have stated a claim under EMTALA, 42 U.S.C. Sec. 1395dd. ³ This statute is also known as the "anti-dumping" statute and it was passed in 1986 in response to a growing concern that hospitals were dumping patients who could not pay by either turning them away from their emergency rooms or transferring them before their emergency conditions were stabilized. Brooks v. Maryland Gen. Hosp., Inc., 996 F.2d 708, 710 (4th Cir.1993). Accordingly, this statute mandates that a hospital ⁴ must conduct appropriate screening examinations for any individual who presents to its emergency department. Further, if an emergency condition is found to exist, the hospital must either provide sufficient treatment to stabilize the patient or transfer the patient in accordance with the strictures of the statute. Green v. Touro Infirmary, 992 F.2d 537, 539 (5th Cir.1993); 42 U.S.C. Sec. 1395dd.

Under the terms of the statute, however, these duties are only triggered when an individual "comes to the emergency department and a request is made on the individual's behalf for examination or treatment...." 42 U.S.C. Sec. 1395dd (emphasis added). These two preconditions are conjunctive requiring both that an individual 1) comes to the emergency department and 2) that a request be made. In the instant case, it is the first requirement that is problematic.

It is undisputed that Nick Miller never physically came to the emergency department at Hamilton. There was only a request over a telephone. Nevertheless, the Plaintiffs We reject this argument for two reasons. First, the language of the statute unambiguously describes the individuals covered by section 1395dd as those who come to the emergency department. Brooker v. Desert Hospital Corp., 947 F.2d 412, 414 (9th Cir.1991); 42 U.S.C. Sec. 1395dd. Except in rare and exceptional circumstances, when " 'we find the terms ... unambiguous, judicial inquiry is complete....' " Pavelic & LeFlore v. Marvel Entertainment Group, 493 U.S. 120, 123, 110 S.Ct. 456, 458, 107 L.Ed.2d 438 (1989) (quoting Rubin v. United States, 449 U.S. 424, 430, 101 S.Ct. 698, 701, 66 L.Ed.2d 633 (1981). No such exceptional circumstances exist in this case. ⁶

                argue that we should not construe this statute to require physical presence at the emergency room.  Instead, the Plaintiffs contend that Congress intended that the statute would extend the hospital's duty to any individual in need of emergency care who requests treatment at the hospital's emergency department. 5  In essence, the Plaintiffs are asking this Court to excise the "comes to" clause out of the statute by construing it so as to make it redundant with the "request is made" clause
                

Second, such an interpretation would render the "comes to" clause a nullity. This would be contrary to "the elementary canon of construction that a statute should be interpreted so as not to render one part inoperative...." Mountain States Tel. & Tel. Co. v. Pueblo of Santa Ana, 472 U.S. 237, 249, 105 S.Ct. 2587, 2594, 86 L.Ed.2d 168 (1985) (quoting Colautti v. Franklin, 439 U.S. 379, 392, 99 S.Ct. 675, 684, 58 L.Ed.2d 596 (1979)); In re Dyke, 943 F.2d 1435, 1443 (5th Cir.1991). Accordingly, we hold Congress to its words when it said that an individual must "come to" the emergency department to trigger a hospital's duty under EMTALA.

Moreover, we find support for our conclusion in the case law construing the statute. While this precise issue has seldom been in controversy, most courts have implicitly recognized that the individual must come to the Finally, this was the conclusion of the only case to have dealt with this issue directly. Johnson v. University of Chicago Hosp., 982 F.2d 230, 233 (7th Cir.1992). In Johnson, the University of Chicago Hospitals (UCH) was operating a telemetry system to direct paramedics transporting emergency patients to the appropriate hospital in the system. During this time, paramedics were dispatched on an emergency call to aid a one-month-old infant who had stopped breathing. On arriving at the scene, the paramedics contacted the telemetry operator from UCH. The paramedics informed the nurse that they were only five blocks from UCH, but the nurse instructed the paramedics to transport the infant to a more distant hospital. Id. at 231.

                emergency room. 7  Additionally, in devising judicial tests for violation of this statute, courts have most often listed as the first element that the individual come to the emergency department. 8
                

The baby died sometime after arriving at the other hospital and the mother of the child brought suit against UCH for, inter alia, a violation of EMTALA. Id. The Seventh Circuit upheld the dismissal of this claim, however, because of its conclusion that, under the plain meaning of the statute, the infant never came to UCH or its emergency department. Id. at 233. In explaining its decision, the court stated that the baby "simply never 'came to' UCH for medical assistance, and thus never crossed the threshold of [EMTALA] liability." Id. at 233 n. 7.

As did the court in Johnson, we find that, from the facts alleged in the complaint, Nick Miller never "came to" the emergency department at Hamilton as required by EMTALA. Accordingly, the Plaintiffs have failed to state a claim on which relief could be granted and the district court correctly granted Hamilton's motion to dismiss under Fed.R.Civ.P. 12(b)(6). ⁹

CONCLUSION

For the foregoing reasons, the district court's dismissal pursuant to Fed.R.Civ.P. 12(b)(6) is AFFIRMED.

1 Sec. 1395dd was enacted as a part of COBRA--the Consolidated Omnibus Budget Reconciliation Act of 1986. Pub.L. No. 99-272, Sec. 9121, 100 Stat. 82, 164-67 (1986).

2 This facility is a small, country clinic where only two family doctors practice.

3 In pertinent part, this...