Source: https://case-law.vlex.com/vid/175-f-3d-170-594290918
Timestamp: 2020-03-29 00:55:31
Document Index: 767345243

Matched Legal Cases: ['§ 1331', '§ 1367', '§ 1395', '§ 1395', '§ 1395', '§ 1395', '§ 1395']

175 F.3d 170 (1st Cir. 1999), 98-1594, Lopez-Soto v. Hawayek - Federal Cases - Case Law - VLEX 594290918
Docket Nº: 98-1594.
Citation: 175 F.3d 170
Party Name: Mayda LOPEZ-SOTO, Et al., Plaintiffs, Appellants, v. Jose HAWAYEK, M.D., Et al., Defendants, Appellees.
175 F.3d 170 (1st Cir. 1999)
Mayda LOPEZ-SOTO, Et al., Plaintiffs, Appellants,
Jose HAWAYEK, M.D., Et al., Defendants, Appellees.
Experiencing normal labor pains, Mayda L¢pez-Soto arrived at Auxilio Mutuo Hospital (the Hospital) in the early morning hours of June 12, 1993. Hospital personnel brought her to the maternity ward where she was examined and admitted. Dr. Jose Hawayek, an obstetrician, broke her water at approximately 7:30 a.m., revealing the presence of thick "pea soup" meconium in the amniotic fluid. Rupturing the membranes of the amniotic sac failed to stimulate dilation, so Dr. Hawayek ordered a cesarean section. L¢pez-Soto gave birth to a baby boy at 1:50 p.m. (roughly 15 minutes after the operation commenced). The infant emerged in severe respiratory distress due to meconium aspiration. His condition presented a medical emergency.
Hospital staffers summoned Dr. Mart¡n Garrido, the pediatrician on call. Dr. Garrido determined that the baby required specialized care and began making arrangements to transfer him to a hospital with a functioning neonatal intensive care unit. Before transport occurred, Dr. Garrido identified an additional cause for medical concern: the presence of a pulmonary pneumothorax. He nonetheless elected to send the infant to the receiving hospital without first attempting to stabilize the patient or to treat that exigent condition. The baby was admitted to the San Juan Pediatric Hospital that evening, but perished the next day.
L¢pez-Soto and her husband brought suit on behalf of themselves and the deceased child in Puerto Rico's federal district court. 1 The complaint named as defendants the Hospital and several caregivers, including Drs. Hawayek and Garrido. L¢pez-Soto premised jurisdiction on the presence of a federal question, see 28 U.S.C. § 1331, that question being
the existence of a putative cause of action against the Hospital arising under federal law (to wit, EMTALA). She added supplemental claims for medical malpractice under local law against all the defendants.
Only the EMTALA claim is relevant here. In her complaint, L¢pez-Soto posited that the Hospital violated EMTALA because her baby was born "with a severe pulmonary condition that required emergency and immediate medical care and treatment," but the Hospital nonetheless transferred him to another institution without stabilizing this condition. The defendants denied the material allegations of the complaint and contested jurisdiction, saying that EMTALA did not apply. After considerable jousting (not relevant here), the district court, acting pursuant to Fed.R.Civ.P. 56, accepted the defendants' jurisdictional argument and dismissed the EMTALA claim. At the same time, the court declined to retain supplemental jurisdiction over the medical malpractice claims, dismissing them without prejudice. See 28 U.S.C. § 1367(c). This appeal ensued.
L¢pez-Soto's EMTALA claim hinges on the Hospital's alleged failure to comply with the statute's stabilization and transfer provisions. See 42 U.S.C. § 1395dd(b)-(c). In a thoughtful opinion, the district court concluded that Congress's isthmian concern with patient dumping--the practice of refusing to accept or treat patients who are uninsured or have no demonstrable means of payment--precluded reading these provisions independently of 42 U.S.C. § 1395dd(a). See L¢pez- Soto v. Hawayek, 988 F.Supp. 41, 45 (D.P.R.1997). The court therefore adopted a conjunctive interpretation of all three subsections and ruled that they create statutory duties for a covered hospital solely with regard to persons who come to the emergency department for assistance. See id. Only in that event must the hospital provide an appropriate medical screening, 42 U.S.C. § 1395dd(a); and, only if that screening uncovers an emergency medical condition must the hospital stabilize the patient and refrain from transferring him except in compliance with the statutory commands, see 42 U.S.C. § 1395dd(b)-(c).
Superimposing this interpretation upon the scenario depicted by L¢pez-Soto, the district court reasoned that the newborn had not come to the Hospital's emergency room seeking treatment for his respiratory distress, but, rather, had come to the Hospital via the operating room. See L¢pez- Soto, 988 F.Supp. at 46. Consequently, the court determined that EMTALA's stabilization and transfer obligations had not been triggered and that L¢pez-Soto had failed to state a cognizable claim under federal law. See id.
For the most part, these duties reside in three principal statutory silos. The most familiar of these is subsection (a), which imposes a duty to triage. This duty takes the form of a requirement that a covered hospital perform an "appropriate medical screening examination" on "any individual"
who "comes to the emergency department" seeking examination or treatment. 42 U.S.C. § 1395dd(a). Clearly, this provision obligates hospitals to screen only those individuals who present themselves at the emergency department.
Subsection (b) has a different focus. It emphasizes stabilization, not screening. Thus, if "any individual ... comes to a hospital and the hospital determines that the individual has an...