Richmond v. Community Hosp. of Roanoke Valley

• Decision Date: 08 May 1995
• Docket Number: Civ. A. No. 93-849-R.
• Citation: 885 F. Supp. 875
• Parties: Dennis Wayne RICHMOND, Plaintiff, v. COMMUNITY HOSPITAL OF ROANOKE VALLEY, et al., Defendants.
• Court: U.S. District Court — Western District of Virginia

885 F. Supp. 875

Dennis Wayne RICHMOND, Plaintiff, v. COMMUNITY HOSPITAL OF ROANOKE VALLEY, et al., Defendants.

Civ. A. No. 93-849-R.

United States District Court, W.D. Virginia.

April 7, 1995.

Order Staying Proceedings Pending Applications for Appeal May 8, 1995.

Michael McHale Collins, Collins & Mooney, Covington, VA, for plaintiff.

Powell M. Leitch, III, Woods, Rogers, & Hazlegrove, Roanoke, VA for Community Hosp. and Young U. Kim, defendants.

Henry M. Sackett, III, Edmunds & Williams, Lynchburg, VA, for Emergency Room Physician, etc. and P.M., Thought to be Dr. Todd Palmerton, etc.

MEMORANDUM OPINION

TURK, District Judge.

This matter comes before the court on defendant Community Hospital of the Roanoke Valley's ("Community Hospital") motion for partial summary judgment pursuant to Federal Rule of Civil Procedure 56. Upon careful consideration of the record, the applicable law, the briefs submitted by the parties, and the arguments presented by counsel at the hearing, the court finds that it must grant defendant's motion for partial summary judgment.

I. BACKGROUND

On the afternoon of November 9, 1991, plaintiff Dennis Wayne Richmond ("Richmond") arrived at Community Hospital's emergency department, complaining of left rib pain. Robin Wright, a registered nurse on duty, "triaged" plaintiff; that is, she checked his vital signs, conducted a ten minute examination, took a verbal history, and made a written nursing assessment.

Dr. Todd Palmerton, an emergency department physician, then examined Richmond. Among other things, Dr. Palmerton noted that plaintiff experienced tenderness in the "lateral left 4th-6th ribs." Dr. Palmerton sent Richmond for chest x-rays, which a radiologist duly interpreted. Based upon his findings and the x-ray results, Dr. Palmerton diagnosed plaintiff as having intercostal neuralgia. Dr. Palmerton prescribed an anti-inflammatory medication and instructed plaintiff to return for a follow-up visit if his symptoms worsened.

Finally, Nurse Judy Anderson discharged plaintiff, instructing him to return to the emergency department if his condition deteriorated or if new problems arose.

Plaintiff returned to the emergency room two days later on November 11, 1991. Community Hospital followed the same general procedures. Nurse Shannon Weakley triaged plaintiff, taking his vital signs and verbal history. Plaintiff complained of "severe left chest and back pain." After triage, Dr. Young Kim, on duty in the emergency department, examined and treated plaintiff. Dr. Kim sent Richmond for a second set of x-rays. Based on his findings and the radiologist's report, Dr. Kim diagnosed plaintiff with left lower lobe pneumonia, prescribed an antibiotic and Tylenol, and instructed him to return in four days for follow-up. Dr. Kim also, at plaintiff's request, referred him to a pulmonologist for more specialized follow-up. Lastly, Nurse Susan Alderman discharged plaintiff with the following instructions: "Please take the medicine as prescribed. Please return around 8 a.m. November 15, 1991 for a check examination. No work until you are checked and released. Return earlier if you have much more trouble."

On the same day, plaintiff saw private physician Dr. Kirk Hippensteel. His diagnosis was "acute pneumonia with peripneumonic pleuritis." He suggested that plaintiff call back later in the week if his symptoms had not improved and that plaintiff return in three weeks for follow-up and x-rays.

On November 13, 1991, Richmond's condition still had not improved. He presented himself to the Alleghany Regional Hospital emergency department, where they performed a chest x-ray, arterial blood gasses, a urinalysis, and a complete blood count. Richmond remained at Alleghany Regional Hospital for twenty-one days and underwent a thoracotomy with decortication.

On November 8, 1993, plaintiff filed a complaint in this court claiming that Community Hospital violated the Emergency Medical Treatment and Active Labor Act of 1986 ("EMTALA"), 42 U.S.C. § 1395dd. Specifically, plaintiff alleges that Community Hospital failed to provide an appropriate medical screening examination, failed to stabilize his condition, and transferred him prior to stabilizing his condition. Plaintiff also alleges pendent state law claims for negligent examination, treatment, and diagnosis of his condition.

Community Hospital has moved for partial summary judgment as to the EMTALA claims. The parties have thoroughly briefed the relevant issues, and the court held a hearing in this matter on March 7, 1995. Therefore, defendant's motion is ripe for this court's consideration.

II. ANALYSIS

Jurisdiction of the court is proper pursuant to 28 U.S.C. §§ 1331 and 1367.

Federal Rule of Civil Procedure 56(c) states that summary judgment is proper where "there is no genuine issue as to any material fact." In this case, defendant "bears the initial burden of pointing to the absence of a genuine issue of material fact." Temkin v. Frederick County Comm'rs, 945 F.2d 716, 718 (4th Cir.1991) (citing Celotex Corp. v. Catrett, 477 U.S. 317, 322, 106 S.Ct. 2548, 2552, 91 L.Ed.2d 265 (1986)), cert. denied, 502 U.S. 1095, 112 S.Ct. 1172, 117 L.Ed.2d 417 (1992). If defendant carries this burden, "the burden then shifts to the nonmoving party to come forward with facts sufficient to create a triable issue of fact." Id. at 718-19 (citing Anderson v. Liberty Lobby, Inc., 477 U.S. 242, 247-48, 106 S.Ct. 2505, 2509-10, 91 L.Ed.2d 202 (1986)).

Moreover, "once the moving party has met his burden, the nonmoving party must come forward with some evidence beyond the mere allegations contained in the pleadings to show there is a genuine issue for trial." Baber v. Hosp. Corp. of Am., 977 F.2d 872, 874-75 (4th Cir.1992). Although admissibility of the evidence at trial is unnecessary, "`unsupported speculation is not sufficient to defeat a summary judgment motion.'" Id. (quoting Felty v. Graves-Humphreys Co., 818 F.2d 1126, 1128 (4th Cir. 1987)).

Congress passed EMTALA to address the issue of treatment of indigent and uninsured patients in hospital emergency rooms:

The statute was designed principally to address the problem of "patient dumping," whereby hospital emergency rooms deny uninsured patients the same treatment provided paying patients, either by refusing care outright or by transferring uninsured patients to other facilities.

Gatewood v. Washington Healthcare Corp., 933 F.2d 1037, 1039 (D.C.Cir.1991) (citing H.R.Rep. No. 241, 99th Cong., 1st Sess., pt. 1, at 27 (1985)). Plaintiff alleges in Counts I through III violations of EMTALA in three respects. In Count I, plaintiff avers that Community Hospital denied him an "appropriate medical screening examination." 42 U.S.C. § 1395dd(a).¹ Plaintiff alleges in Count II that Community Hospital failed to provide the necessary stabilizing treatment for an emergency medical condition and in Count III that Community Hospital transferred him prior to stabilization of an emergency medical condition. 42 U.S.C. §§ 1395dd(b), (c).²

A. Count I: Propriety of Plaintiff's Medical Screening Examination

EMTALA does not specifically define what constitutes an "appropriate medical screening examination." See 42 U.S.C. § 1395dd(e) (defining terms). Various federal courts, including the Fourth Circuit Court of Appeals, however, have developed standards under which to analyze the concept. Most recently, the court in Power v. Arlington Hospital Association set forth the essence of an appropriate medical screening examination:

"the plain language of EMTALA requires a hospital to 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." Baber, 977 F.2d at 879. The key requirement is that a hospital "apply its standard of screening uniformly to all emergency room patients, regardless of whether they are insured or can pay. The Act does not impose any duty on a hospital requiring that the screening result in a correct diagnosis." Brooks v. Maryland Gen. Hosp., Inc., 996 F.2d 708, 710-11 (4th Cir.1993) (emphasis original).

42 F.3d 851, 856 (4th Cir.1994). Moreover, the courts uniformly agree that "EMTALA does not create a broad federal cause of action for emergency room negligence or malpractice." Gatewood, 933 F.2d at 1039. See also Baber, 977 F.2d at 880 (recognizing that "EMTALA is no substitute for state law medical malpractice actions"); Deberry v. Sherman Hosp. Ass'n, 769 F.Supp. 1030, 1034 (N.D.Ill.1991) (noting that EMTALA creates a federal cause of action "`for what amounts to failure to treat,'" not "a sweeping cause of action for malpractice claims traditionally protected by state law" (citing Gatewood, 933 F.2d at 1041)).

The court in Baber recognized that compliance with EMTALA necessitated some screening procedure. 977 F.2d at 879. However, the court noted that "while a hospital emergency room may develop one general procedure for screening all patients, it may also tailor its screening procedure to the patient's complaints or exhibited symptoms." Id. at 879 n. 6 (emphasis added).

The court is of the opinion that while plaintiff may have sufficient evidence to prove his state law claims for negligence and medical malpractice, he has not met his burden on summary judgment as to his EMTALA claim for failure to provide appropriate medical screening. The hospital has provided uncontroverted evidence that it adheres to a general screening procedure for all emergency room patients:

1. triage — to quickly ascertain the immediacy of the patient's need for treatment.

2. history and physical — to obtain information concerning the nature of the patient's problem.

3. physician examination — to explore the precise nature of the patient's problem, in order to lead to an appropriate course of treatment.

Defendant's Memorandum in Response to Plaintiff's Supplemental Brief at 2. Defendant...