Romo v. Union Memorial Hosp., Inc.

• Decision Date: 08 February 1995
• Docket Number: No. 3:93-cv-239-P.,3:93-cv-239-P.
• Citation: 878 F. Supp. 837
• Court: U.S. District Court — Western District of North Carolina
• Parties: Mary Ann ROMO, Administratrix of the Estate of Alvaro M. Romo; and Mary Ann Romo, Plaintiffs, v. UNION MEMORIAL HOSPITAL, INC.; Robert R. Farquharson, M.D.; and Edward B. Bower, M.D., Defendants.

878 F. Supp. 837

Mary Ann ROMO, Administratrix of the Estate of Alvaro M. Romo; and Mary Ann Romo, Plaintiffs, v. UNION MEMORIAL HOSPITAL, INC.; Robert R. Farquharson, M.D.; and Edward B. Bower, M.D., Defendants.

No. 3:93-cv-239-P.

United States District Court, W.D. North Carolina, Charlotte Division.

February 8, 1995.

COPYRIGHT MATERIAL OMITTED

Charles G. Monnett, III, Monnett, Barry & Roberts, William H. Elam, Wishart, Norris, Henninger & Pittman, Charlotte, NC, for plaintiffs.

J.A. Gardner, III, Hedrick, Eatman, Gardner & Kincheloe, Charlotte, NC, Kenneth B. Rotenstreich, Teague, Rotenstreich & Stanaland, Greensboro, NC, Paul A. Reichs, Charlotte, NC, for defendants.

ORDER

ROBERT D. POTTER, Senior District Judge.

THIS MATTER is before the Court on motion of Defendant, Union Memorial Hospital, Inc., filed January 13, 1995, for summary judgment with respect to Plaintiff's Emergency Medical Treatment and Active Labor Act ("EMTALA") claims. Plaintiff filed a brief in opposition to Defendant's motion for summary judgment on January 27, 1995. The Court has reviewed the motion for summary judgment and the briefs filed in support of and in opposition to the motion, as well as the relevant legal authorities. Based upon its review of this case, the Court makes the following findings of facts and conclusions of law.

Factual Background

The claim arises from an unfortunate episode which began on January 2, 1992 and culminated with Mr. Romo's death at CMC on January 5, 1992. On January 2, 1992 Alvaro Romo presented himself to Union Memorial Hospital with complaints of vomiting and abdominal pain. He was examined, diagnosed with gastroenteritis, and subsequently discharged with instructions to follow up with his family physician.

On January 4, 1994, at approximately 8:25 p.m., Romo again presented himself to the Union Memorial Hospital complaining of right-sided abdominal pain with chills and nausea. His vital signs, including temperature, pulse, blood pressure and respirations, were taken and recorded at 8:30 p.m. The medical records, attached at Defendant's Exhibit C, indicate that an evaluation was performed by Dr. Farquharson and that numerous tests and procedures were initiated and performed on Mr. Romo. Plaintiff contends that the record also indicates that there is a period of one and one-half hours wherein the Union Memorial nurses failed to check and record any of Romo's vital signs and a gap of four hours and twenty minutes in checking and recording Romo's temperature and respirations. (Plaintiff's Exhibit C at 9-10).

Sometime later, Dr. Farquharson consulted Dr. Bower by telephone and Dr. Bower arrived at the hospital at approximately 11:30 p.m. Dr. Bower evaluated Romo and concluded, in part, that Romo needed monitoring available in an ICU/CCU bed. Apparently after determining that no ICU/CCU beds were available at Union Memorial Hospital, the decision was made to transfer Romo to CMC. The arraignments were made by Dr. Farquharson and Romo was transported to the CMC via ambulance at approximately 1:30 a.m., on January 5, 1992. Romo arrived at CMC at 2:06 a.m., and was diagnosed with a probable perforated appendix c sepsis. Subsequently, at around 4:30 a.m., Romo suffered a cardiac arrest, was resuscitated, underwent surgery, and expired during that procedure.

Summary Judgment Standard

Summary judgment is appropriate when the pleadings, responses to discovery, and the record reveal that no genuine issue of any material fact exists and that the moving party is entitled to judgment as a matter of law. See Fed.R.Civ.P. 56(c). The party moving for summary judgment has the initial burden of showing that no genuine issue of any material fact exists and that the moving party is entitled to judgment as a matter of law. Celotex Corp. v. Catrett, 477 U.S. 317, 323, 106 S.Ct. 2548, 2552-53, 91 L.Ed.2d 265 (1986). After the moving party has met its burden, the non-moving party must come forward with specific facts showing that evidence exists to support its claims and that a genuine issue for trial exists. Id.; Matsushita Elec. Indus. Co. v. Zenith Radio Corp., 475 U.S. 574, 587, 106 S.Ct. 1348, 1356, 89 L.Ed.2d 538 (1986); see Fed.R.Civ.P. 56(e) (in response to motion for summary judgment, "adverse party may not rest upon the mere allegations or denials of the adverse party's pleading, but the adverse party's response, by affidavits or as otherwise provided in this rule, must set forth specific facts showing that there is a genuine issue for trial"). When considering motions for summary judgment, courts must view facts and inferences in the light most favorable to the party opposing the motion for summary judgment. Matsushita, 475 U.S. at 587-88, 106 S.Ct. at 1356-57; United States v. Diebold, Inc., 369 U.S. 654, 655, 82 S.Ct. 993, 994, 8 L.Ed.2d 176 (1962). When, however, the evidence from the entire record could not lead a rational fact-finder to find for the non-moving party, no genuine issue for trial exists and summary judgment is appropriate. Matsushita, 475 U.S. at 587.

Legal Discussion

Presently before the Court is a federal claim against Union Memorial Hospital under EMTALA, as set forth in 42 U.S.C. § 1395dd (West 1992). Specifically, that Union Memorial Hospital violated that Act by failing to provide an adequate screening and by failing to stabilize Mr. Romo's condition prior to his being transferred to Carolina Medical Center (CMC).

The very mission of the summary judgment procedure is to pierce the pleadings and to assess the proof in order to see whether there is a genuine need for trial. The question here then, is whether there is a need to try the Plaintiff's EMTALA claims. After a careful review of the record in this matter, the Court finds that resolution of the EMTALA claims require the determination of several largely factual questions, which are, of course, traditionally entrusted to a jury. In the present case, there are several material evidentiary facts which remain in dispute, as well as, witness credibility issues and conflicting evidence which must be weighed by the jury at trial. Furthermore, the Plaintiff has met his burden of demonstrating the existence of a genuine dispute with respect to both aspects of her EMTALA claims.¹

Plaintiff has presented evidence that Union Memorial Hospital deviated from its standard screening procedure in treating Mr. Romo. Furthermore, Plaintiff has presented evidence which suggests that Romo had an emergency medical condition; the hospital knew of the condition; the patient was not stabilized, as that term is defined, prior to the transfer; and proper consent was never obtained, nor were appropriate certification and transfer procedures allegedly followed prior to the transfer to CMC.

1. Medical Screening Claim

EMTALA requires that the hospital must provide "an appropriate medical screening examination within the capability of the hospital's emergency department ... to determine whether or not an emergency medical condition ... exists." 42 U.S.C. § 1395dd(a) (West 1992).²

Here, like the Plaintiff in Griffith v. Mt. Carmel Medical Center, 831 F.Supp. 1532 (D.Kan.1993), plaintiff claims that her husband did not receive an appropriate medical screening examination as required under § 1395dd(a), on his January 4, 1994 visit to the emergency room at Union Memorial Hospital. Plaintiff alleges that Romo's screening was different than the screening that would have been received by insured patients with similar medical circumstances. As a preliminary matter, Plaintiff asserts that personnel at Union Memorial Hospital, perhaps including Dr. Farquharson, knew that Romo's patient financial classification was "01", indicating self-pay.

Plaintiff also asserts that the evidence reveals more than a misdiagnosis and, in fact, demonstrates differential treatment. Specifically, Plaintiff's allege that the nurses deviated from certain "nursing protocols" which required vital signs be assessed every ten minutes. (See Plaintiff's Exhibit D). The Court's review of the medical records indeed indicates that this protocol was not met.

Relying, in part, on Brooks v. Maryland Gen. Hosp., Inc., 996 F.2d 708 (4th Cir.1993), Defendant's argue that they performed numerous tests and evaluations, and therefore, the medical screening was appropriate within Union Memorial's capabilities. They further assert, by way of affidavit from Dr. Farquharson and RN Pat Broome, that Romo did not receive disparate treatment.

The Court agrees with Defendant that EMTALA's role is limited,

to imposing a hospital's emergency room the duty to screen all patients as any paying patient would be screened and to stabilize any emergency condition discovered. citing Baber v. Hospital Corp. of America, 977 F.2d 872, 879 (4th Cir.1992); see also, Gatewood v. Washington Health Care Corp., 933 F.2d 1037, 1039 (D.C.Cir.1991) ("An `appropriate' screening is properly determined not by reference to particular outcomes, but instead by reference to a hospital's standard screening procedure.") (emphasis added)....

Brooks, 996 F.2d at 710-711. Here, Defendant cites to several cases which recognize that EMTALA is implicated when there has been disparate treatment between patients with respect to standard screening procedures. The Court further agrees that it ought not simply look at the outcome of the screening. However, the Court would be remiss not to compare this particular screening with other indicia of the standard screening procedures. In doing so, the evidence presented here suggests that the procedure governing the taking and recording of vital signs, part of the nursing protocol which is presumably followed as a matter of routine, was not followed in Mr. Romo's case.

Furthermore, even if Defendant attended to Romo and treated him with a variety, or in his words "a battery", of tests and evaluations, it may still fall short of an "appropriate medical screening," if there is evidence that...