Case Title: Chandler v. Hospital Authority of City of Huntsville

Citation: 548 So. 2d 1384

Docket Number: 

State: alabama

Court: Alabama Supreme Court

Date: 1989-08-25T00:00:00Z

Document:
548 So. 2d 1384 (1989)
Tammy CHANDLER, et al.
v.
HOSPITAL AUTHORITY OF the CITY OF HUNTSVILLE, Alabama.
No. 87-1236.

Supreme Court of Alabama.
August 25, 1989.
*1385 Robert H. Ford and Daniel F. Aldridge of Brinkley, Ford, Chesnut & Aldridge, Huntsville, for appellant.
W. Stanley Rodgers and Patrick M. Lamar of Lanier, Ford, Shaver & Payne, Huntsville, for appellee.
S. Greg Burge of Heninger, Burge & Vargo, Birmingham, for amicus curiae The Alabama Trial Lawyers Ass'n.
ALMON, Justice.
Tammy Chandler brought an action against the Hospital Authority of the City of Huntsville ("the Hospital Authority"), the operator of the Huntsville Hospital, for the wrongful death of her son, Darren. The trial court entered summary judgment on the ground that Ala.Code 1975, § 22-21-137(2), granted immunity from tort actions to hospital building authorities. Chandler appealed and this Court reversed the summary judgment, holding that § 22-21-137(2) was unconstitutional. Chandler v. Hospital Authority of the City of Huntsville, 500 So. 2d 1012 (Ala.1986). The Hospital Authority filed another motion for partial summary judgment, which was granted.
The only issue presented for review is whether Huntsville Hospital had a duty to provide emergency care to Darren even though his mother had no insurance and did not have the $54 emergency room fee.
On August 16, 1983, Chandler carried her 15-day-old son, Darren, to the Ambulatory Care Center ("ACC") in Huntsville for a two-week post-partem checkup. While they were at the ACC, Darren's temperature was taken and Chandler was told that Darren needed to be taken to Huntsville Hospital for emergency care. Chandler carried Darren to Huntsville Hospital as instructed, arriving at approximately 4:00 p.m.
When Chandler arrived at Huntsville Hospital, she was asked if she had either insurance or $54 for the emergency room admission fee. Chandler replied that she had neither. The admitting clerk told Chandler that Darren could not be seen without insurance or the $54 fee. Shortly thereafter, a nurse told Chandler to take Darren home and to give him Tylenol and a warm bath.
At approximately 8:00 p.m. that evening, Chandler returned to Huntsville Hospital with Darren. At approximately 11:00 p.m. Darren was seen by a doctor. He was admitted into Huntsville Hospital at that time. At approximately 4:30 p.m. the next day, he died from spinal meningitis.
*1386 This action was commenced prior to June 11, 1987, and therefore is governed by the "scintilla rule."[1]
Gunnels v. Glenn Machine Works, Inc., 547 So. 2d 448 (Ala.1989); citing Car Center, Inc. v. Home Indemnity Co., 519 So. 2d 1319, 1322 (Ala.1988).
In opposition to the Hospital Authority's motion for partial summary judgment, Chandler submitted a document entitled "Huntsville Hospital's Revised Admission Policies" dated August 10, 1983. The following policies were included within the document:
". . . .
"Madison County:
"DEFINITIONS
". . . .
". . . .
"II. Madison County
". . . .
One who volunteers to act, though under no duty to do so, is thereafter charged with the duty of acting with due care. Berkel & Co. Contractors, Inc. v. Providence Hospital, 454 So. 2d 496 (Ala.1984); Herston v. Whitesell, 374 So. 2d 267 (Ala.1979). "[T]he existence of a voluntarily assumed duty through affirmative conduct is a matter for determination in light of all the facts and circumstances." Parker v. Thyssen Mining Construction, Inc., 428 So. 2d 615 (Ala.1983).
The above-quoted admissions policies present at least a scintilla of evidence from which a jury could reasonably determine that Huntsville Hospital had assumed a duty to provide emergency care to indigent patients in emergency situations. We hold, therefore, that the trial court erred in granting the Hospital Authority's motion for partial summary judgment. The judgment of the trial court is reversed and the cause is remanded.
REVERSED AND REMANDED.
SHORES, ADAMS, HOUSTON and STEAGALL, JJ., concur.
HORNSBY, C.J., and MADDOX, JONES and KENNEDY, JJ., concur in the result.
MADDOX, Justice (concurring in the result).
On original deliverance, I dissented in part because I was of the opinion that the Hospital was immune from suit. Chandler v. Hospital Auth. of the City of Huntsville, 500 So. 2d 1012, 1019 (Ala.1986) (Maddox, J., concurring in part, dissenting in part). While I am still of that opinion, the law of the case is that immunity does not apply. See my opinion concurring specially in Black Belt Wood Co. v. Sessions, 514 So. 2d 1249, 1256-57 (Ala.1986) (Maddox, J., concurring specially), in which I stated:
If there is no immunity, as the majority held on original deliverance, then I concur with the result reached by the majority.
KENNEDY, Justice (concurring in the result).
The majority holds that the duty of the Hospital to provide emergency care to the plaintiff's decedent arose only through the Hospital's voluntary assumption of a duty to provide emergency care to indigent citizens through its own admissions policies. I am of the opinion that, as a matter of public policy and law, such a duty exists without regard to voluntary assumption.
The United States Congress has expressed its dissatisfaction with the common law "no-duty rule" in circumstances such as those presented by this case, as seen in the anti-dumping provisions of the Comprehensive Omnibus Budget Reconciliation Act of 1986 (COBRA), codified at 42 U.S.C. § 1395dd et seq. (Supp. IV 1986). These provisions require a hospital, public or private, participating in the Medicare program and having an emergency department, to provide an appropriate examination within the department's capability to any individual who requests treatment, to determine whether an "emergency medical condition exists." If the hospital determines that the *1388 individual has an emergency medical condition or is in active labor, the hospital must provide either: a) such treatment as is required to stabilize the medical condition or to treat the active labor; or b) a transfer of the individual to another medical facility in accordance with the Act. The Act allows a hospital to transfer a patient without restriction once the patient is stabilized; however, if the patient has not been stabilized or is in active labor, the hospital may not transfer the patient unless: 1) the patient requests a transfer or a qualified medical person certifies that the patient is being transferred for medical reasons; and 2) the transfer is an appropriate transfer within the meaning of the Act. An appropriate transfer is one in which: 1) the receiving facility has available space and qualified personnel and has agreed to accept transfer of the patient and to provide appropriate treatment; 2) the transferring hospital provides the receiving facility with appropriate medical records of the examination and treatment given to the patient by the transferring hospital; 3) the transfer is effected through qualified personnel and equipment; and 4) the transfer meets such other requirements as may be found necessary to ensure the patient's health and safety.
Under the Act, a hospital is relieved of its duty to provide treatment if the individual refuses to consent to treatment or refuses to consent to a proper transfer. Otherwise, if a hospital knowingly, willfully, or negligently fails to comply with the requirements of the Act, the hospital is subject to a bar or to suspension from all Medicare participation, as well as a penalty of not more than $50,000 for each violation. In addition, patients may recover civil damages from the hospital for personal injury caused by a violation of the Act, in accordance with the law of the state in which the hospital is located. Further, while the Act is silent on the matter of punitive damages, it is likely that punitive damages would be recoverable in appropriate circumstances. See A. McClurg, Your Money or Your Life: Interpreting the Federal Act Against Patient Dumping, 24 Wake Forest L.Rev. 173, 219 (1989). Interestingly, statistics compiled by the Health Care Financing Administration show that 98% of the hospitals in this country participate in the Medicare program. See Health Care Financing Admin., Bureau of Management & Strategy, HCFA Statistics 13 (1986); and A. McClurg, 24 Wake Forest L.Rev. at 199 n. 112. (Huntsville Hospital is among the 98% that participate in the Medicare program.) As noted by Professor McClurg in his article, the penalty of a bar or suspension from Medicare participation for refusal to render emergency medical treatment to indigents, would, alone, close the doors of most hospitals in this country. See A. McClurg, 24 Wake Forest L.Rev. at 200.
Recently, a Department of Health and Human Services administrative law judge (A.L.J.) fined a Texas physician $20,000 for transferring an indigent patient who was in active labor to another hospital without treating her. In re: The Inspector General v. Burditt, H.H.S. Admin.Ruling No. C-42 (July 28, 1989). The physician refused to deliver the woman's baby for fear that he might later be sued for malpractice. Over the protestations of the nurses on duty, the woman was sent in an unequipped ambulance to a hospital 160 miles away. Not long after the ambulance departed, the woman told the attendants that she was about to deliver the child. The ambulance driver pulled off onto the side of the highway, and a healthy baby boy was born. The ambulance then took the woman to another hospital to obtain some medication to control post-partum bleeding. She then requested that she be taken back to the hospital where she had first gone. The physician who had refused to deliver her baby on the first visit again refused to see her, and another physician consented to treat her.
The A.L.J., in his order, determined the following: (1) that the physician acted in "reckless disregard" in his failure to treat the woman; (2) that the physician's transfer of the woman to another hospital posed a "threat to the health and safety of the woman and her child"; and (3) that the condition of the woman posed an "emergency *1389 medical condition" within the meaning of COBRA. Id.
Although the Burditt case does not involve a situation where (as here) the patient was refused treatment because of an inability to pay, the A.L.J. did hold the physician liable under COBRA because it was a case of a "`responsible physician' who knowingly violated requirements of Section 1867." Thus, under COBRA, hospitals that accept Medicare funds and provide emergency care must either treat the emergency patient or transfer the patient to another hospital in accordance with the rules outlined above.
The leading case on a hospital's duty to provide emergency care is Wilmington General Hospital v. Manlove, 54 Del. 15, 174 A.2d 135 (1961). In Manlove, the court stated:
". . . .
54 Del. at 22-25, 174 A.2d  at 139-40. This holding was cited with approval in Stanturf v. Sipes, 447 S.W.2d 558 (Mo.1969); and Fabian v. Matzko 236 Pa.Super. 267, 344 A.2d 569 (1975).
Mississippi courts have likewise determined that hospitals have an obligation to provide emergency care:
New Biloxi Hospital, Inc. v. Frazier, 245 Miss. 185, 197, 146 So. 2d 882, 887 (1962).
In Mercy Medical Center of Oshkosh, Inc. v. Winnebago County, 58 Wis.2d 260, 206 N.W.2d 198 (1973), the Supreme Court of Wisconsin discussed the trend in the case law toward imposing a duty on hospitals to provide emergency care:
58 Wis.2d at 266-168, 206 N.W.2d  at 200-201.
Since Winnebago County was decided, other states' courts have held that hospitals have a duty to render emergency care. In Richard v. Adair Hosp. Found. Corp., 566 S.W.2d 791 (Ky.App.1978), the court held:
566 S.W.2d  at 793. In Valdez v. Lyman-Roberts Hosp., Inc., 638 S.W.2d 111 (Tex.Civ.App.1982), the court said:
638 S.W.2d  at 114, n. 1. The Arizona Supreme Court has stated:
St. Joseph's Hospital & Medical Center v. Maricopa County, 142 Ariz. 94, 97, 688 P.2d 986, 989 (1984).
Of the cases that I have found, the most strongly stated is the Georgia Court of Appeals' case of Williams v. Hospital Authority of Hall County, 119 Ga.App. 626, 168 S.E.2d 336 (1969):
119 Ga.App. at 627, 168 S.E.2d  at 337. One commentator expresses his opinion even more strongly than the Georgia court:
Fine, Opening the Closed Doors: The Duty of Hospitals to Treat Emergency Patients, 24 Wash.U.J. Urb. & Contemp.L. 123, 148 (1983).
In addition to the jurisdictions previously cited, some states impose a statutory duty upon hospitals to provide emergency care. "LSA-R.S. 40:2113.4 imposes a duty on hospitals licensed in Louisiana to make emergency services available to all persons residing in the territorial area regardless of insurance or economic status." Hastings v. Baton Rouge Gen. Hosp., 498 So. 2d 713 (La.1986). In addition to Louisiana, nine other states (California,[2] Florida,[3] Illinois,[4] Kentucky,[5] New York,[6] Tennessee,[7] Texas,[8] Wisconsin,[9] and Wyoming[10]) have imposed a statutory duty upon hospitals to provide emergency care to indigents.
If a private hospital holds itself out as a provider to the public of emergency care through the use of an emergency room, the public has a right to assume that the use of the hospital's emergency room is not predicated on a person's ability to pay. To hold otherwise would put indigents on notice that before they seek emergency care for potentially life-threatening injury or illness, they must first determine whether a hospital is public or private. Such a policy would, indeed, be "repugnant to our entire system of government." Williams, supra.
*1392 Regardless of whether a hospital has an admissions policy on indigent emergency room care, a hospital that provides emergency services should be under a duty to provide emergency care to anyone who seeks it and is in need of it. A hospital's first concern, when presented with an emergency situation, should not be the financial status of the person needing care. Rather, its sole concern should be treating the illness or the injury of the person who seeks treatment.
Accordingly, I concur in the result only.
HORNSBY, C.J., and JONES, J., concur.
[1]  See Ala.Code 1975, § 12-21-12.
[2]  Cal.Health & Safety Code § 1317 (Deering 1975).
[3]  Fla.Stat.Ann. § 401.45 (West 1973).
[4]  Ill.Ann.Stat. ch 111½ § 86 (Smith-Hurd 1977).
[5]  Ky.Rev.Stat.Ann. § 216B.400 (Michie/Bobbs-Merrill 1980).
[6]  N.Y. Pub.Health Law § 2805-b (McKinney 1977).
[7]  Tenn.Code Ann. § 53-5201 (1977).
[8]  Tex.Health & Safety Code Ann., § 4438a (Vernon 1976).
[9]  Wis.Stat.Ann. § 46.21(8)(b) (West 1979).
[10]  Wyo.Stat. § 35-2-115(a) (1977).