Ohio County Hospital Corporation v. Martin, No. 2006-CA-002248-MR (Ky. App. 2/22/2008)
| Decision Date | 22 February 2008 |
| Docket Number | No. 2006-CA-002248-MR.,2006-CA-002248-MR. |
| Parties | OHIO COUNTY HOSPITAL CORPORATION, Appellant v. Tina MARTIN, Administratrix of The Estate of Billie Carol Shreve, Deceased; and Donald Ray Shreve, Individually, Appellees. |
| Court | Kentucky Court of Appeals |
Ronald G. Sheffer, William K. Burnham, Louisville, Kentucky, Brief for Appellant.
Ronald Sheffer, Louisville, Kentucky, Oral Argument for Appellant.
A.V. Conway, II, Hartford, Kentucky, Laurence R, Dry, Wanda Dry, Oak Ridge, Tennessee, Brief for Appellees.
A.V. Conway, Hartford, Kentucky, Oral Argument for Appellees.
Before: TAYLOR and THOMPSON, Judges; BUCKINGHAM,1 Senior Judge.
Ohio County Hospital Corporation (the hospital) appeals from a judgment of the Ohio Circuit Court in favor of Tina Martin, administratrix of the estate of Billie Carol Shreve, deceased, and Donald Ray Shreve, the surviving spouse of Billie Carol Shreve. Shreve died after being treated at the hospital following an automobile accident, and this case arose as a result of a claim of medical negligence brought by the administratrix of her estate and by her surviving husband against the hospital and her treating physician. We affirm in part, reverse in part, and vacate in part and remand for a new trial.
On June 22, 2002, at approximately 10:55 a.m., Billie Carol Shreve was injured in an automobile accident. She was transported to the hospital, and she arrived there at 11:20 a.m. She was evaluated by Nurse Holly Strader, a registered nurse, and was seen by Dr. Kevin Gregory, the emergency room physician. She did not complain specifically of pain, but she stated that she was uncomfortable. Shreve was monitored by the nursing staff and Dr. Gregory.
Shreve's condition deteriorated, and she became unconscious at 12:54 p.m. Dr. Gregory concluded that she had gone into shock and was likely hemorrhaging. He was unsure of the site of her hemorrhaging and ordered a CT scan. In the meantime, Shreve received blood transfusions. When the results of the CT scan were received, Dr. Gregory determined that Shreve had internal bleeding from abdominal trauma and that she would require surgery. After learning that no surgeons were available, Dr. Gregory arranged for Shreve to be transferred to Owensboro Medical Health Systems, Inc., in Owensboro for surgery. By the time Shreve was delivered to the hospital in Owensboro, she had bled to death.
Tina Martin, administratrix of Shreve's estate, and Donald Ray Shreve, Shreve's husband, filed a civil complaint in the Ohio Circuit Court alleging negligence against the hospital and Dr. Gregory. The claim against Dr. Gregory was settled before the trial of the claim against the hospital.
The case was tried in the Ohio Circuit Court in August 2006. The jury returned a verdict determining that both Dr. Gregory and the hospital were negligent and that each was liable for 50% of the damages. The jury stated in its verdict that Shreve's estate had suffered damages of $48,000 for destruction of Shreve's power to earn money, $50,000 for her pain and suffering, and $725 for funeral expenses, for a total of $98,725. The jury also stated that Donald Ray Shreve, Shreve's husband, had suffered damages of $250,000 for loss of consortium. Because the jury assessed 50% of the liability against the hospital and 50% against Dr. Gregory, the court entered a judgment of $49,362.50 in favor of Shreve's estate and a judgment of $125,000 in favor of Mr. Shreve.2 This appeal by the hospital followed.
The hospital's first argument is that the trial court erred by not granting it a directed verdict on the appellees' claim for damages for violation of the federal Emergency Medical Treatment and Active Labor Act (EMTALA).3 The hospital asserts that in order to prevail on their claim, the appellees were required to prove that the hospital denied appropriate treatment because of Shreve's insurance status or lack of ability to pay. The hospital notes that the EMTALA was enacted by Congress to prevent hospitals "from dumping patients, who lack insurance to pay for their claims, by either refusing treatment or transferring them to other hospitals." See Thornton v. Southwest Detroit Hosp., 895 F.2d 1131, 1132 (6th Cir. 1990). Thus, the hospital maintains that the appellees did not have a valid EMTALA claim because there was no proof that Shreve was "dumped" to another hospital due to her insurance status or her inability to pay.
The EMTALA is found at 42 U.S.C. § 1395dd. It contains a medical screening requirement, 42 U.S.C §1395dd(a), and a stabilization requirement, 42 U.S.C. § 1395dd(b). It also provides for a private cause of action for violations of the Act by hospitals. 42 U.S.C. § 1395dd(d)(2)(A). There are no Kentucky state cases addressing EMTALA claims.
The medical screening requirement in 42 U.S.C. § 1395dd(a) provides as follows:
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, including ancillary services routinely available to the emergency department, to determine whether or not an emergency medical condition (within the meaning of subsection (e)(1) of this section) exists.
The medical stabilization requirement in 42 U.S.C. § 1395dd(b) provides that if a hospital determines that an individual has an emergency medical condition, it must either provide a medical examination and treatment as within its capabilities in order to stabilize the individual or transfer the individual to another medical facility.
42 U.S.C. § 1395dd(c) addresses the circumstances under which a hospital may transfer an individual who has an emergency medical condition that has not been stabilized. The statute provides that the hospital may not transfer the individual unless one of three requirements is met. First, the individual may request in writing that he or she be transferred to another medical facility. 42 U.S.C. § 1395dd(c)(1)(A)(i). Second, a physician may sign a certification "that based upon the information available at the time of transfer, the medical benefits reasonably expected from the provision of appropriate medical treatment at another medical facility outweigh the increased risks to the individual[.]" 42 U.S.C. § 1395dd(c)(1)(A)(ii). Third, if there is no physician physically present in the emergency room at the time of transfer, a qualified medical person, as defined elsewhere in the statute, may sign the certification described above after a physician has made the required determination and subsequently countersigns the certification. 42 U.S.C. § 1395dd(c)(1)A)(iii).
In this case, the appellees alleged that the hospital failed to provide an appropriate medical screening and/or failed to stabilize Shreve's condition before discharging her and transferring her to another facility. Thus, they alleged violations of both subsections (a) and (b) of 42 U.S.C. § 1395dd. The trial court instructed the jury to determine whether the hospital failed to comply with their statutory duties and whether such failure or failures were substantial factors in causing Shreve's death. Further, the court instructed the jury that it was not to determine under the EMTALA instruction whether the hospital exercised ordinary care.4 The jury found that the hospital failed to provide an appropriate medical screening or failed to stabilize Shreve's condition before transferring her.5
As we have noted, the hospital argues that the "(a)ppellees did not enter any evidence into the record of disparate treatment, or treatment based on insurance status" and that the trial court thus erred in not granting it a directed verdict because, they argue, "[a]ppellees failed to make a prima facie case under EMTALA." We first turn to the appellees' claim under 42 U.S.C. § 1395dd(a).
In Morgan v. North MS Medical Center, Inc., 403 F.Supp.2d 1115 (S.D.Ala. 2005), the court held as follows:
[T]he screening duty is not triggered whenever a hospital neglects to perform a screening test that the plaintiff believes should have been done, or even one that any reasonably diligent hospital would have performed. Rather, EMTALA's screening obligation is focused exclusively on ensuring that a hospital applies the same screening procedures for indigent patients who present at its emergency room that it does for similarly situated patients who have insurance or are otherwise well-heeled.
Id. at 1125. See also Holcomb v. Monahan, 30 F.3d 116, 117 (11th Cir. 1994)("this language only requires a hospital to provide indigent patients with a medical screening similar to one which they would provide any other patient"); Gatewood v. Washington Healthcare Corp., 933 F.2d 1037, 1041 (D.C.Cir. 1991)("The federal Emergency Act is not intended to duplicate preexisting legal protections, but rather to create a new cause of action, generally unavailable under state tort law, for what amounts to failure to treat").
Additionally, the hospital states that EMTALA is not intended to be a federal malpractice statute. See Harry v. Marchant, 291 F.3d 767, 770 (11th Cir. 2002)(EMTALA "was not intended to be a federal malpractice statute"); Morgan, 403 F.Supp.2d at 1124 ().
In response to the hospital's argument, the appellees argue that the hospital has misstated the law and that they were not required to introduce proof of bad motive or other nonmedical reasons in order to prove disparate treatment. They cite Power v. Arlington Hospital Association, 42 F.3d 851 (4th ...
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