Pennington-Thurman v. Christian Hosp. Ne.
| Decision Date | 22 October 2019 |
| Docket Number | Case No. 4:19-CV-162 PLC |
| Parties | WILMA PENNINGTON-THURMAN, Plaintiff, v. CHRISTIAN HOSPITAL NORTHEAST, Defendant. |
| Court | U.S. District Court — Eastern District of Missouri |
This matter is before the Court on Defendant Christian Hospital Northeast's motion to dismiss pursuant to Fed. R. Civ. P. 12(b)(6). [ECF No. 17] For the following reasons, Defendant's motion is granted in part and denied in part.
The facts, as alleged in Plaintiff's pro se complaint, are as follows: At 3:45 a.m. on January 31, 2017, Plaintiff, a "two-time cancer patient under the care of oncologist Dr. Juan Carden," arrived by ambulance at Defendant's emergency department. [ECF No. 1 at ¶¶ 1, 5] Plaintiff was suffering "severe leg cramps, 'Charlie [sic] Horse' in both thighs, legs and feet." [Id. at ¶ 2] Emergency department staff assigned Plaintiff to a bed and left her "screaming for help from her room due to pain on scale of 10[.]" [Id. at¶¶ 3-4]
At 4:05 a.m., a nurse noted: [Id. at ¶ 8] At 4:27 a.m., Dr. Derrick Lowery reviewed "Plaintiff's chart from May 22, 2009," which contained a "flag...to contact" Dr. Carden. [Id. at ¶¶ 5-6] Dr. Lowery did not contact Dr. Carden. [Id. at ¶6] At 4:42 a.m., a nurse noted that she had placed a fall risk armband on Plaintiff and wrote: [Id. at ¶ 9]
Dr. Lowery saw Plaintiff at 5:12 a.m. [Id. at ¶ 11] At that time, Dr. Lowery was unable to obtain information from Plaintiff because she was screaming, and he informed her he would "come back after the shot has worked."1 [Id.]
At 5:49 a.m., Plaintiff denied pain or discomfort and no longer appeared to be in distress. [Id. at ¶ 12] At that time, a nurse advised Plaintiff that her bloodwork was "fine" and presented Plaintiff with "release papers." [Id. at ¶ 14] Plaintiff informed the nurse that "she did not want to sign the release papers because she did not feel well." [Id. at ¶ 15] In response, the nurse summoned the head nurse. [Id.] Despite telling the head nurse that she was "going to throw up," the head nurse stated that Plaintiff was "not going to be admitted to the hospital." [Id.] After Plaintiff threw up, emergency department staff wheeled Plaintiff to the waiting room and left her "slumped over in the wheelchair" until sometime after 8:00 a.m., when Plaintiff's sister arrived to pick her up. [Id. at ¶¶ 15-16]
Plaintiff filed a complaint against Defendant and Dr. Lowery2 seeking monetary relief for alleged violations of the Emergency Medical Treatment and Active Labor Act (EMTALA), 42U.S.C. § 1395dd, and claims of medical malpractice. [Id.] More specifically, Plaintiff claimed Defendants violated EMTALA by failing to: (1) provide appropriate medical screening because they believed Plaintiff lacked health insurance; and (2) stabilize Plaintiff prior to discharge. [Id.]
Along with her complaint, Plaintiff filed an affidavit stating that she obtained the written opinion of "a qualified health care provider," as required by Mo. Rev. Stat. § 538.225. [ECF No. 1 at 18] Plaintiff identified Dr. Sebastian Rueckert, Defendant's vice president and regional chief medical officer, as the qualified health care provider. [Id.] She averred that Dr. Rueckert provided an opinion, in the form of a letter, which stated that Defendant "failed to provide the kind of treatment that 'a reasonably prudent and careful healthcare provider would have under similar circumstances'" and "[t]his failure caused or contributed to the harm alleged in the lawsuit." [Id.] Plaintiff attached Dr. Rueckert's letter to the affidavit. [ECF No. 1-1]
Defendant moves for dismissal for failure to state a claim pursuant to Fed. R Civ. P. 12(b)(6). [ECF No. 17] Plaintiff opposes the motion. [ECF No. 27]
When ruling on a Rule 12(b)(6) motion to dismiss, the court must accept as true all of the factual allegations in the complaint, but it need not accept legal conclusions. Ashcroft v. Iqbal, 556 U.S. 662, 678 (2009). "To survive a motion to dismiss, a complaint must contain sufficient factual matter, accepted as true, to 'state a claim to relief that is plausible on its face.'" Id. (quoting Bell Atl. Corp. v. Twombly, 550 U.S. 544, 570 (2007)). A claim satisfies the plausibility standard "when the plaintiff pleads factual content that allows the court to draw the reasonable inference that the defendant is liable for the misconduct alleged." Id. (citing Twombly, 550 U.S. at 556).
In applying these principles, a court must construe a plaintiff's pro se complaint liberally. Stone v. Harry, 364 F.3d 912, 914 (8th Cir. 2004). Thus, "if the essence of an allegation is discernible, even though it is not pleaded with legal nicety, then the district court should construe the complaint in a way that permits the layperson's claim to be considered within the proper legal framework." Jackson v. Nixon, 747 F.3d 537, 544 (8th Cir. 2014) (quoting Stone, 364 F.3d at 915). However, a pro se complaint "still must allege sufficient facts to support the claims advanced." Stone, 364 F.3d at 914.
Defendant moves for dismissal of Plaintiff's EMTALA claims because Plaintiff "failed to plead factual allegations" suggesting that: 1) she received no screening; 2) she received improper screening for a discriminatory purpose; 3) she received screening that was different from other patients with charley-horse cramps; and 4) she had an emergent condition that Defendant failed to stabilize. [ECF No. 18 at 1] Defendant also urges the Court to either decline to exercise supplemental jurisdiction over Plaintiff's state law medical malpractice claims or dismiss her state law claims for failure submit a written opinion from a health care provider as required by Mo. Rev. Stat. § 538.225. [Id. at 1-2]
In response, Plaintiff asserts that, because Dr. Lowery failed to "carefully read" her chart and did not see Plaintiff until ninety minutes after her arrival to the emergency department, "she was treated differently from other patients and differently from the treatment prescribed by the hospital's normal screening process." [ECF No. 27 at 3, 6] Plaintiff also maintains she stated an EMTALA claim for failure to stabilize because she alleged that "she was discharged and'dumped' in the waiting room area with a 'Fall Risk' arm band on after she complained she felt ill and was going to throw up."3 [Id. at 3]
Congress enacted EMTALA to "address a distinct and rather narrow problem - the 'dumping' of uninsured, underinsured, or indigent patients by hospitals who did not want to treat them."4 Summers v. Baptist Med. Ctr. Arkadelphia, 91 F.3d 1132, 1136 (8th Cir. 1996) EMTALA imposes two requirements on hospitals with emergency departments - namely, to screen and to stabilize patients. 42 U.S.C. § 1395dd(a)-(b). The statute provides:
In the case of a hospital that has a hospital emergency department, if any individual...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....exists.5
42 U.S.C. § 1395dd(a).
Importantly, EMTALA does not "create[] a general federal cause of action for medical malpractice in emergency rooms." Summers, 91 F.3d at 1137. "Rather,...EMTALA focuses onuniform treatment of patients presented in hospital emergency departments." Hunt ex rel. Hunt v. Lincoln Cty. Mem. Hosp., 317 F.3d 891, 894 (8th Cir. 2003). "Patients are entitled under EMTALA, not to correct or non-negligent treatment in all circumstances, but to be treated as other similarly situated patients are treated, within the hospital's capabilities." Summers, 91 F.3d at 1138. Therefore, "a claim under EMTALA requires a showing of a lack of uniform treatment with other similarly situated patients." Mead v. Salem Memorial Dist. Hosp., No. 4:07-CV-452 TIA, 2008 WL 205273, at *3 (E.D. Mo. Jan. 23, 2008) (citing Summers, 91 F.3d at 1138).
Defendant contends that "the fact allegations in Plaintiff's Complaint do not support her claim that [Defendant] failed to appropriately screen her." [ECF No. 18 at 4] While EMTALA does not define the term appropriate medical screening examination, "[m]ost of the courts that have interpreted the phrase have defined it as a screening examination that the hospital would have offered to any other patient in a similar condition with similar symptoms." Marshall v. East Carroll Parish Hosp. Serv. Dist., 134 F.3d 319, 323 (5th Cir. 1998) (collecting cases). See also Summers, 91 F.3d at 1138 ().
The Eighth Circuit has recognized three types of improper screenings that are actionable under EMTALA: (1) "failure to screen at all"; (2) "improper screening of patients for a discriminatory reason"; (3) and "screening a patient differently from other patients perceived to have the same condition." Summers, 91 F.3d at 1139. Defendant argues that Plaintiff's complaint does not state a claim for any of the three categories of failure to screen.
With respect to the first category of failure to screen, the complaint alleged: a nurse talked to Plaintiff, noted her discomfort and "cramps in Rt thigh," and inquired whether an injury had caused the pain in her legs; Dr. Lowery reviewed Plaintiff's chart; and emergency department staff performed blood work and informed Plaintiff of the results. The complaint's factual allegations establish that Defendant's nursing staff and Dr. Lowery...
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