Summers v. Baptist Medical Center Arkadelphia

• Decision Date: 05 August 1996
• Docket Number: No. 95-1468EA,95-1468EA
• Citation: 91 F.3d 1132
• Parties: , 51 Soc.Sec.Rep.Ser. 350 Harold SUMMERS, Appellant, v. BAPTIST MEDICAL CENTER ARKADELPHIA, Appellee.
• Court: U.S. Court of Appeals — Eighth Circuit

Page 1132

91 F.3d 1132

65 USLW 2113, 51 Soc.Sec.Rep.Ser. 350

Harold SUMMERS, Appellant, v. BAPTIST MEDICAL CENTER ARKADELPHIA, Appellee.

No. 95-1468EA.

United States Court of Appeals,

Eighth Circuit.

Submitted April 9, 1996.

Decided Aug. 5, 1996.

Troy L. Henry, Jonesboro, AR, argued, for appellant.

Stuart Paul Miller, Little Rock, AR, argued, for appellee.

Before RICHARD S. ARNOLD, Chief Judge, HEANEY, McMILLIAN, FAGG, BOWMAN, WOLLMAN, MAGILL, BEAM, LOKEN, HANSEN, MORRIS SHEPPARD ARNOLD, and MURPHY, Circuit Judges, en banc.

RICHARD S. ARNOLD, Chief Judge.

Harold Summers brought this case against Baptist Medical Center Arkadelphia (Baptist), a hospital in Arkadelphia, Arkansas. The case arises under the Emergency Medical Treatment and Active Labor Act of 1986 (EMTALA), 42 U.S.C. § 1395dd. Summers claims that he was not appropriately screened for treatment when he was brought in to Baptist's emergency room after a deer-hunting accident. The District Court ¹ granted Baptist's motion for summary judgment and dismissed the complaint. Summers appealed, and a panel of this Court reversed and remanded for trial, one judge dissenting. Summers v. Baptist Medical Center Arkadelphia, 69 F.3d 902 (8th Cir.1995). We granted Baptist's suggestion for rehearing en banc, thus vacating the opinion and judgment of the panel. Having heard oral argument before the Court en banc, we now affirm the judgment of the District Court. We hold that something more than, or different from, ordinary negligence in the emergency-room screening process must be shown to make out a federal claim under EMTALA.

I.

We state the facts in the light most favorable to the plaintiff, the party opposing summary judgment. On October 25, 1992, Summers fell out of a tree stand while deer hunting near Arkadelphia. An ambulance brought him to Baptist's emergency room. A nurse took the medical history, and a physician saw Summers immediately. Summers testified that the doctor pressed "on my stomach and stuff." Deposition of Harold Summers, Record on Appeal (R.) 43. Summers said he "was hurting in my chest real bad and I was hearing this popping noise every time I breathed.... I [told the doctor] I was hurting [in my chest].... I heard this snapping, and he told me I was having muscle spasms." Ibid. Summers also complained of pain in his back.

The emergency-room physician ordered four x-rays of the patient's spine. (Other routine tests were done, but they are not material for present purposes.) Both the thoracic and the lumbar spine were covered. The physician recalls the patient's complaining of pain in his back, and Baptist conceded in the District Court that Summers complained of chest pain, but the doctor testified that Summers did not complain of pain in the front part of his chest. The doctor pressed on the front and back of the chest, noticed no difficulty in breathing, and heard no popping or crackling-type sounds on listening to the chest, Deposition of G.H. Ferrell, Jr., M.D., R. 137-38. The doctor did not remember the patient's saying he could hear popping-type sounds, R. 138, and felt or heard nothing to indicate a broken sternum, R. 139. "If he had complained of pain in the sternum or pain in the ribs, we would have x-rayed those." R. 144.

No x-rays of the chest were taken. The spinal x-rays showed, in the opinion of the physician at Baptist, only an old break at the eighth thoracic vertebra. Summers was told that he was suffering from muscle spasms. He said he was in pain and asked to be admitted to the hospital. He was told no. Summers then said he had insurance and $1,200 in cash, in case the hospital felt his admission would cause some sort of financial problems, but he was still refused admission. The doctor thought he did not need to be admitted to the hospital. Summers was given pain injections and discharged with instructions to see a doctor at home (Jonesboro, Arkansas) the next day. He was loaded into a pick-up truck and had to endure the five-hour drive home in pain.

The next day Summers felt too sore to get out of bed, and did not go to his family doctor. The day after that, though, October 27, he was in such pain that he went by ambulance to St. Bernard's Regional Medical Center. He was given, among other tests, a chest x-ray. This x-ray was difficult to read, so a CT (computerized tomography) scan was done. The scan revealed a fresh break of the seventh thoracic vertebra. In addition, the x-ray showed a broken sternum and a broken seventh rib. According to Rebecca Barrett-Tuck, M.D., a Jonesboro neurosurgeon, the chest injury "certainly does constitute a life threatening injury," Affidavit of Dr. Barrett-Tuck, R. 115. Summers was kept in the hospital at Jonesboro for 14 days, some of that time in intensive care. It is fair to conclude that if a chest x-ray had been taken at Arkadelphia, the broken breast-bone and rib would have been discovered, Summers would have been hospitalized at once, and the patient would have been spared at least two unnecessary days of anxiety and pain.

II.

The plaintiff's main claim is that, on the basis of this record, a jury could properly find Baptist had failed to "provide for an appropriate medical screening examination within the capability of [its] ... emergency department...." 42 U.S.C. § 1395dd(a). Baptist agrees that patients complaining of pain in the front of their chest, or of snapping or popping noises when breathing, would normally be given a chest x-ray. The jury could find that Summers did so complain, but he was not given a chest x-ray. His screening examination was therefore not "appropriate."

In order to consider this argument, we first set out the relevant part of the statute and then describe how courts have interpreted it. It is always important to pay close attention to the words of a statute, or any other document that one must construe, so we begin by setting out those words:

§ 1395dd. Examination and treatment for emergency medical conditions and women in labor

(a) Medical screening requirement

In the case of a hospital that has a hospital emergency department, if any individual (whether or not eligible for benefits under this subchapter) 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 (within the meaning of subsection (e)(1) of this section) exists.

The statute applies to hospitals which have executed provider agreements under the Medicare Program, and there is no dispute that Baptist is such a hospital. The operative language of the statute for present purposes is that such a hospital "must provide for an appropriate medical screening examination within the capability of the hospital's emergency department ... to determine whether or not an emergency medical condition ... exists." What is meant by the word "appropriate"? One possible meaning, perhaps the most natural one, would be that medical screening examinations must be correct, properly done, if not perfect, at least not negligent. It would be easy to say, for example, simply as a matter of the English language, that a negligently performed screening examination is not an appropriate one. So far as we can determine, however, no court has interpreted the statute in such an expansive fashion, and it is easy to understand why.

First of all, the purpose of the statute was 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. A patient is "dumped" when he or she is shunted off by one hospital to another, the second one being, for example, a so-called "charity institution." The legislative history underlying the enactment of EMTALA, which we think proper to consult in order to interpret the ambiguous term "appropriate," makes this limited purpose clear. See, e.g., H.R.Rep. No. 241, 99th Cong., 1st Sess., Part I, at 27 (1985), reprinted in 1986 U.S.Code Cong. & Admin.News 579, 605, where the following passage appears:

Explanation of provision.--The Committee is greatly concerned about the increasing number of reports that hospital emergency rooms are refusing to accept or treat patients with emergency conditions if the patient does not have medical insurance. The Committee is most concerned that medically unstable patients are not being treated appropriately. There have been reports of situations where treatment was simply not provided. In numerous other instances, patients in an unstable condition have been transferred improperly, sometimes without the consent of the receiving hospital.

We must be mindful, on the other hand, that it is the statute, and not a committee report, that is signed by the President and has therefore become law. We do not cite the committee report or the evident purpose behind the statute in support of a theory that a person must show that he has been "dumped" in order to bring an action under EMTALA. The statute clearly applies to "any individual," 42 U.S.C. § 1395dd(a) whether insured or not, and, therefore, the fact that Baptist's motivation in this particular case was obviously not to dump an uninsured or indigent patient does not defeat the plaintiff's action. We have no doubt that "dumping" is covered by the statute, and that a refusal to screen a patient because he or she had no insurance would violate the statute, but other practices can violate it as well. The question is not whether a plaintiff has insurance, or whether he was refused screening because of lack of insurance, but, rather, whether he was afforded an "appropriate" medical screening examination.

So far as we can tell, every court that has considered...