Document ID: s3://data.kl3m.ai/documents/govinfo/USCOURTS/USCOURTS-ca5-16-10192/USCOURTS-ca5-16-10192-0/pdf.json

Parties Involved:
Danny Fewins
Appellant
Melissa Fewins
Appellant
Granbury Hospital Corporation
Appellee
Scott Jones
Appellee
Questcare Medical Services, Professional Association
Appellee

Document Text:

IN THE UNITED STATES COURT OF APPEALS

FOR THE FIFTH CIRCUIT

No. 16-10192

DANNY FEWINS, Individually and as Next Friend for DAF, a Minor; 

MELISSA FEWINS, Individually and as Next Friend for DAF, a Minor,

Plaintiffs - Appellants

v.

GRANBURY HOSPITAL CORPORATION, doing business as Lake Granbury 

Medical Center; SCOTT JONES, M.D.; QUESTCARE MEDICAL SERVICES, 

PROFESSIONAL ASSOCIATION,

Defendants - Appellees

Appeal from the United States District Court 

for the Northern District of Texas

USDC No. 3:14-CV-898

Before BENAVIDES, HAYNES, and GRAVES, Circuit Judges.

PER CURIAM:*

This is an appeal from an order granting summary judgment for 

the Appellee, Lake Granbury Medical Center (“LGMC”). Appellants 

Danny Fewins and Melissa Fewins, individually and as Next Friend for 

their minor son, (“D.A.F.”), brought this suit against LGMC for violations 

 

* Pursuant to 5TH CIR. R. 47.5, the court has determined that this opinion should not 

be published and is not precedent except under the limited circumstances set forth in 5TH 

CIR. R. 47.5.4.

United States Court of Appeals

Fifth Circuit

FILED

October 25, 2016

Lyle W. Cayce

Clerk

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of the Emergency Medical Treatment and Active Labor Act (“EMTALA”) 

arising from LGMC’s treatment of D.A.F. on June 29, 2012. Because 

Appellants have not raised a material issue of fact with respect to any of 

their claims brought pursuant to EMTALA, we AFFIRM the district 

court’s grant of summary judgment in favor of LGMC.

I. FACTUAL AND PROCEDURAL HISTORY

 On June 22, 2012, while playing at a local park, D.A.F. was climbing a 

tree and fell approximately three feet. Although he seemed fine at first 

with only a small cut and bruise on his leg, several days later he began 

running a fever and complaining of pain in both legs. As a result, on June 

27, his mother took him to Glen Rose Medical Center (“GRMC”) in Glen 

Rose, Texas. The Fewins did not have health insurance. His mother told 

the staff that he had fallen on June 22 and that he now complained of 

pain when his legs were touched or he moved or put weight on them. The 

nursing staff measured D.A.F.’s vital signs: blood pressure 115/86, heart 

rate of 110, respiratory rate of 16, and temperature of 99.9. The staff 

noted that D.A.F. had been crying and that he had limited range of 

motion in his hips and thighs, which were sensitive to palpation. D.A.F. 

reported his pain as rating a ten on the pain rating scale of ten and was 

given Tylenol with codeine for pain relief. X-rays of his femur and hip 

were ordered. The chart described the results of the x-rays as normal. 

D.A.F. was discharged from the hospital with a diagnosis of acute pain in 

his right lower extremity. 

The next day, June 28, 2012, D.A.F. stayed home with his father 

and seemed to fare better. That night, he began to run a fever and 

complained of increasing pain in his hips. D.A.F. did not want to move. 

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During the early morning of June 29, Mrs. Fewins took D.A.F. to LGMC. 

At LGMC’s emergency room, his vital signs were as follows: a 

temperature of 97.6; pulse rate of 125; respiratory rate of 22; and 10 out 

of 10 on the pain scale. Mrs. Fewins informed the emergency room staff 

that two days ago she had taken her son to the emergency room at the 

GRMC. Dr. Scott Jones, a board-certified emergency physician 

performed a physical examination of D.A.F., which revealed moderate 

tenderness in the left lower extremity. Dr. Jones ordered blood and urine 

testing and a CT of the child’s lower extremities and pelvis. The CT was 

read as having sub-acute subcutaneous contusions and a small 

intramuscular sub-acute hematoma. The blood tests results were a white 

blood cell count of 14.7, with presence of 81% neutrophils and 12% bands. 

According to the Fewins’ expert, Dr. Carlson, the blood test results reveal 

an abnormally elevated white blood cell count and were highly suggestive 

of a bacterial infection. Dr. Jones later testified at his deposition that 

although the tests were “outside the lab’s reference range,” his opinion 

was that there were no “clinically significant abnormalities.” Dr. Jones 

did not consider the results elevated or abnormal in a six-year old. 

Dr. Jones’s notes provided that there was no evidence of anything 

other than a contusion/hematoma and that a muscle strain was 

suspected. Dr. Jones thought it seemed like the patient cried and 

complained of pain more when his mother was present. Mrs. Fewins 

stated to Dr. Jones that her son sometimes plays up his injuries to her. 

Dr. Jones believed that although D.A.F. was in pain, he was exaggerating 

his symptoms. Dr. Jones did not see any evidence of serious etiology and 

did not think the contusion/hematoma/strain constituted a serious threat 

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to D.A.F.’s life or a limb-threatening condition. Dr. Jones consulted with 

a radiologist and diagnosed a contusion on each hip and acute pain in his 

right lower extremity. Dr. Jones noted the patient’s condition was stable 

and discharged D.A.F. The mother was instructed to continue to 

administer Tylenol with codeine and to follow up D.A.F.’s care with his 

pediatrician on Monday. At discharge, D.A.F. refused to walk because of 

the pain.

Early the next morning on June 30, the Fewins took their son to the 

emergency room at Cook Children’s Medical Center (“Cook Children’s”). 

His temperature was 103.6, pulse 166, respirations of 32 and pain 

reported as 6 out of 10. He was noted to have swelling and exquisite 

tenderness in his left femur upon palpitation. There was a decrease in 

white blood count indicating infection. He was admitted to the hospital 

and began receiving antibiotics for infection and morphine for pain. The 

diagnosis at the time of admission was myositis, fever and limp. He was 

hospitalized from June 30 to August 10, and underwent several surgeries 

and was treated for a Methicillin-resistant Staphylococcus aureus 

(“MRSA”) infection. As a result, he has permanent bone damage and is 

at risk for future infection and injuries. 

On March 11, 2014, David and Melissa Fewins, individually and as 

Next Friend for D.A.F., brought the instant suit against LGMC for 

violations of the EMTALA arising from LGMC’s treatment of D.A.F. on 

June 29, 2012.1 In addition, the Fewins brought a malpractice claim, 

 

1 In the same action, the Fewins also named Dr. Jones and Questcare Medical Services 

as defendants. However, the district court severed the claims against LGMC from the other 

defendants, creating two separate actions. Vander Zee v. Reno, 73 F.3d 1365, 1368 n.5 (5th 

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alleging that LGMC was negligent with respect to the care and treatment 

provided to D.A.F. On May 9, 2014, LGMC filed a motion to dismiss for 

failure to state a claim. On January 13, 2015, the district court denied 

the motion to dismiss. On May 1, LGMC filed a motion for summary 

judgment. Two weeks later, the Fewins filed a motion for partial 

summary judgment. Subsequently, on May 21, LGMC filed a motion to 

strike the opinions of the Fewins’s expert witness, Dr. Carlson. 

On August 7, the district court held a hearing on the motions for 

summary judgment, partial summary judgment, and to exclude the 

opinions of Dr. Carlson. At the conclusion of the hearing, the district 

court orally granted LGMC’s motion for summary judgment, concluding 

that there was an adequate medical screening evaluation conducted by 

Dr. Jones and thus, there was no EMTALA violation. The court also 

concluded that Dr. Carlson’s expert testimony was “not the product of 

reliable principles and methods and that he did not reasonably apply the 

principles and methods, had those been reliable, to the facts of the case.” 

Thus, the court ruled that Dr. Carlson’s testimony was not admissible 

under Federal Rule of Evidence 702. The court also found that there was 

“no evidence that the nurses engaged in any willful and wanton 

negligence that would support a claim against [LGMC].” 

On January 25, 2016, the court issued a memorandum opinion and 

order granting LGMC’s motion for summary judgment and denying the 

 

Cir. 1996). Thus, although the district court entered final judgment with respect to the claims 

against LGMC, as set forth at II.D. infra, we do not have appellate jurisdiction over the order 

granting Dr. Jones and Questcare Medical Services’s motion to exclude the expert witness’s 

testimony.

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Fewins’s motion for partial summary judgment. Subsequently, the 

district court entered final judgment, and the Fewins timely appealed.

II. ANALYSIS

A. Standard of Review

This Court reviews a “grant of summary judgment de novo, 

applying the same standard as the district court.” QBE Ins. Corp. v. 

Brown & Mitchell, Inc., 591 F.3d 439, 442 (5th Cir. 2009). The moving 

party is entitled to summary judgment if it “shows that there is no 

genuine dispute as to any material fact and the movant is entitled to 

judgment as a matter of law.” Fed. R. Civ. P. 56(a).

B. EMTALA Claim

The Fewins contend that the district court erred in granting 

summary judgment in favor of LGMC, arguing that there are genuine

issues of material fact with respect to their EMTALA claim. The statute 

requires that a hospital provide the following care to a person seeking 

emergency medical treatment: “(1) an appropriate medical screening, 

(2) stabilization of a known emergency medical condition, and 

(3) restrictions on transfer of an unstabilized individual to another 

medical facility.” Battle v. Mem. Hosp. at Gulfport, 228 F.3d 544, 557 

(5th Cir. 2000) (citing 42 U.S.C. § 1395dd(a)-(c)). 

However, Congress did not intend the EMTALA to be utilized as a 

federal malpractice statute. Marshall v. East Carroll Parish Hosp. Serv. 

Dist., 134 F.3d 319, 322 (5th Cir. 1998). Instead, it “was enacted to 

prevent ‘patient dumping,’ which is the practice of refusing to treat 

patients who are unable to pay.” Id. (citations omitted). As such, “an 

EMTALA ‘appropriate medical screening examination’ is not judged by 

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its proficiency in accurately diagnosing the patient’s illness, but rather 

by whether it was performed equitably in comparison to other patients 

with similar symptoms.” Id. Thus, if the patient is “provided an 

appropriate medical screening examination,” the hospital “is not liable 

under EMTALA even if the physician who performed the examination 

made a misdiagnosis that could subject him and his employer to liability 

in a medical malpractice action brought under state law.” Id. 

To survive a motion for summary judgment, a plaintiff must submit 

evidence demonstrating a material fact issue with respect to whether the 

hospital afforded an appropriate medical screening examination under 

EMTALA. Id. at 323. The statute itself does not define the parameters 

of an appropriate examination. Id. An appropriate examination is one 

that the hospital would have provided “to any other patient in a similar 

condition with similar symptoms.” Id. The plaintiff has the burden of 

demonstrating that the hospital failed to provide an appropriate 

examination under EMTALA. Id. at 323–24. The plaintiff may carry this 

burden by demonstrating that either: (1) the hospital failed to follow its 

own standard screening procedures; or (2) there were “differences 

between the screening examination that the patient received and 

examinations that other patients with similar symptoms received at the 

same hospital”; or (3) the hospital offered “such a cursory screening that 

it amounted to no screening at all.” Guzman v. Memorial Hermann Hosp. 

Sys., 409 F. App’x 769, 773 (5th Cir. 2011). 

1. Cursory Screening

The Fewins contend that Dr. Jones’s screening of D.A.F. was so 

cursory that it did not amount to a screening. In support of that 

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contention, the Fewins point to Mrs. Fewins’s deposition testimony that 

although she knew something was wrong with D.A.F., Dr. Jones did not 

want to listen to her. The Fewins assert that Mrs. Fewins’s testimony 

must be believed for the purposes of summary judgment analysis, and 

thus, her testimony raises a fact issue as to whether the screening was 

so cursory that it amounted to no screening. While it is correct that we 

must view the evidence in the light most favorable to the nonmoving 

party, Am. Home Assurance Co. v. United Space Alliance, LLC, 378 F.3d 

482, 486 (5th Cir. 2004), there is undisputed evidence that demonstrates 

that the screening was not cursory. 

D.A.F. arrived at LGMC’s emergency room at 5:48 a.m. Within six 

minutes, he was in triage and the nurse took his vital signs. At 6:02, Dr. 

Jones began evaluating him and took a history from him and his mother. 

The medical records show that Dr. Jones reviewed the nurse’s 

documentation and then performed a physical examination of D.A.F. Dr. 

Jones then ordered several lab tests, including blood tests and a 

urinalysis. Dr. Jones also ordered a CT scan of the lower extremities and 

pelvis. In addition to receiving the report about the CT scan from 

Nighthawk Radiology Services, Dr. Jones called LGMC’s staff radiologist 

to consult with him. The records also note that Dr. Jones reviewed all 

lab results and concluded there were no “clinically significant 

abnormalities.” 

The only case relied upon by the Fewins to show that the screening 

was cursory is a First Circuit opinion. Correa v. Hosp. S.F., 69 F.3d 1184 

(1st Cir. 1995). In Correa, the patient was a 65-year old woman who 

presented to the emergency room feeling nauseous and having chest 

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pains. Id. at 1188. Although the patient waited at least two hours, she 

received no treatment or screening and finally gave up and went to 

another facility and passed away shortly thereafter. Id. at 1189. Under 

those circumstances, the First Circuit held that the jury’s finding that 

the hospital denied the plaintiff an appropriate screening examination 

“unimpugnable.” Id. at 1193. Correa is inapposite. Here, D.A.F. was 

triaged almost immediately and then examined by Dr. Jones, who 

ordered a CT and lab tests. After reviewing the results of the lab tests 

and consulting a radiologist, Dr. Jones concluded D.A.F. had a hematoma 

and discharged him. In light of the undisputed evidence in the record,

the Fewins’s contention that the screening was so cursory that it did not 

constitute a screening is meritless. 

2. Failure to Follow Procedure

To show that LGMC did not follow its own screening procedure, the 

Fewins contend that LGMC violated its pain management policy in 

screening D.A.F. The Fewins point to the testimony of Ann Quinlan, the 

LGMC Corporate Representative, as proof that the pain management 

policy was violated. The Fewins assert that Quinlan’s testimony 

demonstrates that the nurses were expected to follow LGMC’s pain 

management policy. Quinlan’s testimony does demonstrate that the 

nurses at LGMC were expected to follow the “hospital-wide nursing 

policy on pain assessment.” The Fewins also contend that Quinlan 

admitted that the nurses failed to follow the policy’s required 

assessments. Contrary to the Fewins’s contention, Quinlan testified that 

the nurse who saw D.A.F. “did follow” the policy on pain management. 

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The Fewins further contend that the nurses were expected to follow 

the pain management policy as part of the medical screening 

examination. This contention is incorrect. During the deposition, the 

Fewins’s attorney asked Quinlan whether there are “any medical 

screening examination protocols that apply to nursing staff in the 

emergency department.” Quinlan responded as follows: “No. The 

medical screening exam is always done by a physician or a licensed 

independent practitioner.” Additionally, Quinlan specifically testified 

that nurse practitioners or physician’s assistants did not perform 

EMTALA medical screening examinations at LGMC. Quinlan testified 

that although the nurse practitioner may gather the information, a 

physician sees all the patients for purposes of the EMTALA medical 

screening. This Court has explained that if a triage assessment is 

preliminary to and not part of the medical screening examination, then 

whether the triage violated the hospital’s policy is not material to the 

EMTALA claim. Stiles v. Tenet Hosp., Ltd., 494 F. App’x 432, 436 (5th 

Cir. 2012). Accordingly, even assuming that the Fewins could 

demonstrate that the nurses violated the pain management policy in 

assessing D.A.F., because their assessment was not part of the medical 

screening examination, any such violation would not be material to the 

Fewins’s EMTALA claim. 

Indeed, Dr. Carlson’s own testimony makes clear that the pain 

management policy was not part of the emergency medical screening 

examination pursuant to EMTALA. Dr. Carlson testified that “LGMC 

had no standard emergency medical screening examination protocol” and 

that the “general screening policy delegated the medical screening 

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examination to the emergency room doctor, who was allowed to use his 

or her individual judgment on each individual patient in determining 

whether the screening examination was adequate.” Dr. Carlson also 

testified that Dr. Jones “had enough information based on the history, 

physical exam, the CBC and CT to say that a soft tissue infection was the 

most serious diagnosis and most likely diagnosis.” Thus, Dr. Carlson’s 

testimony demonstrates that Dr. Jones obtained adequate information 

from his screening examination to make the correct (or at least most 

likely) diagnosis. As LGMC contends, boiled down, Dr. Carlson’s 

criticism is that Dr. Jones failed to diagnose the infection in D.A.F. This 

argument does not implicate an EMTALA claim. See Marshall, 134 F.3d 

at 322 (explaining that if a patient is “provided an appropriate medical 

screening examination,” a hospital “is not liable under EMTALA even if 

the physician who performed the examination made a misdiagnosis that 

could subject him and his employer to liability in a medical malpractice 

action brought under state law”). In sum, the Fewins have not shown 

that the alleged violation of the pain management policy created a fact 

issue with respect to their EMTALA screening examination claim. 

3. Disparate Screenings of Similar Symptoms

The Fewins next contend that D.A.F. was screened disparately 

compared with three other patients who had similar symptoms. To 

obtain a pool of patients who had similar symptoms, the Fewins’s expert, 

Dr. Carlson, identified the relevant symptoms and the associated medical 

codes and requested medical records from LGMC that matched his 

request. In response, LGMC provided the medical records of three 

patients. 

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The first patient was an 81-year old male who arrived at LGMC 

complaining of lower leg pain. He ranked his pain as 1 out of 10 and his 

white blood cell count was elevated. He was taking penicillin for his 

cellulitis. The second patient was a 58-year old male who was obese and 

complained of hip pain. His white blood cell count was elevated. He had 

a history of asthma, congestive heart failure, hypertension, diabetes, 

renal failure and atrial fibrillation. He was taking numerous 

prescription medications for these health conditions. The third patient 

was a 79-year old female with dementia who had a sudden onset of 

weakness and pain in her knee. Her white blood cell count was elevated. 

She was wearing a prosthesis and previously had surgery on her knee. 

Unlike D.A.F., all three patients were admitted to the hospital. The 

Fewins’s expert witness, Dr. Carlson, testified that in his opinion D.A.F. 

was treated disparately from the other three patients. However, as the 

district court explained, EMTALA does not apply unless patients who are 

perceived to have the same medical condition receive disparate 

treatment. Marshall, 134 F.3d at 323 (citing Vickers v. Nash General 

Hosp., Inc., 78 F.3d 139, 144 (4th Cir. 1996)). D.A.F. was a child who 

appeared healthy prior to falling from the tree. Dr. Jones perceived 

D.A.F.’s pain to be caused by the contusion or hematoma that resulted 

from the fall. The comparators were much older than D.A.F. with 

medical histories unlike D.A.F.’s history. Thus, although the other 

patients may have had similar symptoms, they do not appear to have 

been “in a similar condition” to D.A.F. Id. at 323. Moreover, the 

physicians evaluating those three patients perceived that each patient 

was possibly suffering from an infection. The medical records 

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demonstrate that Dr. Jones did not perceive D.A.F. to have an infection. 

Indeed, at the hearing before the district court, D.A.F.’s counsel admitted 

that Dr. Jones “didn’t perceive it to be an emergency.”2 Accordingly, 

because the Fewins have not provided competent evidence showing that 

D.A.F. was perceived to have the same medical condition as the other 

patients, they cannot demonstrate that D.A.F. received disparate 

screening. Marshall, 134 F.3d at 323 (citing inter alia Vickers, 78 F.3d 

at 144). 

4. Stabilization

The Fewins also contend that D.A.F. was not stabilized prior to his 

discharge in violation of EMTALA. A hospital’s duty to stabilize does not 

arise unless it has actual knowledge of the patient’s unstabilized 

emergency medical condition. Marshall, 134 F.3d at 325. To prevail on 

this issue, the Fewins “must identify evidence from which a jury could 

conclude that [LGMC] had actual knowledge that [D.A.F.] had an 

emergency medical condition and, if so, that he was not stabilized prior 

to the discharge.” Battle, 228 F.3d at 559. 

 As previously noted at footnote 2 supra, at the hearing before the 

district court, D.A.F.’s counsel admitted that the only record evidence to 

show that Dr. Jones perceived D.A.F. to have an “emergency medical 

condition”3 was Dr. Jones’s checking the box on the form indicating that 

 

2 After admitting that Dr. Jones did not perceive D.A.F. as having an “emergency 

condition,” counsel stated that Dr. Jones did check the box on the form for a “certified medical 

emergency.” As explained in Section II.B.2., infra, Dr. Jones’s checking the box does not raise 

a material issue of fact with respect to whether Dr. Jones thought D.A.F. had an “emergency 

medical condition.” 3 42 U.S.C. § 1395dd(c); Battle, 228 F.3d at 558. 

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there was a “certified medical emergency.” Therefore, to demonstrate 

that D.A.F. had an “emergency medical condition,” the Fewins rely on Dr. 

Jones’s notation in the medical record that “Patient’s condition 

represents a certified medical emergency. Disposition date/time: 

06/29/2012 08:24.” (emphasis added). At the hearing, the district court 

ruled that documenting a “certified medical emergency” is not the same 

as finding an “emergency medical condition.” The court held “as a matter 

of law, from the undisputed facts, that Dr. Jones did not find an 

emergency medical condition. [I]t is the position of the plaintiffs that 

there was one and he should have found it, but it’s clear that he did not

find one.” The court further held that although Dr. Jones administered 

an adequate and appropriate medical screening evaluation, he did not 

find that D.A.F. had an emergency medical condition. 

During his deposition, Dr. Jones testified that his notation of a 

“certified medical emergency” did not mean that D.A.F. had an 

“emergency medical condition.” He testified that those two terms are 

“very different.” He explained that when a patient presents in the 

emergency room with a “certified medical emergency,” the physician does 

not know whether they have an “emergency medical condition.” Once a 

patient is in the emergency room and presents with a “condition which 

could potentially be a serious emergent condition, . . . we are instructed 

to document that they have a certified medical emergency.” If the 

physician finds a certified medical emergency, the physician is “obligated 

to investigate it, to do a medical screening exam, to investigate what the 

extent of the injury or illness is.” He further explained that unless it is 

documented that a person has a certified medical emergency, there is “no 

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testing or work up or assessment” of the patient. Dr. Jones understood 

that a certified medical emergency must be documented for a third-party 

payor to cover the emergency room visit. Nonetheless, if a “patient still 

requests the evaluation,” he would then perform it. Dr. Jones testified 

that the physicians documented that “virtually every patient who came 

in the door” had a certified medical emergency unless the patient had a 

trivial complaint such as a hangnail. 

The medical record shows that D.A.F.’s vital signs had improved by 

the time of discharge and that Dr. Jones did not believe that the lab test 

results were clinically abnormal. D.A.F.’s reported pain level had 

decreased to a zero at the time of discharge. Dr. Jones concluded that 

D.A.F. was medically stable and discharged him. Dr. Jones testified that 

after he conducted the medical screening exam of D.A.F., he concluded 

that D.A.F. did not have an emergency medical condition. 

Although we must view the evidence in the light most favorable to 

the Fewins, there is no evidence that raises a fact issue with respect to 

Dr. Jones’s opinion that D.A.F. did not have an emergency medical 

condition despite his documenting D.A.F. as having a “certified medical 

emergency.” The evidence demonstrates that Dr. Jones, whose 

knowledge is imputed to LGMC, did not perceive or have actual 

knowledge that D.A.F. had an emergency medical condition. Thus, the 

Fewins have not shown that the district court erred in granting summary 

judgment to LGMC on the stabilization claim. Battle, 228 F.3d at 559. 

C. Negligence/Malpractice Theory

The Fewins contend that fact issues preclude summary judgment 

on their claim of negligence/malpractice against LGMC. During the 

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hearing before the district court, Fewins’s counsel specifically stated 

that: “Setting aside the EMTALA issue, there are no negligence 

allegations against the hospital.” Id.4 The Fewins therefore abandoned 

any negligence claims they had against LGMC. Further, even if this 

claim had not been abandoned below, the argument with respect to this 

issue on appeal is abandoned by the inadequate briefing. See e.g., Young 

v. Repine (In re Repine), 536 F.3d 512, 518 n.5 (5th Cir. 2008); see also

Fed. R. App. P. 28(a)(8) (requiring citation to authorities).

D. Exclusion of Expert Witness Testimony

Finally, the Fewins contend that the district court erred in granting 

LGMC’s motion to exclude the testimony of their expert witness, Dr. 

Carlson, whose opinion criticized Dr. Jones’s medical treatment of D.A.F. 

As set forth above, even considering Dr. Carlson’s opinion testimony, we 

conclude that the district court properly granted summary judgment 

with respect to the EMTALA claims against LGMC. Thus, we find it 

unnecessary to reach this issue in disposing of the Fewins’s appeal from 

the district court’s final judgment in favor of LGMC. 

The Fewins also filed a notice of appeal from a separate order issued 

on February 18, 2016, in which the district court granted Dr. Jones and 

Questcare’s motion to exclude Dr. Carlson’s testimony. However, this is 

an interlocutory order, and the district court did not certify it pursuant 

to Federal Rule of Civil Procedure 54(b), nor did the court enter a final 

 

4 Additionally, the Fewins’s counsel stated that his complaints against the nurses 

only relate to the EMTALA claims. 

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judgment with respect to these two defendants.5 Additionally, the appeal 

of this non-final order is neither inextricably intertwined with LGMC’s 

appeal nor is it necessary to ensure meaningful review of LGMC’s appeal. 

We therefore do not have pendent appellate jurisdiction of the district 

court’s order. See Thornton v. General Motors Corp., 136 F.3d 450, 453 

(5th Cir. 1998) (explaining that pendent appellate jurisdiction should 

only be found “proper in rare and unique circumstances where a final 

appealable order is inextricably intertwined with an unappealable order 

or where review of the unappealable order is necessary to ensure 

meaningful review of the appealable order”) (internal quotation marks 

and citations omitted). Accordingly, we dismiss for lack of jurisdiction 

the appeal from the February 18, 2016 order granting the motion to 

exclude Dr. Carlson’s opinion testimony. 

III. CONCLUSION

For the aforementioned reasons, we AFFIRM the district court’s 

grant of summary judgment in favor of LGMC. We DISMISS for lack of 

jurisdiction the appeal from the February 18, 2016 order granting Dr. 

Jones and Questcare’s motion to exclude Dr. Carlson’s opinion testimony.

 

5 The summary judgment in favor of LGMC was final and appealable. The district 

court had issued an order severing and staying the claims against Dr. Jones and Questcare. 

When the district court severed the claims against these two defendants, it created two 

separate actions. Vander Zee v. Reno, 73 F.3d 1365, 1368 n.5 (5th Cir. 1996). The district 

court then entered a judgment dismissing all of the claims against LGMC that are now before 

this Court on appeal. Accordingly “no Rule 54(b) certification was required to render the 

judgment final and appealable.” Id. (citing United States v. O’Neil, 709 F.2d 361, 368–69 (5th 

Cir. 1983)).

 Case: 16-10192 Document: 00513733379 Page: 17 Date Filed: 10/25/2016