United States District Court, D. Maine
ORDER ON DEFENDANT'S MOTION FOR SUMMARY
TORRESEN UNITED STATES CHIEF DISTRICT JUDGE.
surviving wife of Hermel Michaud (“Michaud”)
brought suit against Calais Regional Hospital, alleging
violations of the Emergency Medical Treatment and Active
Labor Act (“EMTALA”), 42 U.S.C. § 1395dd.
Before me is Calais Regional Hospital's motion for
summary judgment. Def.'s Mot. for Summ. J. (ECF No. 54).
For the reasons stated below, the motion is DENIED.
following account is taken from the parties' statements
of material facts, credited to the extent that the facts are
either admitted or supported by record
citations. I take the facts in the light most
favorable to the non-movant.
had a medical history of Alzheimer's dementia and chronic
renal failure. Joint Statement of Material Facts
(“JSMF”) ¶¶ 4, 90 (ECF No.
63). Michaud's dementia caused him to have difficulty
managing his medication, as well as problems with memory,
attention, and language. JSMF ¶¶ 91-92. On November
20, 2013, Michaud was undergoing dialysis at the Sunrise
County Dialysis when he experienced a syncopal episode,
meaning he experienced a “sudden loss of consciousness
and postural tone that spontaneously resolves.” JSMF
¶¶ 1-2. Michaud's body spasmed, his dentures
fell out, and he stopped breathing for several moments. JSMF
¶¶ 2, 46-47. Sunrise staff placed external
defibrillator pads on Michaud, but he regained consciousness
independently. JSMF ¶ 47. An ambulance took Michaud to
the Calais Regional Hospital, where he arrived at
approximately 4:08 p.m. and was admitted at 4:20 p.m. JSMF
Mullen, M.D. was the attending emergency department physician
at the time. JSMF ¶ 7. There is no written hospital
protocol in the record for specific screening procedures that
are triggered by an emergency department patient arriving
with syncope and chronic renal failure, but Dr. Mullen
described his protocol in comparable instances. JSMF
¶¶ 38, 42. When a patient arrives in the emergency
department after a syncopal episode, Dr. Mullen first looks
for an “immediate life threat” to the patient and
then for evidence that the cause of the symptoms puts the
patient at high or low risk. JSMF ¶¶
27-29. Dr. Mullen stated that “[a]s soon as they have
any high-risk feature, such as age, comorbidities, findings
on the diagnostics . . . then usually admission would
happen.” JSMF ¶ 42. Regarding the age indicator,
Dr. Mullen stated “any patient over the age of 50, my
likelihood of recommending admission is going to be extremely
high” and also that “for patients who present
with syncope in [Michaud's] age group, it's a
required admission to the hospital.” JSMF ¶¶
28, 42. Dr. Mullen further stated that a patient with similar
symptoms “is going to require further diagnostics,
including prolonged cardiac monitoring, to better elucidate
the cause of the syncope.” JSMF ¶ 42. This is
because “[t]here could be a life-threatening
condition.” JSMF ¶ 42.
instance, Dr. Mullen provided the following screening. First,
he categorized Michaud as high risk. JSMF ¶ 82. Dr.
Mullen “thought cardiac was the number one cause,
” and dangerous “cardiac causes were at the top
of the list.” JSMF ¶¶ 22, 84. Cardiac causes
are the most common life-threatening conditions associated
with syncope. JSMF ¶ 83. Dr. Mullen's list also
included less dangerous cardiac conditions that can cause
syncope in conjunction with dialysis. JSMF ¶ 22. Dr.
Mullen then ordered several diagnostic tests for Michaud.
From 4:20-4:37 p.m., a nurse took Michaud's vital signs
and pertinent medical history. JSMF ¶ 9. At 4:35 p.m.,
Michaud was placed on a cardiac monitor. JSMF ¶ 11. A
nurse collected a blood sample at 5:10 p.m., and Dr. Mullen
received the laboratory results at 5:52 p.m. JSMF ¶ 12.
An electrocardiogram (“EKG”) for
Michaud was administered at 5:45 p.m. JSMF ¶ 11. X-ray
film was taken of Michaud at 5:46 p.m. JSMF ¶ 15.
these tests, Dr. Mullen observed that Michaud's heart
beat rate was slow, with a prolonged QT interval greater than
500 milliseconds. JSMF ¶¶ 13, 88. Dr. Mullen noted
that this was a “significant finding” because it
put Michaud at risk of torsade de pointe, an arrhythmia that
can lead to sudden cardiac death. JSMF ¶¶ 17, 85.
The EKG also showed Michaud had a bradycardic sinus rhythm,
or slow heart beat rhythm. JSMF ¶¶ 13, 17. Aside
from these cardiac indications, Dr. Mullen recorded that
Michaud was “asymptomatic and physiologically
stable.” JSMF ¶ 19. Dr. Mullen recorded that
Michaud's vital signs were otherwise normal, his
laboratory results were “essentially normal, ”
and the results of the x-ray were normal. JSMF ¶¶
14, 16. Michaud was “alert and oriented, with a normal
mood and affect, ” although he complained of feeling
tired, and having pain in his legs and back, and he was
growing impatient and agitated. JSMF ¶ 20.
on the screening to this point, Dr. Mullen determined it was
necessary to admit Michaud for cardiac monitoring to
“figure out why his heart was doing what it was
doing.” JSMF ¶¶ 24, 32, 85. Although Dr.
Mullen stated the test results provided no “clear
evidence” that Michaud's syncope was caused by a
cardiac condition, he was concerned with Michaud's age,
complex comorbidities, and the risks presented by the EKG
results. JSMF ¶¶ 24, 28, 88. Dr. Mullen told
Michaud that syncope “is something that does require
admission.” JSMF ¶ 82.
Regional Hospital did not offer dialysis, however, and Dr.
Mullen believed there was an unwritten hospital policy not to
admit a dialysis patient. JSMF ¶ 38. Dr. Mullen
therefore determined it was necessary to transfer Michaud to
the Eastern Maine Medical Center for further cardiac
monitoring. JSMF ¶¶ 36, 62. Dr. Mullen stressed to
Michaud that the transfer was necessary. JSMF ¶ 64.
initially resisted transfer. JSMF ¶¶ 64-65.
However, Michaud was accompanied at the hospital by his wife
Shirley Michaud and step-daughter Brenda Donaghy. When
Donaghy arrived, she informed hospital staff that she needed
to be with Michaud to help him understand the questions asked
of him. JSMF ¶ 54. She was present on three of
approximately five occasions when Dr. Mullen checked in on
Michaud, including when Dr. Mullen told Michaud that transfer
was necessary, and she convinced Michaud not to object. JSMF
¶¶ 57, 66, 68. A nurse confirmed that Michaud would
be transferred, and then Donaghy left the hospital to pack a
bag in preparation for accompanying Michaud to Eastern Maine
Medical Center. JSMF ¶¶ 69-70. Donaghy left her
phone number and asked the nurse to call if something
happened regarding Michaud or his transfer. JSMF ¶ 71.
Donaghy left, Dr. Mullen stuck his head in the door of
Michaud's room and told him that he was not being
transferred and was being sent home. JSMF ¶ 72. Dr.
Mullen recommended that Michaud follow up with his
nephrologist and primary care physician for placement of a
portable Holter heart monitoring device. JSMF ¶ 32. The
cause of Michaud's syncope remained unknown to Dr.
Mullen, but his final report states that the “syncopal
episode was most likely due to some mild bradycardia that
during dialysis caused a transient hypotension which caused
myoclonic activity.” JSMF ¶¶ 24-26. Dr.
Mullen's final diagnosis for Michaud was “acute
syncope” and “chronic renal failure.” JSMF
¶ 26. Michaud's wife went to get the car while
nursing staff discussed discharge instructions with Michaud.
JSMF ¶ 73.
was discharged at 8:10 p.m. JSMF ¶ 30. He had been in
the hospital for just under four hours. JSMF ¶¶ 5,
30. Upon discharge, Michaud's wife drove him the two
minute trip from the hospital to their home. JSMF ¶ 75.
Five minutes after entering the house, Michaud collapsed.
JSMF ¶ 76. An ambulance was dispatched at 8:37 p.m., and
the emergency medical team attempted CPR and defibrillation.
JSMF ¶¶ 78-79. Efforts to revive Michaud ceased at
9:25 p.m. JSMF ¶ 80. Michaud is believed to have died of
a malignant cardiac arrhythmia. JSMF ¶ 76.
Plaintiff's expert, James Matthews, M.D., stated his
opinion that appropriate screening required
“maintaining [Michaud] on monitoring for a least
overnight.” JSMF ¶ 33. Dr. Mathews also stated
that “syncope in a renal failure ...