Case Title: Miller v. Patel

Citation: 

Docket Number: 21S-CT-00455

State: indiana

Court: Indiana Supreme Court

Date: 2021-10-07T00:00:00Z

Document:
I N  T H E  
Indiana Supreme Court 
Supreme Court Case No. 21S-CT-455 
Betty Miller, Individually and as Personal 
Representative of the Estate of John Allen Miller, 
Appellant (Plaintiff below), 
–v– 
Laxeshkumar Patel, M.D., John Schiltz, M.D., 
Benjamin Coplan, M.D., Joseph Hill, M.D., Erik 
Fossum, M.D., Bradford Hale, M.D., Christine Tran, 
M.D., James Blickendorf, M.D., Robert McAllister, 
M.D., Sara Koerwitz, M.D., Timothy Held, PA, 
Community Health Network, Inc., d/b/a Community 
Howard Regional Health Hospital and Community 
Howard Behavioral Health, Community Physicians of 
Indiana, Inc., d/b/a Community Physician Network, 
Community Howard Regional Health, Inc., St. Joseph 
Hospital & Health Center, Inc., St. Vincent Health, 
Inc., Ascension Health, Inc., and Medical Associates, 
LLP, 
Appellees (Defendants below). 
FILED
C L E R K
Indiana Supreme Court
Court of Appeals
and Tax Court
Oct 07 2021, 9:55 am
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Argued: June 2, 2021 | Decided: October 7, 2021 
Appeal from the Marion Superior Court 
No. 49D01-1812-CT-49633 
The Honorable Heather A. Welch, Judge 
On Petition to Transfer from the Indiana Court of Appeals 
No. 20A-CT-1088 
Opinion by Justice Massa 
Chief Justice Rush and Justices David, Slaughter, and Goff concur. 
 
Massa, Justice. 
Betty Miller sued numerous health-care providers for negligently 
treating her mentally ill grandson. More than two years after the 
treatment, she sought to amend her complaint under Indiana Trial Rule 
15(C) to allege a violation of 42 U.S.C. § 1395dd, the Emergency Medical 
Treatment and Labor Act (EMTALA), which has a two-year statute of 
limitations. The trial court denied her request, and an appellate panel 
affirmed. Both concluded the statute of limitations preempted an 
amendment under our trial rules. Because we find no preemption, we 
reverse and remand.  
Facts and Procedural History 
According to Miller’s complaint, from December 9, 2016, through 
January 8, 2017, various providers treated her grandson, Zachary Miller, 
for his mental illness. On January 8, Zachary arrived at Community 
Howard Regional Health Hospital’s emergency room and requested 
admission for his mental illness and dangerous propensities. He was 
treated and discharged. He then went to Miller’s home and killed her 
husband, John Allen Miller. 
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In December 2018, Miller sued the providers, alleging their negligent 
care and treatment of Zachary led to John’s death. In February 2020, she 
moved to amend her complaint under Trial Rule 15(C) to add a new claim 
against Community Health Network, Inc. and Community Howard 
Regional Health, Inc., which own and operate Community Howard 
Regional Health Hospital, for violating EMTALA. The trial court denied 
her motion. It relied heavily on Williams v. Inglis, 142 N.E.3d 467, 476 (Ind. 
Ct. App. 2020), trans. denied, which held EMTALA’s two-year statute of 
limitations preempted an amendment under Trial Rule 15(C). 
Miller appealed, and our Court of Appeals affirmed. It rejected Miller’s 
attempts to distinguish Williams from her case. Miller v. Patel, 160 N.E.3d 
1111, 1119 (Ind. Ct. App. 2020), vacated. It also dismissed the significance 
of federal district court cases that addressed EMTALA amendments under 
the equivalent federal rule, because they did not involve preemption. Id. at 
1120–21. A dissenting judge on the panel believed it would be 
“inconsistent to hold that Indiana Trial Rule 15(C) ‘directly conflicts with’ 
. . . EMTALA when federal courts have allowed relation back under the 
similar federal rule.” Id. at 1123 (Tavitas, J., dissenting).   
Miller sought transfer, which we now grant. See Ind. Appellate Rule 
58(A).  
Standard of Review 
We generally review a trial court’s decision to grant or deny an 
amendment under Trial Rule 15(C) for an abuse of discretion. Ind. Farmers 
Mut. Ins. Co. v. Richie, 707 N.E.2d 992, 996 (Ind. 1999). However, we review 
questions of law, including preemption and statutory interpretation, de 
novo. State v. Norfolk S. Ry. Co., 107 N.E.3d 468, 471 (Ind. 2018); Young v. 
Hood’s Gardens, Inc., 24 N.E.3d 421, 424 (Ind. 2015).  
Discussion and Decision 
Congress enacted EMTALA to prevent hospitals from “dumping” 
indigent patients. Brooks v. Md. Gen. Hosp., Inc., 996 F.2d 708, 710 (4th Cir. 
Indiana Supreme Court | Case No. 21S-CT-455 | October 7, 2021 
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1993) (internal quotation marks omitted). To that end, EMTALA requires 
hospital emergency departments to (1) screen individuals for “emergency 
medical condition[s]” and (2) stabilize any such conditions or transfer the 
individuals as permitted by the statute. 42 U.S.C. § 1395dd(a)–(c). An 
individual personally harmed by a hospital’s violation of an EMTALA 
“requirement” may sue that hospital, 42 U.S.C. § 1395dd(d)(2)(A), in state 
or federal court, HCA Health Servs. of Ind., Inc. v. Gregory, 596 N.E.2d 974, 
977 (Ind. Ct. App. 1992), trans. denied. However, the action must be 
brought no “more than two years after the date of the violation.” 42 U.S.C. 
§ 1395dd(d)(2)(C).  
Federal law preempts state law when the two are at odds, U.S. Const. 
art. VI., and this preemption can be express or implied, Norfolk S. Ry. Co., 
107 N.E.3d at 471. Express preemption occurs when Congress explicitly 
defines a statute’s “preemptive effect.” Basileh v. Alghusain, 912 N.E.2d 
814, 818 (Ind. 2009). EMTALA contains an express preemption clause: 
“The provisions of this section do not preempt any State or local law 
requirement, except to the extent that the requirement directly conflicts 
with a requirement of this section.” 42 U.S.C. § 1395dd(f). In Williams, 142 
N.E.3d at 476, the Court of Appeals relied on this preemption clause to 
hold that Trial Rule 15(C) was preempted, because its application “would 
directly conflict with” EMTALA’s two-year statute of limitations. We now 
conclude there is no direct conflict and disapprove Williams’ contrary 
holding.  
While an express preemption clause “supports a reasonable inference” 
that Congress did not intend preemption beyond that clause, it does not 
“entirely foreclose[]” implied preemption. Freightliner Corp. v. Myrick, 514 
U.S. 280, 288–89 (1995); see also Hillman v. Maretta, 569 U.S. 483, 498 (2013). 
Implied preemption occurs through conflict and field preemption. Norfolk 
S. Ry. Co., 107 N.E.3d at 471. Conflict preemption arises when federal and 
state law directly conflict, making it impossible to comply with both, or 
when state law is “an obstacle to the accomplishment and execution of the 
full purposes and objectives of Congress.” Basileh, 912 N.E.2d at 818. Field 
preemption arises when comprehensive federal legislation occupies an 
entire field of regulation, leaving no room for state law. Id. Here, we 
conclude neither type of implied preemption exists.  
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I. 
EMTALA’s statute of limitations does not 
expressly preempt Miller’s proposed 
amendment under Trial Rule 15(C).  
EMTALA’s preemption clause is noticeably narrow. It disclaims 
preemption except when there is a direct conflict between a “State or local 
law requirement” and an EMTALA “requirement.” 42 U.S.C. § 1395dd(f). 
The clause “provides for limited preemption.” Brooks, 996 F.2d at 715; see 
also Deanco Healthcare, LLC v. Becerra, 365 F. Supp. 3d 1029, 1037 (C.D. Cal. 
2019) (“EMTALA contains a statement indicating a general congressional 
intent not to preempt state law.”). And it explicitly invokes one category 
of conflict preemption. See Basileh, 912 N.E.2d at 818. Assuming both the 
statute of limitations and Trial Rule 15(C) are “requirement[s]” for the 
purpose of EMTALA’s preemption clause, there is no direct conflict.1 
Trial Rule 15 governs amendments to pleadings, and subsection (C) 
provides, relevant here, that “[w]henever the claim or defense asserted in 
the amended pleading arose out of the conduct, transaction, or occurrence 
set forth or attempted to be set forth in the original pleading, the 
amendment relates back to the date of the original pleading.” Its federal 
equivalent, Federal Rule of Civil Procedure 15(c)(1)(B), similarly provides 
that “[a]n amendment to a pleading relates back to the date of the original 
pleading when the amendment asserts a claim or defense that arose out of 
 
1 EMTALA defines various words and terms but not “requirement.” See 42 U.S.C. § 1395dd(e). 
However, “it is a normal rule of statutory construction that identical words used in different 
parts of the same act are intended to have the same meaning.” Taniguchi v. Kan Pac. Saipan, 
Ltd., 566 U.S. 560, 571 (2012) (internal quotation marks omitted); see also Antonin Scalia & 
Bryan A. Garner, Reading Law: The Interpretation of Legal Texts 170 (2012) (“A word or phrase is 
presumed to bear the same meaning throughout a text; a material variation in a term suggests 
a variation in meaning.”). Throughout EMTALA, “requirement” refers to obligations placed 
on hospitals, like the medical screening and stabilization requirements. See, e.g., 42 U.S.C. § 
1395dd(a)–(b). Because nothing indicates the preemption clause uses “requirement” 
differently than the rest of the statute, the clause is seemingly aimed at state and local 
obligations that directly conflict with EMTALA obligations. The statute of limitations, then, 
would not be an EMTALA “requirement.” Nor would Trial Rule 15(C) be a state 
“requirement.” In that case, the preemption clause would be inapplicable. But we need not 
decide this question because there is no direct conflict. 
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the conduct, transaction, or occurrence set out—or attempted to be set 
out—in the original pleading.” This similarity is unsurprising, of course, 
as many of our trial rules are based on the federal civil procedure rules. 
Richie, 707 N.E.2d at 997. Under both rules, a new claim can be timely by 
relating back to the date when the original complaint was filed. McCarty v. 
Hosp. Corp. of Am., 580 N.E.2d 228, 230–31 (Ind. 1991); Bensel v. Allied Pilots 
Ass’n, 387 F.3d 298, 310 (3d Cir. 2004). These rules ensure claims comply, 
rather than conflict, with statutes of limitations. 
In federal court, a plaintiff could try to amend her complaint with an 
EMTALA claim. See Fed. R. Civ. P. 15(c)(1)(B). Indeed, district courts have 
allowed such an amendment. See, e.g., Freedman v. Fisher, 89 F. Supp. 3d 
716, 719–20 (E.D. Pa. 2015) (concluding the plaintiff’s EMTALA claim 
related back to the filing of the original complaint). We fail to see how an 
amendment under Trial Rule 15(C) directly conflicts with EMTALA’s 
statute of limitations when an amendment under the equivalent federal 
rule would not. Because there is no material difference between the two 
procedural rules, Miller is not trying to use state law to “extend, expand, 
or enlarge” her federal rights. Gregory, 596 N.E.2d at 977. Both rules work 
harmoniously with statutes of limitations by bringing claims within the 
necessary time period. EMTALA’s express preemption clause does not 
prevent Miller’s proposed amendment because there is no direct conflict.  
II. 
There is no implied preemption that would 
prevent Miller’s proposed amendment under 
Trial Rule 15(C).  
The absence of express preemption does not end our analysis. See 
Myrick, 514 U.S. at 288–89. We must still consider the two strands of 
implied preemption: conflict and field. And we conclude neither prohibits 
Miller’s proposed amendment.  
Conflict preemption exists either when federal and state law directly 
conflict, so it is impossible to comply with both, or when state law is an 
obstacle to achieving Congress’ objectives. Basileh, 912 N.E.2d at 818. As 
previously discussed, there is no direct conflict between the statute of 
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limitations and Trial Rule 15(C). Miller can comply with both: An 
amendment under Trial Rule 15(C) relates back to the date of the filing of 
the original complaint, allowing her new claim to be timely under the 
statute of limitations. And an amendment under Trial Rule 15(C) does not 
interfere with Congress’ objectives. To help enforce EMTALA and 
compensate injured individuals, Congress created a private cause of 
action subject to a statute of limitations. 42 U.S.C. § 1395dd(d)(2)(A), (C). 
Statutes of limitations are legislative judgments and serve important 
purposes. But amendments under Trial Rule 15(C) and Federal Rule of 
Civil Procedure 15(c)(1)(B) are “premised on the notion that a party is not 
entitled to the protection of the statute of limitations.” Bensel, 387 F.3d at 
310. This is because the allegations in the original complaint provided 
notice that the defendant “may be subject to any possible additional 
claims” stemming from those allegations. McCarty, 580 N.E.2d at 231. A 
Trial Rule 15(C) amendment is not an obstacle to Congress’ objectives.  
Field preemption exists when there is no room for state law because 
comprehensive federal legislation occupies an entire field of regulation. 
Basileh, 912 N.E.2d at 818. It arises only if Congress “adequately indicated 
an intent to occupy the field of regulation, thereby displacing all state laws 
on the same subject.” Brown v. Hotel and Rest. Emps. and Bartenders Int’l 
Union Loc. 54, 468 U.S. 491, 501 (1984). Here, there is no indication 
Congress intended to occupy an entire field. It did not restrict EMTALA 
claims to federal court, see Gregory, 596 N.E.2d at 977; Smith v. Richmond 
Mem’l Hosp., 416 S.E.2d 689, 695 (Va. 1992), which would have occupied 
the field for pursuing these claims and displaced state procedural rules 
like Trial Rule 15(C). Accordingly, there is no field preemption.   
Conclusion 
Because we find EMTALA’s statute of limitations does not preempt an 
amendment under Trial Rule 15(C), we reverse the trial court. In denying 
Miller’s motion, the trial court focused only on preemption. It must now 
consider whether the EMTALA claim arose out of the same conduct set 
forth or attempted to be set forth in the original complaint, along with 
other relevant factors. See Palacios v. Kline, 566 N.E.2d 573, 575 (Ind. Ct. 
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App. 1991). Accordingly, we remand for reconsideration of Miller’s 
motion in light of our opinion.  
Rush, C.J., and David, Slaughter, and Goff, JJ., concur. 
A TT O R N E YS F O R  AP P EL LA N T  
Nicholas C. Deets 
Tyler J. Zipes 
Hovde Dassow + Deets, LLC 
Indianapolis, Indiana 
A TT O R N E YS F O R  AP P EL LE E S 
Edna M. Koch 
Joseph D. McPike, II 
Erin E. Myers 
Zeigler Cohen & Koch 
Indianapolis, Indiana  
 
Jon M. Pinnick 
Schultz & Pogue, LLP  
 
Indianapolis, Indiana