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Michaud v. Calais Regional Hospital

United States District Court, D. Maine

March 7, 2017

SHIRLEY MICHAUD, Plaintiff,
v.
CALAIS REGIONAL HOSPITAL, Defendant.

          ORDER ON DEFENDANT'S MOTION FOR SUMMARY JUDGMENT

          NANCY TORRESEN UNITED STATES CHIEF DISTRICT JUDGE.

         The 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.

         BACKGROUND

         The 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.[1] I take the facts in the light most favorable to the non-movant.

         Michaud had a medical history of Alzheimer's dementia and chronic renal failure. Joint Statement of Material Facts (“JSMF”)[2] ¶¶ 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.[3] 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 ¶ 5.

         James 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.

         In this 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.

         From 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.

         Based 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.

         Calais 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.

         Michaud 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.

         After 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.

         Michaud was discharged at 8:10 p.m.[4] 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.

         The 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 ...


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