Tolton v. American Biodyne, Inc.

• Decision Date: 03 March 1995
• Docket Number: No. 93-3893,93-3893
• Parties: , Pens. Plan Guide P 23913J Mattie TOLTON and Ronald Tolton, Plaintiffs-Appellants, v. AMERICAN BIODYNE, INC., et al., Defendants-Appellees.
• Court: U.S. Court of Appeals — Sixth Circuit

Page 937

48 F.3d 937

63 USLW 2592, Pens. Plan Guide P 23913J

Mattie TOLTON and Ronald Tolton, Plaintiffs-Appellants, v. AMERICAN BIODYNE, INC., et al., Defendants-Appellees.

No. 93-3893.

United States Court of Appeals Sixth Circuit.

Argued July 7, 1994.

Decided March 3, 1995.

Lester S. Potash (argued and briefed), Cleveland, OH.

Jack E. Fuchs (argued and briefed), Jane E. Garfinkel, Sandra P. Kaltman, Thompson, Hine & Flory, Cincinnati, OH, Terrance P. Gravens, Coin, Gravens & Franey, Cleveland, OH, for American Biodyne, Inc.

William H. Baughman, Jr., Patrick M. Duke (briefed), John M. Baker, Sr., Weston, Hurd, Fallon, Paisley & Howley, Cleveland, OH, for Thomas McArthy, Ph.D.

Craig S. Cobb, Kenneth J. Knabe, Theodore M. Dunn (briefed), Myra Staresina, Janik & Dunn, Cleveland, OH, for Michael Schur, Ph.D.

William J. Coyne, Sr. (briefed), Cleveland, OH, for St. Vincent Charity Hosp. & Health Center, M. McKenny, R.N., Fink, R.N.

Janis L. Small (argued and briefed), Jacobson, Maynard, Tuschman & Kalur, Cleveland, OH, for Dr. Stavridis.

Janis L. Small, Jacobson, Maynard, Tuschman & Kalur, Douglas G. Leak, Jacobson, Maynard, Tuschman & Kalur, Cleveland, OH, for C. Alonzo, M.D., Dr. Kirkland, Lakeland Emergency Associates, Inc.

William J. O'Neill, Thomas P. Meaney, Jr., Dan L. Makee (briefed), McDonald, Hopkins, Burke & Haber, Cleveland, OH, for CIGNA Health Plan of Ohio.

Before: KENNEDY and SILER, Circuit Judges; and CHURCHILL, District Judge. ^*

KENNEDY, Circuit Judge.

Plaintiffs, Mattie Tolton and Ronald Tolton ("plaintiffs"), appeal the District Court's grant of summary judgment in this action arising from the suicide of Henry V. Tolton ("Tolton"). ¹ Plaintiffs sued CIGNA Health Plan of Ohio, Inc., American Biodyne, Inc., Thomas McArthy, Ph.D., Michael Schur, Ph.D., St. Vincent Charity Hospital ("St. Vincent"), Dr. Cohn, Dr. Stavridis, Dr. Alonzo, Dr. Kirkland, Lakeland Emergency Associates, Margaret McKenny, R.N., and Mary Fink, R.N. Plaintiffs' claims include: wrongful death; medical malpractice; negligent and intentional refusal to authorize inpatient treatment for Tolton in reckless disregard of his safety and in violation of the insurance policy; insurance bad faith; breach of contract; liability of CIGNA for the alleged malpractice of Biodyne; negligent retention of the services of American Biodyne by CIGNA; loss of consortium; and violations of the Emergency Medical Treatment and Active Labor Act ("EMTALA"), 42 U.S.C. Sec. 1395dd. The District Court granted summary judgment in favor of defendants.

On appeal, plaintiffs assign three errors. First, plaintiffs contend that the District Court erroneously concluded that plaintiffs' state law claims against CIGNA, American Biodyne, Schur, and McCarthy were preempted by the Employee Retirement Income Security Act ("ERISA"), 29 U.S.C. Sec. 1001, et. seq. Second, plaintiffs contend that the District Court erred in granting summary judgment in favor of St. Vincent regarding the EMTALA claim. Finally, plaintiffs argue that the District Court erroneously granted summary judgment on the state law claims in favor of St. Vincent, Dr. Cohn, Dr. Stavridis, Dr. Alonzo, Dr. Kirkland, Nurse Fink, Nurse McKenny, and Lakeland Emergency Associates. For the following reasons, we affirm.

I. Facts

Henry V. Tolton was employed as a Recruiter/Public Relations Specialist by United Way-Big Brothers/Big Sisters of Greater Cleveland ("United Way"). United Way provided group health insurance to Tolton and other employees through Connecticut General Life Insurance Company. This plan, called the Exclusive Provider Plan, was administered by CIGNA Health Plan of Ohio ("CIGNA") pursuant to a managed care option. The parties concede that the plan is a qualified employee benefit plan pursuant to ERISA, 29 U.S.C. Sec. 1002(1). CIGNA contracted with American Biodyne ("Biodyne") to provide mental health benefits to eligible plan participants.

On November 29, 1989, Tolton visited Biodyne for an evaluation and intake interview with Thomas McCarthy, a psychologist who performed utilization review. Tolton told McCarthy that he was addicted to crack cocaine and wanted to "get off the stuff." Pursuant to Biodyne protocol, McCarthy challenged Tolton to remain drug free for five days and to return if he successfully met the challenge. On December 5, 1989, Tolton telephoned Biodyne and spoke with Michael Schur, another psychologist. After learning that Tolton had last used drugs two days before, Schur challenged Tolton to remain drug free until December 7, 1989. Tolton expressed displeasure with Biodyne's "challenge" policy.

On December 7, 1989, Tolton contacted Biodyne again. Tolton refused to see McCarthy, but agreed to meet Schur the next day. On December 8, 1989, Schur offered Tolton an outpatient program and scheduled a follow-up appointment in seven days. Tolton failed to keep the appointment. On January 18, 1990, Tolton telephoned Biodyne and stated that he was suicidal. Tolton, however, hung up before he could be connected with a health care practitioner. Tolton then called CIGNA and again expressed suicidal thoughts. Schur called Tolton, and Tolton stated that he was not suicidal and made an appointment to see Schur that afternoon. Tolton requested inpatient care, which was not authorized.

Tolton next presented himself at the emergency room of St. Vincent Charity Hospital on January 18, 1990, seeking treatment for his suicidal thoughts. St. Vincent contracts with Lakeland Associates to staff its emergency room with physicians. Dr. Alonzo examined Tolton and noted Tolton's intention to commit suicide with a gun. Mary Fink, a registered nurse, was on duty at the emergency room. Fink called Biodyne to discuss Tolton's condition. Tolton was referred to the East Side Crisis Shelter, where he remained for five days.

On January 23, 1990, Tolton was admitted to Bradley House, a state supported thirty-day residential drug and alcohol treatment program. Subsequently, on February 5, 1990, Tolton was admitted to New Joshua Center, a ninety-day treatment program, but did not complete the program.

Tolton returned to St. Vincent's emergency room on February 18, 1990, where he was evaluated by a doctor on duty. According to hospital records, Tolton stated that he did some "terrible thing last night--threatened a lady [with] a knife and would have killed her and himself if he'd had a gun." Tolton also stated that he was very suicidal. Margaret McKenny was on duty as a nurse. Tolton was referred again to the East Side Crisis Shelter, and, after he refused, to his treating physician, Dr. Gebert.

On February 19, 1990, Tolton received treatment at the Family Practice Center of University Hospitals of Cleveland. At this time, Tolton signed a statement agreeing to see either Dr. Frank, a psychiatrist, or Dr. Gebert daily. Until March 2, 1990, Tolton met with either Gebert or Frank daily. On March 2, 1990, Tolton was referred by Bradley House to Orca house, another ninety-day state supported treatment program. Tolton visited University Hospitals again on March 7th, pledging not to commit suicide without first talking with Dr. Frank. Tolton left Orca house on March 17, 1990. On March 23, 1990, Tolton committed suicide.

Plaintiffs brought this action against defendants in state court. Pursuant to 28 U.S.C. Secs. 1441, 1446, CIGNA removed the action from the Cuyahoga County Court of Common Pleas to federal court based upon ERISA preemption. Plaintiffs then amended their complaint to include a cause of action under ERISA. The District Court granted summary judgment in favor of CIGNA, Biodyne, McCarthy and Schur, holding that plaintiffs' state law claims were preempted by ERISA. The District Court granted summary judgment on the EMTALA claims in favor of McKenny, Fink, St. Vincent, Lakeland Emergency Associates, Cohn, Kirkland, Stavridis, and Alonzo, holding that plaintiffs did not allege that Tolton was in imminent danger of death when he sought treatment at St. Vincent's emergency room or that he was denied treatment due to his inability to pay.

II. Standard of Review

We review a grant of summary judgment de novo. See Kraus v. Sobel Corrugated Containers, Inc., 915 F.2d 227, 229 (6th Cir.1990). Summary judgment is appropriate if a party, after adequate opportunity for discovery, "fails to make a showing sufficient to establish the existence of an element essential to that party's case, and on which that party will bear the burden of proof at trial." Celotex Corp. v. Catrett, 477 U.S. 317, 322, 106 S.Ct. 2548, 2552, 91 L.Ed.2d 265 (1986). "The mere existence of a scintilla of evidence in support of the plaintiff's position will be insufficient; there must be evidence on which the jury could reasonably find for the plaintiff." Anderson v. Liberty Lobby, Inc., 477 U.S. 242, 252, 106 S.Ct. 2505, 2512, 91 L.Ed.2d 202 (1986).

III. The ERISA Claims

A. Removal

As a threshold matter, plaintiffs argue that the District Court was without subject matter jurisdiction and should have remanded the case to state court. Specifically, plaintiffs contend that their complaint alleged state claims, and that they are neither participants nor beneficiaries in an ERISA plan. Plaintiffs argue, therefore, that removal based upon ERISA preemption was improper.

Generally, the well-pleaded complaint rule bars removal of a case to federal court based upon a federal defense. See Metropolitan Life Ins. Co. v. Taylor, 481 U.S. 58, 63, 107 S.Ct. 1542, 1546, 95 L.Ed.2d 55 (1987). "One corollary of the well-pleaded complaint rule developed in the case law, however, is that Congress may so completely pre-empt a particular area that any civil complaint raising this select group of claims is necessarily federal in character." Id. Applying this corollary to ERISA, the Supreme Court held that a state cause of action may be removed to federal court if the cause of action is preempted by ERISA and falls within the scope of ERISA's...