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Walley v. York Hospital

United States District Court, D. Maine

July 27, 2018

GELI WALLEY, Plaintiff


          D. Brock Hornby, United States District Judge.

         The issue presented by this 12(b)(6) motion is whether the plaintiff's one-count Complaint has stated a claim under the Federal Emergency Medical Treatment and Active Labor Act (EMTALA), 42 U.S.C. § 1395dd et seq., as opposed to an ordinary medical malpractice claim under Maine state law. I conclude that she has failed to state a federal claim and Grant the defendant's motion to dismiss.


         I take the facts as stated in the plaintiff's complaint, as well as any concessions the parties have made. The defendant York Hospital is a participating hospital with a dedicated emergency department within the meaning of EMTALA. Compl. ¶¶ 4, 9 (ECF No. 1). For purposes of its motion, York Hospital admits that it is covered by EMTALA and that it operates an emergency department. Def.'s Mot. 4 n.3 (ECF No. 5).

         The plaintiff came to the Hospital's Emergency Department around 8:00 p.m. on March 23, 2016, believing that she was having a stroke. Compl. ¶¶ 18-19. (York Hospital admits that the plaintiff came to the hospital on March 23, 2016, seeking treatment. Def.'s Mot. 4 n.3.) She was formally admitted to the hospital at 11:03 p.m. with a stroke diagnosis, namely, “trans cerebral ischemic attack uns.” Compl. ¶¶ 34-36. On the evening of March 25, 2016, York Hospital transferred her to Maine Medical Center. Compl. ¶¶ 52, 54; Pl.'s Opp'n 5 (ECF No. 6). The plaintiff had another stroke before she was transferred. Compl. ¶ 53.


         This court, the First Circuit, and the Department of Health and Human Services' Centers for Medicare and Medicaid Services (CMS) have repeated time and again that EMTALA is not a medical malpractice statute. See, e.g., Ramos-Cruz v. Centro Medico del Turabo, 642 F.3d 17, 18 (1st Cir. 2011) (it “is a limited anti-dumping statute, not a federal malpractice statute.”); Correa v. Hosp. San Francisco, 69 F.3d 1184, 1193 (1st Cir. 1995); Feighery v. York Hosp., 59 F.Supp.2d 96, 102 (D. Me. 1999); Medicare Program; Clarifying Policies Related to the Responsibilities of Medicare-Participating Hospitals in Treating Individuals With Emergency Medical Conditions, 68 Fed. Reg. 53222, 53223 (Sept. 9, 2003) (“In enacting [the private right of enforcement in EMTALA], Congress did not intend for the statute to be used as a Federal malpractice statute.”). Instead, Congress enacted EMTALA to stop so-called hospital “dumping” practices by which some hospitals denied admission to patients who lacked insurance or ability to pay. Congress did not create the federal law to supersede state law on medical malpractice.[1] Fraticelli-Torres v. Hosp. Hermanos, 300 Fed.Appx. 1, 3-4 (1st Cir. 2008); Bryan v. Rectors & Visitors of Univ. of Virginia, 95 F.3d 349, 351-52 (4th Cir. 1996); Feighery, 59 F.Supp.2d at 102 (collecting cases). I assess the Complaint in that framework.

         This one-count Complaint asserts that York Hospital's treatment of the plaintiff violated EMTALA as follows: (1) The Hospital failed to provide an appropriate medical screening examination of her stroke symptoms in a timely manner; (2) it failed to stabilize her emergency medical condition in a timely manner; (3) it failed to admit her within a reasonable amount of time; and (4) it failed to transfer her in a timely manner to a primary stroke center. Compl. ¶¶ 57-60. York Hospital's motion seeks to dismiss the entire Complaint and argues that EMTALA permits a cause of action founded upon only (1) failure to provide an appropriate screening and (2) transferring her without first stabilizing her condition, i.e., the first two assertions. Def.'s Mot. 3-4. The plaintiff's response implicitly accepts this characterization of her Complaint, argues that her first two assertions are sufficient to state a claim, and does not address the last two. Pl.'s Opp'n 2. The first two, therefore, are the claims that I assess.[2]Because the plaintiff has not argued that her federal cause of action survives even if I rule in the Hospital's favor on the first two claims, I conclude that she is not pursuing the other two as separate federal claims. In any event, the plaintiff has not shown that they are independent EMTALA violations as opposed to ordinary medical malpractice claims.[3]

         I choose to address in reverse order the two claims in dispute.

         Failure to Stabilize

         EMTALA provides that when a hospital determines that an individual has an emergency medical condition, it “must provide . . . such treatment as may be required to stabilize the medical condition” or “transfer [her] to another medical facility.” 42 U.S.C. § 1395dd(b)(1). There are special conditions for transferring a patient who has not been stabilized, so as to avoid the “dumping” that EMTALA sought to end. Id. § 1395dd(c). CMS has promulgated the following regulation regarding the stabilization requirement:

If a hospital has screened an individual . . . and found the individual to have an emergency medical condition, and admits that individual as an inpatient in good faith in order to stabilize the emergency medical condition, the hospital has satisfied its special responsibilities under this section [concerning the obligation to stabilize] with respect to that individual.

42 C.F.R. § 489.24(d)(2)(i). The regulation also states: “If the hospital admits the individual as an inpatient for further treatment, the hospital's obligation under this section ends, as specified in paragraph (d)(2) of this section.” Id. § 489.24(a)(1)(ii) (emphasis added). The plaintiff acknowledges in her Complaint that York Hospital did admit her as an inpatient on March 23, 2016; the Complaint does not allege that the Hospital was not acting in good faith in doing so.[4] Under this regulation, then, York Hospital had no EMTALA stabilization obligation, although it may have had state law medical malpractice obligations. York Hospital explicitly relied upon this regulation in both its Motion and its Reply. The plaintiff in her opposition simply did not address the regulation.[5]

         CMS has given this regulatory interpretation of the EMTALA stabilization requirement considerable attention. First, in 2002, recognizing a difference of opinion among courts, CMS proposed applying the stabilization requirement to inpatients who were admitted in order to stabilize their emergency medical conditions. Medicare Program; Changes to the Hospital Inpatient Prospective Payment Systems and Fiscal Year 2003 Rates, 67 Fed. Reg. 31404, 31475 (May 9, 2002).[6] After extensive negative public comments, and consideration of the federal case law, however, CMS in 2003 adopted the version now in effect, 68 Fed. Reg. 53222, that the stabilization obligation is satisfied and ends upon patient admission so far as a federal remedy is concerned. 42 C.F.R. ยง 489.24(a)(1)(ii), (d)(2)(i). CMS reexamined the issue in 2012 and after considering additional public comment decided ...

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