Romar v. Fresno Community Hosp. and Medical Center

• Decision Date: 10 October 2008
• Docket Number: No. 1:03-cv-6668 AWI SMS.,1:03-cv-6668 AWI SMS.
• Citation: 583 F.Supp.2d 1179
• Parties: Christina ROMAR, a minor suing through her mother and legal representative, Cora ROMAR, Plaintiff, v. FRESNO COMMUNITY HOSPITAL AND MEDICAL CENTER, and Dr. Thomas Mansfield, Defendants.
• Court: U.S. District Court — Eastern District of California

583 F.Supp.2d 1179

Christina ROMAR, a minor suing through her mother and legal representative, Cora ROMAR, Plaintiff, v. FRESNO COMMUNITY HOSPITAL AND MEDICAL CENTER, and Dr. Thomas Mansfield, Defendants.

No. 1:03-cv-6668 AWI SMS.

United States District Court, E.D. California.

October 10, 2008.

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Kevin Gerard Little, Law Office of Kevin G. Little, Fresno, CA, for Plaintiff.

Celene Boggs Resong, Stammer, McKnight, Barnum & Bailey, Fresno, CA, for Defendants.

ORDER ON APPLICATION OF THE MICRA DAMAGES CAP TO PLAINTIFF'S EMTALA CLAIM

ANTHONY W. ISHII, Chief Judge.

This is an the Emergency Medical Treatment and Active Labor Act, 42 U.S.C. § 1395dd ("EMTALA") case that stems from three presentations to Fresno Community Hospital and Medical Center's ("FCH") emergency room by minor Plaintiff Christina Romar in December 2002. At this point in the proceedings, it has become necessary to determine whether the $250,000 non-economic damages limitation of the California Medical Injury Compensation Reform Act, California Civil Code § 3333.2 ("MICRA"), applies to Plaintiffs EMTALA disparate screening claim. For the reasons that follow, the Court concludes that the MICRA cap does not apply to Plaintiffs' EMTALA disparate screening claims.

Plaintiff's Argument

Plaintiff argues that two federal district courts have held that EMTALA claims are not subject to the severe non-economic damage limitations applicable to medical malpractice claims under MICRA. See Jackson v. East Bay Hosp., 980 F.Supp. 1341, 1344 (N.D.Cal.1997) ("Jackson I"); Burrows v. Redbud Community Hosp. Dist., 188 F.R.D. 356, 358 (N.D.Cal.1997). Jackson I first determined that EMTALA incorporates state damages law. It next determined that the MICRA damages cap was part of California's general tort law and that the MICRA cap was not arbitrary and not preempted by EMTALA. Jackson I then noted that, as recognized by the Ninth Circuit and other federal courts, EMTALA does not create a federal remedy for medical negligence, nor does it duplicate state-law medical malpractice claims; rather, it makes hospitals strictly liable. Jackson I observed that California law recognizes that the same set of facts may support both MICRA and non-MCRA claims; thus, the same set of facts is not necessarily based on professional negligence. Since EMTALA is not a negligence statute, Jackson concluded that an EMTALA cause of action is not based on professional negligence and that the MCRA cap does not apply. Jackson I should be followed here.

The federal cases which have applied other states' damages caps are distinguishable. The malpractice damages cap in Michigan, Indiana, and Virginia are all broader in scope than MICRA. The Fourth Circuit decision in Brooks v. Maryland Gen. Hosp., 996 F.2d 708 (4th Cir. 1993) is more instructive because Maryland's damages cap is very similar to MCRA. Brooks concluded that the Maryland damages cap, which applied to claims based on the breach of the standard of care, did not encompass EMTALA claims. See Brooks, 996 F.2d at 713.

Finally, the California supreme court case of Barris v. County of Los Angeles, 20 Cal.4th 101, 83 Cal.Rptr.2d 145, 972 P.2d 966 (1999) is not dispositive. Barris was expressly limited to a failure to stabilize claim, which is not present in this case. Barris also rejected the premise that EMTALA is not a negligence statute, despite the legion of federal cases to the contrary. Because of the many federal cases that recognize that EMTALA is not a negligence statute, Barris cannot be followed.

Under the rationale of Jackson I and Brooks, the Court should hold that MICRA's cap does not apply to this case.

FCH's Argument

FCH argues that MICRA applies to actions for injury against a health care provider based on professional negligence, which means a negligent act or omission by a health care provider in rendering professional services that are within the scope of services for which the provider is licensed. MICRA applies to professional conduct even if no special training, knowledge, or skill is required. As the Ninth Circuit recognized in Taylor v. United States, 821 F.2d 1428 (9th Cir.1987), MICRA's application depends upon whether the duty breached falls within the services for which the health care provider is licensed.

In Barris, the California supreme court determined that the MICRA cap applied to the EMTALA stabilization claim before it. Barris recognized that most federal courts have applied a state's damages cap to EMTALA. Barris adopted the analytical approach of Power v. Arlington Hosp. Assoc., 42 F.3d 851 (4th Cir.1994) and held that a court is to look at the underlying conduct challenged and its legal basis to determine whether, if brought under state law, it would constitute a cause of action subject to a cap. Power found that Virginia's medical malpractice damages cap applied to disparate screenings.

Finally, Jackson I should not be followed. Barris rejected Jackson I on the basis that Jackson I erroneously stated that EMTALA claims do not rest on any proof that a hospital was negligent or failed to provide adequate treatment, and further erroneously held that EMTALA requires proof of a hospital's intentional refusal to provide care. Because California law determines the damages available under EMTALA and the California Supreme Court has disavowed Jackson I's damages analysis, Jackson I should not be followed.

The MICRA cap applies in this case because Plaintiff is claiming that she was disparately screened when additional diagnostic tests were not utilized even though other patients with sufficiently similar symptoms received the tests. The failure to obtain additional testing is an act that falls within the licensing of a hospital and is based on professional judgment. Further, expert witnesses in this case are necessary to determine whether the screening received was disparate. Plaintiff's case involves professional negligence that falls under MICRA.

Legal Standards

Damages Under EMTALA & MICRA

EMTALA provides in pertinent part:

Any individual who suffers personal harm as a direct result of a participating hospital's violation of a requirement [under EMTALA] may, in a civil action against the participating hospital, obtain those damages available for personal injury under the law of the State in which the hospital is located, and such equitable relief as appropriate.

42 U.S.C. § 1395dd(d)(2)(A). "By enacting this provision, Congress explicitly directed federal courts to look to state law ... to determine both the type and amount of damages available," which may include medical malpractice damages caps. Power v. Arlington Hosp. Assoc., 42 F.3d 851, 860-63 (4th Cir.1994); see also Smith v. Botsford Gen. Hosp., 419 F.3d 513, 518 (6th Cir.2005); Brooks v. Maryland Gen. Hosp., 996 F.2d 708, 715 (4th Cir.1993); Jackson v. East Bay Hosp., 980 F.Supp. 1341, 1346 (N.D.Cal.1997); Barris v. County of Los Angeles, 20 Cal.4th 101, 111, 83 Cal.Rptr.2d 145, 972 P.2d 966 (1999).

California has a damages cap on noneconomic damages of $250,000 for claims "based on professional negligence" by health care providers. Cal. Civ.Code § 3333.2(b). In relevant part, MICRA reads:

(a) In any action for injury against a health care provider based on professional negligence, the injured plaintiff shall be entitled to recover non-economic losses to compensate for pain, suffering, inconvenience, physical impairment, disfigurement and other nonpecuniary damage.

.....

(c) For the purposes of this section:

......

(2) "Professional negligence" means a negligent act or omission to act by a health care provider in the rendering of professional services, which act or omission is the proximate cause of a personal injury or wrongful death, provided that such services are within the scope of services for which the provider is licensed and which are not within any restriction imposed by the licensing agency or licensed hospital.

Cal. Civ.Code § 3333.2(a), (c)(2). "In other contexts, the [California] Supreme Court has applied an expansive definition to the MICRA definition of `based on professional negligence,' but it has not done so in the context of § 3333.2." Perry v. Shaw, 88 Cal.App.4th 658, 661, 106 Cal.Rptr.2d 70 (2001).

"It is settled that additional causes of action may arise out of the same facts as a medical malpractice action that do not trigger MICRA." Unruh-Haxton v. Regents of University of California, 162 Cal.App.4th 343, 352, 76 Cal.Rptr.3d 146 (2008); see Smith v. Ben Bennett, Inc., 133 Cal.App.4th 1507, 1514, 35 Cal.Rptr.3d 612 (2005). For example, in addition to medical malpractice, causes of action against a health care provider for "battery, products liability, premises liability, fraud, breach of contract, and intentional or negligent infliction of emotional distress" may arise from out of the same set of facts. Smith, 133 Cal.App.4th at 1515, 35 Cal.Rptr.3d 612. If a plaintiff "chooses to proceed on both non-MICRA and MICRA causes of action, and obtains a recovery that may be based on a non-MICRA theory, the limitations of [MICRA] should not apply." Waters v. Bourhis, 40 Cal.3d 424, 437-38, 220 Cal.Rptr. 666, 709 P.2d 469 (1985). "[W]hen a cause of action is asserted against a health care provider on a legal theory other than medical malpractice, the courts must determine whether it is nevertheless based on the `professional negligence' of the health care provider so as to trigger MICRA." Smith, 133 Cal.App.4th at 1514, 35 Cal.Rptr.3d 612. The California Supreme Court adopted the analytical framework of the federal Fourth Circuit for determining whether the MICRA cap applies to a particular EMTALA claim. Barris, 20 Cal.4th at 114, 83 Cal.Rptr.2d 145, 972 P.2d 966.

[T]he court's task in determining whether Civil Code § 3333.2 applies to a particular kind of EMTALA claim . . . properly involves examining the legal theory underlying the particular...