Citations
- 158 F. Supp. 3d 579
Full opinion text
MEMORANDUM OPINION AND ORDER
BARBARA M. G. LYNN, UNITED STATES DISTRICT JUDGE, NORTHERN DISTRICT OF TEXAS
This Memorandum Opinion and Order sets forth the grounds for the Court’s originally pronounced decisions (1) granting the Motion for Summary Judgment [Docket Entry # 54], filed by Defendant Gran-bury Hospital Corporation d/b/a Lake Granbury Medical Center (“LGMC”), and (2) denying the Motion for Partial Summary Judgment [Docket Entry # 61], filed by Plaintiffs David Fewins and Melissa Fewins, individually and as next friend for D.A.F., a minor.
I. Background
On Friday, June 29, 2012, Plaintiff Melissa Fewins took' her six-year-old son, D.A.F, to the emergency room at LGMC because he had been complaining of pain in his left leg since Suffering a fall six days earlier. Plaintiffs did not have health insurance. Upon D.A.F.’s arrival at LGMC, the nursing staff performed a triage assessment and measured his vital signs, which were normal. D.A.F. rated his pain as a ten, using the Wong-Baker face scale, on a one-to-ten scale, with ten as the worst pain ever. Defendant Scott Jones, M.D., a board certified emergency medicine physician, also examined D.A.F. and noted contusions on both hips. Dr. Jones ordered lab tests and a CT scan of D.A.F.’s lower extremities and pelvis. The results of those tests were generally normal, except that D.A.F.’s white blood cell count was elevated and the CT scan showed subcutaneous contusions and a hematoma/seroma on the right hip. Dr. Jones diagnosed D.A.F. with contusions on both hips and discharged the child from the LGMC emergency room with instructions that he take Tylenol with codeine for pain, and follow-up with his pediatrician on Monday, July 2. The next day, however, Plaintiffs took D.A.F. to the emergency room at Cook Children’s Medical Center (“CCMC”). On arrival, D.A.F. had a fever and swelling and tenderness in his left leg. D.A.F.’s white blood cell count was lower than it had been on Friday, and other test results suggested he was suffering from a bacterial infection. CCMC admitted D.A.F. to the hospital and began administering antibiotics. D.A.F. remained hospitalized from June 30 to. August 10, during which time he underwent several surgeries and was treated for a methicillin-resistant staphylococcus aureus (“MRSA”) infection. D.A.F. has permanent bone damage and is at risk for future injuries and infection. Plaintiffs contend that D.A.F. would have experienced a better outcome if LGMC had administered antibiotics to him on June 29, and transferred him to a pediatric medical center.
Plaintiffs allege LGMC violated the Emergency Medical Treatment and Active Labor Act (“EMTALA”), 42 U.S.C.A. § 1395dd, by failing to provide D.A.F. with an appropriate medical screening examination to determine whether D.A.F. had an emergency medical condition. According to Plaintiffs, LGMC did not give D.A.F. the same medical screening examination it provided to other patients .with the same or similar signs and/or symptoms; nor did the hospital provide D.A.F. with a medical screening examination that was consistent with the applicable national standard of care. Plaintiffs further allege D.A.F. had an emergency medical condition 'that was not stabilized while he was at LGMC, and the hospital discharged, or “dumped,” him from its emergency room because he was uninsured, in violation of EMTALA. In the alternative, Plaintiffs contend that LGMC was negligent with respect to the care and treatment provided to D.A.F.
LGMC moved for summary judgment as to all of Plaintiffs’ claims and causes of action, arguing that Plaintiffs’ EMTALA screening claims fail because Dr. Jones performed an appropriate medical screening examination and there is no evidence that' LGMC provided a higher level of screening to other patients who presented with substantially similar . complaints. LGMC further argued that Plaintiffs’ EM-TALA stabilization claims fail because Dr. Jones did not diagnose an emergency medical condition. Finally, LGMC argued that it is entitled to summary judgment on Plaintiffs’ negligence claims because there is no evidence of negligence. Plaintiffs disputed LGMC’s arguments and asserted they are entitled to partial summary judgment because they established, as a matter of law, that the hospital violated EMTALA when it failed to provide an appropriate medical screening examination to D.A.F. and discharged him with an unstabilized emergency medical condition. The issues were fully briefed and argued at a hearing held on August 7, 2015. At the conclusion of the heáring, the Court granted Defendants’ motion for summary judgment and denied Plaintiffs’ motion for partial summary judgment. The reasons for the Court’s decisions are set forth below.
II. Legal Standards
Summary judgment is warranted “if the movant shows that there is no genuine dispute as to any material fact and the movant is entitled to judgment as a matter of law.” Fed. R. Civ. P. 56. A dispute as to a material fact is genuine, if the evidence is sufficient to permit a reasonable factfin-der to return a verdict for the nonmoving party. Crowe v. Henry, 115 F.3d 294, 296 (5th Cir.1997). A fact is material if its resolution could affect the outcome of the action. Weeks Marine, Inc. v. Fireman’s Fund Ins. Co., 340 F.3d 233, 235 (5th Cir.2003). The substantive law determines which facts are material. See Anderson v. Liberty Lobby, Inc., 477 U.S. 242, 247, 106 S.Ct. 2505, 91 L.Ed.2d 202 (1986). A party seeking summary judgment who does not have the burden of proof at trial, like LGMC here, need only point to the absence of admissible evidence to support the nonmovant’s claim. See Duffy v. Leading Edge Prods., Inc., 44 F.3d 308, 312 (5th Cir.1995). Once the movant meets its initial burden, the burden shifts to the nonmov-ing party to produce evidence or designate specific facts in the record showing the existence of a genuine issue for trial. See Fordoche, Inc. v. Texaco, Inc., 463 F.3d 388, 392 (5th Cir.2006). By contrast, a mov-ant who bears the burden of proof at trial, such as Plaintiffs, must establish “beyond peradventure all of the essential elements of the claim or defense to warrant judgment in hjs favor.” Fontenot v. Upjohn Co., 780 F.2d 1190, 1194 (5th Cir.1986) (emphasis in original). The “beyond peradventure” standard is a “heavy” burden. See Carolina Cas. Ins. Co. v. Sowell, 603 F.Supp.2d 914, 923-24 (N.D.Tex.2009).
III. Analysis
A. EMTALA
EMTALA is an anti-patient dumping statute, enacted to prevent hospitals from refusing to treat patients because of their non-insured status or inability to pay. Marshall v. E. Carroll Parish Hosp. Serv. Dis’t., 134 F.3d 319, 322 (5th Cir.1998). EMTALA requires a hospital to provide any person who presents to the emergency room “an appropriate medical screening examination... to determine whether or not an emergency medical condition exists.” 42 U.S.C. § 1395dd(a). An emergency medical condition is “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 (i) placing the health of the individual .. .in serious jeopardy, (ii) serious impairment to bodily functions, or (iii) serious dysfunction of any bodily organ or part.” Id., § 1395dd(e)(l). If the hospital determines that such a condition exists, the hospital must either stabilize the person’s condition, or, under certain circumstances, transfer the individual to another medical facility. Id., § 1395dd(b). The Act provides a private cause of action to a person who suffers harm as a direct result of an EiyiTALA violation. Id., § 1395dd(d)(2)(A).
1. Screening Claim
Plaintiffs first contend that LGMC violated EMTALA because it failed to provide D.A.F. an “appropriate medical screening examination.” EMTALA does not define what constitutes an “appropriate screening examination,” but the Fifth Circuit has held that such an examination is “a screening examination that the hospital would have offered to any other patient in a similar condition with similar symptoms.” Guzman v. Mem. Hermann Hosp. Sys., 409 Fed.Appx. 769, 773 (5th Cir.2011) (quoting Marshall, 134 F.3d at 323). Whether an examination is considered an “appropriate medical screening examination” is determined “by whether it was performed equitably in comparison to other patients wjth similar symptoms,” not “by its proficiency in accurately diagnosing the patient’s illness.” Marshall, 134 F.3d at 322. A plaintiff may prove an EMTALA violation by (1) pointing to differences’ between the screening examination that the plaintiff received and examinations that other patients with similar symptoms received at the same hospital; (2) showing that the hospital did not follow its own standard screening procedures; or (3) showing that the hospital provided such a cursory screening that it amounted to no screening at all. Guzman, 409 Fed.Appx. at 773; Battle v. Mem. Hosp. at Gulfport, 228 F.3d 544, 558 (5th Cir.2000).
Judged against these standards, the Court concludes, based on the factual record, that LGMC provided D.A.F. an “appropriate medical screening examination,” as required by EMTALA. The summary judgment evidence shows that LGMC nurses completed a triage assessment and measured D.A.F.’s vital signs within a few minutes of the first time he presented to the emergency room. LGMC App. at 6, 136. Shortly thereafter, Dr. Jones, a board-certified emergency medicine physician, also examined D.A.F. Id. at 2, 27. Dr. Jones’s examination consisted of taking a patient history from D.A.F. and his mother, and conducting a physical examination, including a neurological motor exam. See id. at 2-3, 51 & 56. The initial examination lasted approximately fifteen minutes. See id. at 2. Dr. Jones ordered various laboratory tests, including blood tests consisting of a Basic Metabolic Panel and a Complete Blood Count, as well as a urinalysis. Id. at 4, 57. He also ordered a CT scan of D.A.F.’s lower extremities and pelvis. Id. While D.A.F. and his mother were waiting for the results of these tests, LGMC nurses monitored D.A.F. and assessed his vital signs. Id. at 7, 8. The nurses consistently noted that D.A.F. exhibited no neurological, cardiovascular, or respiratory problems. Id. Dr. Jones reviewed the test results and discussed the CT scan with LGMC’s staff radiologist. Id. at 3, 60-61. Dr. Jones then reevaluated D.A.F., found his vital signs to be stable, and diagnosed D.A.F. with contusions on both the right and left hip. Id. at 3, 4. Dr. Jones concluded D.A.F. was stable and ordered that he be discharged from the emergency room. Id. at 4. This is not the type of screening that was so cursory that it amounted to no screening at all.
Plaintiffs attempt to establish a fact question regarding alleged disparate screening by pointing to medical records from three other patients they contend had symptoms similar to those of D.A.F. but were admitted to the hospital for further evaluation and treated with antibiotics. The first comparator patient was an 81-year-old man who, like D.A.F., presented to the LGMC emergency room complaining of lower leg pain. See LGMC App. at 580-96. Initial lab tests revealed his white blood cell count was elevated. Id. However, the patient also had a history of serious medical conditions, including recent cellulitis, for which he was taking penicillin, prescribed by an infectious disease specialist. Id. The second comparator was an obese, 58-year-old man who presented to LGMC with hip pain; initial tests revealed a higher than normal white blood cell count. Id. at 597-645. He had a medical history of asthma, congestive heart failure, hypertension, diabetes, renal failure, and atrial fibrillation. Id. He was taking at least ten prescription medications for his long-standing, various health concerns at the time he presented to LGMC. Id. The third comparator was a 79-year-old female suffering from dementia, who presented to LGMC with a sudden onset of weakness and pain in her right knee. Id. at 646-77. Her lab test results showed a high white blood cell count. Id. The woman had previously had surgery on her knee and had a prosthesis. Id.
EMTALA is implicated only when other individuals who are perceived to have the same'- medical condition receive disparate treatment. Marshall, 134 F.3d at 323 (citing Vickers v. Nash General Hosp., Inc., 78 F.3d 139, 144 (4th Cir.1996)). Here, none of the alleged comparator patients were perceived to have the same medical condition as D.A.F. Dr. Jones perceived D.A.F., a pediatric patient who was otherwise in good health, to be suffering from pain caused by a.fall; he did not perceive that D.A.F. might be suffering from an infection. By contrast, the screening doct