Tenet Hospitals Ltd. v. Boada

• Decision Date: 27 January 2010
• Docket Number: No. 08-07-00329-CV.,08-07-00329-CV.
• Citation: 304 SW 3d 528
• Parties: TENET HOSPITALS LIMITED, a Texas Limited Partnership, d/b/a Providence Memorial Hospital, Appellant, v. Francisco BOADA and Irma Boada, Appellees.
• Court: Texas Court of Appeals

304 S.W.3d 528

TENET HOSPITALS LIMITED, a Texas Limited Partnership, d/b/a Providence Memorial Hospital, Appellant, v. Francisco BOADA and Irma Boada, Appellees.

No. 08-07-00329-CV.

Court of Appeals of Texas, El Paso.

October 21, 2009.

Rehearing Overruled January 27, 2010.

Yvonne K. Puig, Fulbright & Jaworski L.L.P., Austin, TX, for Appellant.

John Grost, El Paso, TX, for Appellees.

Before McCLURE, J., CARR, J., and GOMEZ, Judge.

OPINION

ANN CRAWFORD McCLURE, Justice.

Tenet Hospitals Limited d/b/a Providence Memorial Hospital (Providence) appeals the denial of its motion to dismiss pursuant to Section 74.351 of the Texas Medical Liability and Insurance Improvement Act. For the following reasons, we affirm in part and reverse in part.

FACTUAL SUMMARY

On February 5, 2005, Francisco Boada presented at Providence complaining of severe abdominal pain. He was attended by two emergency room physicians and discharged the next morning. He returned to Providence later in the day and underwent surgery for entrapment and death of his small bowel. He suffered the loss of most of his small bowel, short bowel syndrome, persistent fatigue, great weight loss, and profound weakness. Some of these effects are permanent.

On February 1, 2007, the Boadas filed suit against Providence alleging violations of the Emergency Medial Treatment and Active Labor Act (EMTALA). Providence filed an answer raising an affirmative defense that the Boadas' claims were subject to Chapter 74 of the Texas Civil Practice and Remedies Code. The Boadas filed a motion for partial summary judgment asking that Providence's affirmative defense be stricken as their claims were not health care liability claims as defined in Chapter 74.

On April 12, 2007, the Boadas filed an amended petition, joining Dr. Andrea Gonzales and Dr. Randy J. Goldstein as defendants. Negligence claims against the physicians included allegations of (1) failure to timely assess and treat Mr. Boada's severe abdominal pain; (2) failure to make proper tests; (3) failure to take a proper history; (4) failure to perform proper physical examinations; and (5) failure to obtain a proper consultation. The petition asserted the same EMTALA claims against Providence and added negligence allegations that hospital employees, agents, or contractors (1) failed to properly assess Mr. Boada; (2) failed to keep the emergency physician apprised of Mr. Boada's condition; and (3) failed to provide adequate analgesia.

On May 4, 2007, the Boadas served the reports and curricula vitae of Edward L. Felix, M.D. and T. Laurence Huffman, M.D. Providence filed objections to both reports and moved for dismissal, arguing that the physicians were not qualified to opine as to causation because neither is licensed to practice medicine in Texas and because their reports did not constitute expert reports as defined by Chapter 74. Providence also challenged Dr. Huffman's report because he was not qualified to opine as to EMTALA violations. The Boadas filed a response.

On July 23, 2007, the Boadas served the report and curriculum vitae of Ruthie Robinson, Ph.D., R.N. This report was served more than 120 days after the Boadas filed their original petition. Providence objected to and challenged this report as well. The trial court denied Providence's objections to the reports as well as its motion to dismiss.

STANDARD OF REVIEW

We review a trial court's decision on a motion to dismiss under Section 74.351 for an abuse of discretion. See American Transitional Care Ctrs. of Tex., Inc. v. Palacios, 46 S.W.3d 873, 875 (Tex.2001). An abuse of discretion occurs when the trial court acts in an unreasonable or arbitrary manner, without reference to any guiding rules or principles. Walker v. Gutierrez, 111 S.W.3d 56, 62 (Tex.2003). A trial court will be deemed to have acted arbitrarily and unreasonably if the trial court could have reached only one decision, yet reached a different one. See Teixeira v. Hall, 107 S.W.3d 805, 807 (Tex.App.-Texarkana 2003, no pet.). To that end, a trial court abuses its discretion when it fails to analyze or apply the law correctly. In re Sw. Bell Tel. Co., 226 S.W.3d 400, 403 (Tex.2007), citing In re Kuntz, 124 S.W.3d 179, 181 (Tex.2003). An abuse of discretion does not occur merely because the appellate court may have decided a discretionary matter in a different way than the trial court. Downer v. Aquamarine Operators, Inc., 701 S.W.2d 238, 241-42 (Tex.1985). However, to the extent resolution of the issues presented requires interpretation of the statute, we review the ruling de novo. See Buck v. Blum, 130 S.W.3d 285, 290 (Tex.App.-Houston 14th Dist. 2004, no pet.).

IS AN EMTALA CLAIM A HEALTH CARE LIABILITY CLAIM?

In its first issue, Providence complains that the Boadas' EMTALA claim is a health care liability claim subject to Chapter 74. EMTALA is a federal law enacted in 1986 to prevent "patient dumping"—that is, the practice of refusing to treat patients who are unable to pay. Marshall v. E. Carroll Parish Hosp. Serv. Dist., 134 F.3d 319, 322 (5th Cir.1998). It was not intended to be used as either a federal malpractice statute or a national standard of medical care. Id. It serves as a gap filler to provide a remedy for "failure to treat," which is generally not included within state malpractice actions. Root v. Liberty Emergency Physicians, Inc., 68 F.Supp.2d 1086, 1091 (W.D.Mo. 1999), aff'd, 209 F.3d 1068 (8th Cir.2000). EMTALA creates a cause of action for individuals who are purportedly harmed either by a participating hospital's failure to (1) provide them with an "appropriate medical screening" to establish if an emergency medial condition exists or (2) to "stabilize" the patient before transfer or discharge if a statutorily defined emergency medical condition has been detected. 42 U.S.C. § 1395dd(a)-(c) (2006). A cause of action may be established in one of two ways. "First, the claimant may establish that the hospital did not meet these requirements because the hospital's screening examination was not appropriate. Second, the claimant may establish that the hospital determined that an emergency medical condition existed and failed to stabilize the condition or transfer the patient to another hospital." Casey v. Amarillo Hospital District, 947 S.W.2d 301, 304 (Tex.App.-Amarillo 1997, pet. denied).

Medical liability claims are governed by Chapter 74 of the Texas Civil Practice and Remedies Code. Under this chapter, a claimant shall, not later than the 120th day after the date the claim was filed, serve on each party or the party's attorney one or more expert reports, with a curriculum vitae of each expert listed in the report for each physician or health care provider against whom a liability is asserted. TEX.CIV.PRAC. & REM.CODE ANN. § 74.351(a). A plaintiff cannot recast a health care liability claim in the language of another cause of action to avoid the requirements of the Act. Gormley v. Stover, 907 S.W.2d 448, 450 (Tex.1995); Sorokolit v. Rhodes, 889 S.W.2d 239, 242 (Tex.1994). We review the underlying nature of the cause of action to determine if the plaintiff has attempted to recast his claim. Sorokolit, 889 S.W.2d at 242; Bush v. Green Oaks Operator, Inc., 39 S.W.3d 669, 671 (Tex.App.-Dallas 2001). If the cause of action is based on a breach of the accepted standard of medical care, the cause of action is a health care liability claim. Gormley, 907 S.W.2d at 450; Sorokolit, 889 S.W.2d at 242.

Generally, when substantive federal claims are raised in state court, state law and procedural rules still govern the manner in which the federal questions are tried and proved. See Jack B. Anglin Co. v. Tipps, 842 S.W.2d 266, 268 (Tex.1992) (orig. proceeding); Mitchell v. Missouri-Kansas-Texas R.R. Co., 786 S.W.2d 659, 661 (Tex.1990) (on reh'g); Dillard Dept. Stores, Inc. v. Owens, 951 S.W.2d 915, 919 (Tex.App.-Corpus Christi 1997, no writ). EMTALA does not create an exception to this general rule: "The provisions of this section do not preempt any State or local law requirement, except to the extent that the requirement directly conflicts with a requirement of this section." 42 U.S.C. § 1395dd(f). A state statute presents an actual conflict with federal law when compliance with both federal and state regulations is a physical impossibility or where the state law "stands as an obstacle" to the "execution of the full purposes and objectives of Congress." Hyundai Motor Co. v. Alvarado, 974 S.W.2d 1, 4 (Tex.1998).

In this instance, Chapter 74 does not present an obstacle for any of the Boadas' rights under EMTALA. Compliance with both is possible. See Johnson v. Nacogdoches Co. Hosp. Dist., 109 S.W.3d 532, 536 (Tex.App.-Tyler 2001, pet. denied) (compliance with the Texas Tort Claims Act does not thwart the purposes of EMTALA); Herman v. St. Paul Medical Center, No. 05-01-01364-CV, 2002 WL 1060530, at *3 (Tex.App.-Dallas 2002, pet. denied) (not designated for publication) ("anti-dumping" claim is a health care liability claim). We thus agree with Providence that the Boadas are asserting a health care liability claim subject to the procedural provisions of Chapter 74. We sustain Issue One.

HOW DO EMTALA CLAIMS DIFFER FROM NEGLIGENCE CLAIMS?

Casey clearly delineates an EMTALA claim from a negligence claim. An EMTALA violation is not to be judged against a negligence standard. Casey, 947 S.W.2d at 304. The requirement that the screening examination be "appropriate" requires that hospitals determine what their screening procedures will be and then apply them uniformly to all individuals in the emergency room. Id. For the claimant to establish that the hospital's screening procedures are not appropriate, the claimant must establish that he did not receive the same screening examination as every other person who enters the emergency room with the same or similar condition. Id. If a hospital provides an appropriate medical screening examination, it is not liable under EMTALA...