Spradlin v. Acadia-St. Landry Med. Found.
| Decision Date | 29 February 2000 |
| Docket Number | No. 98-C-1977.,98-C-1977. |
| Citation | 758 So.2d 116 |
| Parties | Rickey G. SPRADLIN v. ACADIA-ST. LANDRY MEDICAL FOUNDATION. |
| Court | Louisiana Supreme Court |
Peter T. Dazzio, Chris James LeBlanc, Watson, Blanche, Wilson & Posner, Baton Rouge, Counsel for Applicant.
Thomas Robert Shelton, Lafayette, Counsel for Respondent.
C. Scott Carter, Adrienne LaCour, Charles Owen Taylor, Metairie, Lynn Marie Terrebonne, LaPlace, Counsel for Carter & Taylor Law Firm (Amicus Curiae).
This is an action against a private hospital for survival and wrongful death damages. This matter is before the court on an exception of prematurity. The narrow issue is whether plaintiffs' claims under the federal Emergency Medical Treatment and Active Labor Act (EMTALA), 42 U.S.C. § 1395dd, and under the Louisiana "anti-dumping"2 statute, La.Rev.Stat. 40:2113.4-2113.6, when the claims are joined with medical malpractice claims, are subject to the pre-suit medical review panel requirement of the Louisiana Medical Malpractice Act, La.Rev.Stat. 40:1299.47 A.
On August 24, 1995, at 12:45 p.m., Rickey Spradlin took his wife to the emergency room of defendant's private hospital with complaints of vomiting, upper back pain, fever and diarrhea. Mrs. Spradlin was examined by a doctor, two nurses and a respiratory therapist. Based on the results of laboratory tests and chest x-rays, the emergency room doctor diagnosed right upper lobe pneumonia and provisionally diagnosed right upper lobe cancer. After discussing his diagnosis with the couple, the doctor arranged for Mrs. Spradlin's transfer by ambulance to a public hospital about forty-five minutes away.3
Mrs. Spradlin suffered cardiac arrest in the public hospital that night and died early the next morning. The autopsy report states the probable cause of death as pseudomonas pneumonitis.
Plaintiffs, Mrs. Spradlin's survival and wrongful death beneficiaries, filed this action, naming the private hospital as the sole defendant and alleging patient "dumping" in violation of both EMTALA, 42 U.S.C. § 1395dd, and La.Rev.Stat. 40:2113.4.4 Defendant lodged a dilatory exception of prematurity, claiming that it was a qualified health care provider and that the Louisiana Medical Malpractice Act required the entirety of plaintiffs' claims to be submitted first to a medical review panel. The district court overruled the exception without assigning reasons.
On defendant's application, the court of appeal exercised its supervisory jurisdiction and addressed the merits of the issue, initially agreeing with the district court. The court of appeal held that "[w]hile the Louisiana Medical Malpractice Act offers protections to medical providers whose liability arise from acts of negligence pertaining to the treatment of patients, EMTALA and La. R.S. 40:2113.4, exceptions to La. R.S. 40:1299.41, specifically govern instances in which damages result from the deprivation of emergency services by those ordinarily covered providers on the basis of an individual's lack of means." 97-845, p. 7 (La.App. 3d Cir.1/21/98), 711 So.2d 699, 702-03.
On rehearing, however, the court sustained defendant's exception of prematurity in part, holding that plaintiffs' action was premature to the extent they alleged conduct that constitutes a medical malpractice claim. The court stated:
On [original hearing], we determined that the plaintiff's claims for damages pursuant to the Emergency Medical Treatment and Active Labor Act (EMTALA), 42 U.S.C. 1395dd and its Louisiana statutory equivalent, La. R.S. 40:2311[sic], were not subject to the procedural and substantive limitations imposed by the Louisiana Medical Malpractice Act.... After reviewing the petition, it appears that the plaintiff has alleged behavior on the part of the defendant which, if proven, would constitute malpractice and which occurred in the treatment of the decedent prior to the transfer and separately from the decision to transfer. Therefore, these claims appear to be unrelated to the EMTALA or "dumping" claim. Therefore, we conclude that the Louisiana Medical Malpractice Act applies to these claims and that these claims must be presented to a Medical Review Panel prior to suit.
97-845, p. 1 (La.App. 3d Cir.6/24/98), 711 So.2d 699, 703 (on reh'g).
We granted defendant's application for certiorari, which urged that an EMTALA claim joined in the same action with a medical malpractice claim must also be submitted to a medical review panel. 98-1977 (La.11/6/98), 726 So.2d 914.
The dilatory exception of prematurity questions whether the cause of action has matured to the point where it is ripe for judicial determination. This exception is the proper procedural mechanism for a qualified health care provider to invoke when a medical malpractice plaintiff has failed to submit the claim for decision by a medical review panel before filing suit against the provider. In this type of case, the exception of prematurity neither challenges nor attempts to defeat any of the elements of the plaintiffs cause of action. Rather, the defendant asserts that the plaintiff has failed to take some preliminary step necessary to make the controversy ripe for judicial involvement. Thus a malpractice claim against a private qualified health care provider is subject to dismissal on a timely filed exception of prematurity if such claim has not first been screened by a pre-suit medical review panel. La.Rev.Stat. 40:1299.47 A. This pre-suit screening process acts to delay, not to defeat, a tort suit for malpractice. Frank L. Maraist and Thomas C. Galligan, Jr., Louisiana Tort Law § 21-3(f) (1996).
Defendant argues that when a plaintiff joins a medical malpractice claim with alternative theories of liability, the entirety of the plaintiffs case is subject to the medical review panel requirement. This argument, of course, raises such issues as whether EMTALA incorporates procedural and substantive provisions of the applicable state law and whether EMTALA preempts any of those provisions.
The statutory definition of malpractice and the federal and state prohibition against patient "dumping" often involve similar conduct. The term "malpractice" has its roots (and relevance) in differentiating professionals from nonprofessionals for purposes of applying certain statutory limitations on tort liability. Health care providers are said to "practice" their profession, and their negligence in providing such professional services is called malpractice. Maraist & Galligan, supra at § 21-2.
On the other hand, hospitals, which are the only health care providers covered by EMTALA, are distinct legal entities that do not, in the traditional sense of the word, "practice" medicine. In the absence of statute, hospitals are subject to potential tort liability only vicariously on the basis of respondeat superior or independently on the basis of negligent hiring or training of the professional staff members employed by the hospital. Hospitals have frequently avoided even those forms of tort liability by asserting as a defense the independent contractor status of their professional staff members.
Indeed, this ability of hospitals to insulate themselves from tort liability, coupled with the general "dumping" problem, has been cited as one factor prompting Congress' creation of a private cause of action against hospitals in EMTALA. Wendy W. Bera, Comment, Preventing "Patient Dumping": The Supreme Court Turns Away the Sixth Circuit's Interpretation of EMTALA, 36 Hous. L.Rev. 615, 623 (1999).
In analyzing the relationship between the two "anti-dumping" statutes (EMTLA, which creates a separate cause of action for damages, and La.Rev.Stat. 40:2113.45) and the Louisiana Medical Malpractice Act, we first discuss the acts individually in the order of their adoption.
In 1975, the Louisiana Legislature, in response to a perceived medical malpractice crisis, enacted the Medical Malpractice Act.6 Under the Act, a private health care provider, by taking specified steps, can become qualified for entitlement to certain limitations not available to other tort defendants. The primary limiting provisions available to private health care providers are the maximum amount of damages and the mandatory pre-suit review by a medical review panel, along with the special prescriptive and peremptive periods for malpractice actions provided by La.Rev. Stat. 9:5628.7
Since all of the limiting provisions applicable to qualified health care providers are "special legislation in derogation of the rights of tort victims," these provisions are all strictly construed. Sewell v. Doctors Hosp., 600 So.2d 577, 578 (La.1992). Moreover, these special provisions apply only to "malpractice," as defined in the Act, and any other liability of the health care provider is governed by general tort law.8
In 1980, the Louisiana Legislature enacted La.Rev.Stat. 40:2113.4-2113.6, establishing a statutory duty on the part of certain hospitals to provide emergency services to all persons residing in the territorial area, regardless of whether they are insured or able to pay. Section 2113.4 provides in part:
A. Any general hospital licensed under this Part, which is owned or operated, or both, by a hospital service district, which benefits from being financed by the sale of bonds that are exempt from taxation as provided by Louisiana law, or which receives any other type of financial assistance from the state of Louisiana and which offers emergency room services to the public and is actually offering such services at the time, shall make its emergency services available to all persons residing in the territorial area of the hospital regardless of whether the person is covered by private, federal Medicare, or Medicaid, or other insurance. Each person shall receive these services free from discrimination based on...
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