Opinion ID: 1822880
Heading Depth: 1
Heading Rank: 7

Heading: Federal Preemption under EMTALA

Text: Preemption issues are statutory construction issues. As Professor Tribe aptly articulates, the question of whether federal law in fact preempts state action in any given case necessarily remains largely a matter of statutory construction and cannot be reduced to any general formula. Laurence H. Tribe, American Constitutional Law § 6-25 (2d ed.1988). The starting point is thus the statute itself. Indeed, EMTALA expressly addresses preemption, providing that [t]he provisions of this section do not preempt any State or local law requirement of this section, except to the extent that the requirement directly conflicts with a requirement of this section. 42 U.S.C. § 1395dd(f). Under this type of preemption, dual regulation of the same conduct is permitted as long as there is no conflict. As noted above, the state malpractice act and federal EMTALA requirements often regulate the same conduct. Since EMTALA only preempts state law to the extent that state law directly conflicts with federal law, the issue becomes whether imposing a mandatory pre-suit medical review panel requirement directly conflicts with EMTALA. A state law may be preempted because of a direct or actual conflict with federal law in one of two ways: First, there is preemption ... if it is impossible to comply with both state and federal law. If dual compliance is not physically impossible ... there is no actual conflict. Second, state law actually conflicts with federal law where state law stands as an obstacle to the accomplishment of the full purposes and objectives of Congress. 2 Ronald D. Rotunda and John E. Nowak, Treatise on Constitutional Law § 12.4 (3d ed.1999)(quoting Silkwood v. Kerr-McGee Corp., 464 U.S. 238, 104 S.Ct. 615, 78 L.Ed.2d 443 (1984)). Hence, the test for determining whether a direct conflict exists is two-fold: Such a [direct] conflict is found where compliance with both federal and state regulations is a physical impossibility, or where state law stands as an obstacle to the accomplishment and execution of the full purposes and objectives of Congress. (emphasis added). 2 Norman J. Singer, Sutherland Statutory Construction § 36.08.50 (5th ed.1993); Deberry v. Sherman Hosp. Ass'n, 741 F.Supp. 1302, 1307 (N.D.Ill.1990). Defendant contends that it is theoretically possible for a plaintiff in a given case to comply with the Louisiana Medical Malpractice Act requirement of obtaining a decision from the medical review panel before filing suit and EMTALA's two-year limitation for filing suit. Defendant argues that when a plaintiff requests a medical review panel soon after the violation occurs and the one-year malpractice prescriptive period (rather than the three-year peremptive period) applies, compliance with both theoretically is possible. Defendant points out that the malpractice victim may file suit if the panel decision is not rendered within one year of the appointment of the panel chair. However, as defendant concedes, the period of time a medical review panel takes to render a decision is outside of the malpractice victim's control, and extensions of the time for the panel decision are common so that the timing of the decision frequently occurs outside the two-year period for filing an EMTALA claim. Unlike the Louisiana Medical Malpractice Act which contains several provisions tolling prescription during the medical review panel proceeding, EMTALA contains a two-year limitation that is not subject to any tolling. Since the state tolling provisions cannot toll the running of EMTALA's two-year statute of limitations, the medical review panel requirement directly conflicts with EMTALA. Smith v. Richmond Memorial Hosp., 243 Va. 445, 416 S.E.2d 689, cert. denied, 506 U.S. 967, 113 S.Ct. 442, 121 L.Ed.2d 361 (1992). Because of this direct conflict, the panel requirement is preempted by federal law. Moreover, even if it is theoretically possible to comply with both the pre-suit medical review panel requirement and EMTALA's two-year limitation, engrafting such a procedural requirement onto an EMTALA claim would obstruct the accomplishment and execution of Congress' purpose and objectives. Finally, [a] state legislature or court cannot limit the rights that a plaintiff has in a federal claim that is pursued in a state court. 2 Norman J. Singer, Sutherland Statutory Construction § 36.08.50 (5th ed.1993). The court in Power v. Arlington Hosp. Ass'n, supra , explained: As the [Virginia Supreme Court in] Smith observed, EMTALA establishes a separate federal cause of action, cognizable in federal and state courts, independent of any additional or pendant state claims, with a two-year statute of limitation in § 1395dd(d)(2)(C) for filing claims. Id. Notwithstanding the fact that the Virginia Act tolls the statute of limitations during compliance with its procedural prerequisites, these state law tolling provisions cannot toll the running of EMTALA's two-year statute of limitations.... Because Virginia's procedural requirements are potentially in direct conflict with, and therefore inconsistent with EMTALA, we hold that they are not applicable to an EMTALA claim.... 42 F.3d 851, 866 (quoting Smith v. Richmond Memorial Hosp., 416 S.E.2d at 695). Permitting plaintiffs' medical malpractice and EMTALA claims to be lumped together and then applying the mandatory pre-suit panel review procedure to the claims as a whole would subvert the plain meaning and intent of 42 U.S.C. § 1395dd. Griffith v. Mt. Carmel Medical Ctr., 842 F.Supp. 1359, 1364 (D.Kan.1994)(declining to engraft comparative fault law onto EMTALA claim). Unlike medical review panels which are designed to weed out spurious medical malpractice claims and to encourage pre-trial settlement, EMTALA's private cause of action is designed to penalize hospitals and thereby discourage dumping. This difference in purpose buttresses our holding that the procedural requirement of the Louisiana Medical Malpractice Act directly conflicts with EMTALA and is thus preempted. [11]