Thornton v. Southwest Detroit Hosp.

Decision Date09 February 1990
Docket NumberNo. 89-1398,89-1398
Citation895 F.2d 1131
Parties, 58 USLW 2486, 28 Soc.Sec.Rep.Ser. 538, Medicare&Medicaid Gu 38,437 Elease THORNTON, Plaintiff-Appellant, v. SOUTHWEST DETROIT HOSPITAL, Defendant-Appellee.
CourtU.S. Court of Appeals — Sixth Circuit

Donnelly W. Hadden (argued), Donnelly W. Hadden, P.C., Detroit, Mich., for plaintiff-appellant.

Dale L. Hebert (argued), Richard Boothman, Boothman, Hebert & Eller, Detroit, Mich., for defendant-appellee.

Before MARTIN, JONES and GUY, Circuit Judges.

BOYCE F. MARTIN, Jr., Circuit Judge.

Elease Thornton appeals the district court's grant of summary judgment to the defendant, Southwest Detroit Hospital, in her action under the Emergency Medical Treatment and Active Labor Act, 42 U.S.C. Sec. 1395dd. For the reasons stated below, we affirm the judgment of the district court.

Elease Thornton suffered a stroke on August 27, 1987. Elease Thornton initially was taken to Redford Community Hospital, but she was transferred to the Southwest Detroit Hospital emergency room, which admitted her to its Intensive Care Unit. She spent ten days in the Hospital's Intensive Care Unit and 11 more days in regular in-patient care. On September 16, 1987, her doctor planned to have her admitted into the Detroit Rehabilitation Institute for post-stroke rehabilitation therapy. The Detroit Rehabilitation Institute refused to accept Elease Thornton because her health insurance would not cover the cost. Instead, Elease Thornton's doctor discharged her from the Hospital to her sister's home for basic home nursing care. After the discharge, Elease Thornton's condition deteriorated until she finally gained admission to the Detroit Rehabilitation Institute on December 23, 1987.

Elease Thornton brought this action under the Emergency Medical Treatment and Active Labor Act. 42 U.S.C. Sec. 1395dd. She alleges that she suffered from an emergency medical condition when she entered the Hospital and that the Hospital failed to stablize her condition before discharging her as required by the Act. Id. The Act requires hospitals to give emergency aid to indigent patients who suffer from an "emergency medical condition" or "active labor." American hospitals have a long tradition of giving emergency medical aid to anyone in need who appeared on the emergency room doorstep. Many hospitals have abandoned this tradition under modern pressures to cut costs or increase profits. Congress enacted the Act in order to preserve and restore this tradition by preventing hospitals from dumping patients, who lack insurance to pay for their claims, by either refusing treatment or transferring them to other hospitals. See generally, Note, Preventing Patient Dumping: Sharpening the COBRA's Fangs, 61 N.Y.U.L.Rev. 1186 (1986).

A preliminary question is whether federal courts have subject matter jurisdiction to hear cases brought under the Act. 28 U.S.C. Sec. 1331. Although the parties did not address this issue, subject matter jurisdiction may be raised sua sponte at any juncture because a federal court lacks authority to hear a case without subject matter jurisdiction. Fed.R.Civ.P. 12(h)(3). Federal district courts have subject matter jurisdiction in "all civil actions arising under the Constitution, laws, or treaties of the United States." 28 U.S.C. Sec. 1331. The Act creates a private right of action under federal law in 42 U.S.C. Sec. 1395dd(d)(3)(A), stating:

Any individual who suffers personal harm as a direct result of a participating hospital's violation of a requirement of this section 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 is appropriate.

Although this language clearly creates a private cause of action, it is silent as to whether that cause of action may be brought in federal court.

Federal courts have jurisdiction under section 1331 in "only those cases in which a well-pleaded Complaint establishes either that federal law creates the cause of action or that the plaintiffs right to relief necessarily depends on resolution of a substantial question of federal law." Franchise Tax Board v. Construction Laborers Vacation Trust, 463 U.S. 1, 27-28, 103 S.Ct. 2841, 2856, 77 L.Ed.2d 420 (1983). The private cause of action created by the Act meets each of the alternative prongs of the Franchise Tax test. First, the action depends upon "resolution of a substantial question of federal law." Id, at 27-28, 103 S.Ct. at 2856. A plaintiff under the Act must show that she was suffering from an "emergency medical condition" and that the defendant transferred her before it had "stabilized" her within the meaning of the Act. 42 U.S.C. Sec. 1395dd. Second, Congress has created a new, federal cause of action. Franchise Tax, 463 U.S. at 27-28, 103 S.Ct. at 2855-2856. A cause of action under the Act is not analogous to a state medical malpractice claim because it creates liability for a refusal to treat, which state malpractice law does not. Under either prong of the Franchise Tax test, a cause of action under the Act arises under federal law.

In addition, ample evidence shows that Congress intended for federal courts to have jurisdiction over actions brought under the Act. See Bryant v. Riddle Memorial Hospital, 689 F.Supp. 490, 493 (E.D.Pa.1988). The House Committee on Ways and Means, to which H.R. 3128, the bill that eventually became the Act, was referred, stated:

Any persons or entity adversely and directly affected by a participating hospital's violation of these requirements may bring an action, in an appropriate state or federal court, for damages to the person arising from the violation....

H.R.Rep. No. 241(I) 99th Cong., 1st Sess. 28, reprinted in 1986 U.S.Code Cong. & Admin.News 42, 606 (emphasis added). The House Judiciary Committee, which fully considered and revised portions of H.R. 3128, also intended that a federal cause of action would be created. H.R.Rep. No. 241(III) 99th Cong., 1st Sess. 6-7, reprinted in 1986 U.S.Code Cong. & Admin.News 728-29. Indeed, the Judiciary Committee explicitly rejected an amendment that would have stricken the new federal cause of action by a roll call vote. H.R.Rep. No. 241(III) 99th Cong., 1st Sess., 9, reprinted in 1986 U.S.Code Cong. & Admin.News 731. There can be no doubt that federal courts have subject matter jurisdiction in suits brought under the Act.

Having held that federal courts have subject matter jurisdiction in cases brought under the Act, we turn to the merits of Elease Thornton's appeal. The parties do not dispute that Elease Thornton suffered from an "emergency medical condition" when she entered the Hospital emergency room. In section 1395dd(e)(1), the Act defines an "emergency medical condition" as a medical condition manifesting itself by acute symptoms of sufficient severity (including severe pain) such that the absence of immediate medical attention could reasonably be expected to result in--

(A) placing the patient's health in serious jeopardy,

(B) serious impairment to bodily functions, or

(C) serious dysfunction of any bodily organ or part.

Under this definition, a patient suffers from an emergency medical condition if she is in imminent danger of death or serious disability. Immediately after suffering a stroke, Elease Thornton suffered from an emergency medical condition.

The key question is whether the Hospital violated the Act by releasing Elease Thornton before her condition "stabilized." The term, "stabilized," means that "no material deterioration of the condition is likely, within reasonable medical probability, to result from the transfer of the individual from a [hospital]." 42 U.S.C. Sec. 1395dd(e)(4)(B). The district court found that no genuine issue of material fact existed as to...

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