Opinion ID: 701833
Heading Depth: 2
Heading Rank: 1

Heading: Private Right of Action Against Physicians

Text: 10 In 1986, Congress enacted the Emergency Medical Treatment and Active Labor Act, commonly known as the Patient Anti-Dumping Act, in response to a growing concern about the provision of adequate emergency room medical services to individuals who seek care, particularly as to the indigent and uninsured. H.R.Rep. No. 241, 99th Cong., 1st Sess. (1986), reprinted in 1986 U.S.C.C.A.N. 726-27. Congress was concerned that hospitals were dumping patients who were unable to pay, by either refusing to provide emergency medical treatment or transferring patients before their conditions were stabilized. 11 42 U.S.C. Sec. 1395dd(a) provides that if any individual comes to the emergency department of a hospital which participates in Medicare, and a request is made on the individual's behalf for examination or treatment for a medical condition, the hospital must provide for an appropriate medical screening examination within the capability of the hospital's emergency department ... to determine whether or not an emergency medical condition ... exists. 12 If the hospital determines that the individual has an emergency medical condition, the hospital must provide either-- 13 (A) within the staff and facilities available at the hospital, for such further medical examination and such treatment as may be required to stabilize the medical condition, or 14 (B) for transfer of the individual to another medical facility in accordance with subsection (c) of this section. 15 42 U.S.C. Sec. 1395(b). 16 The question whether the EMTALA authorizes a private right of action against a physician is one of first impression in our circuit. The EMTALA on its face authorizes two types of enforcement, an administrative action for civil money penalties and a private right of action for civil damages. A participating hospital that negligently violates the EMTALA is subject to a civil money penalty of not more than $50,000. 42 U.S.C. Sec. 1395dd(d)(1)(A). Any physician who is responsible for the examination, treatment, or transfer of an individual, who negligently violates the EMTALA, is also subject to a civil money penalty of not more than $50,000. 42 U.S.C. Sec. 1395dd(d)(1)(B). 17 With respect to an aggrieved individual's private right of action, 42 U.S.C. Sec. 1395dd(d)(2) provides: 18 Any individual who suffers personal harm as a direct result of a participating hospital's violation of a requirement of this section may, in a civil action against the participating hospital, obtain those damages available for personal injury under the law of the State in which the hospital is located, and such equitable relief as is appropriate. 19 (Emphasis added.) 20 The plain text of the EMTALA explicitly limits a private right of action to the participating hospital. Perhaps the most widely accepted canon of statutory construction instructs us to first determine whether Congress has directly spoken to the precise question at issue. If the intent of Congress is clear, that is the end of the matter, for the court ... must give effect to the unambiguously expressed intent of Congress. Chevron USA, Inc. v. Natural Resources Defense Council, Inc., 467 U.S. 837, 842-43, 104 S.Ct. 2778, 2781-82, 81 L.Ed.2d 694 (1984). 21 Notwithstanding the clear statutory language, Eberhardt urges us to find an implied private right of action against physicians. He argues that under the standard articulated in Cort v. Ash, 422 U.S. 66, 95 S.Ct. 2080, 45 L.Ed.2d 26 (1975), such a cause of action would enable individuals to enforce the EMTALA more effectively. Eberhardt's argument fails. 22 In Cort, the Supreme Court set forth the four-part test for determining whether a private remedy is implicit in a statute not expressly providing one: (1) Does the statute create a federal right in favor of the plaintiff? (2) Is there any indication of legislative intent, explicit or implicit, either to create such a remedy or to deny one? (3) Is it consistent with the underlying purposes of the legislative scheme to imply such a remedy for the plaintiff? (4) Is the cause of action one traditionally relegated to state law? Id. at 78, 95 S.Ct. at 2087-88. 23 Consistent with the statutory language, the legislative history of the EMTALA evinces a clear Congressional intent to bar individuals from pursuing civil actions against physicians. An earlier draft of Sec. 1395dd(d)(2), the provision which provides for a private right of action, did not precisely identify which parties could bring actions under the provision, nor did it identify those against whom they could bring such an action. H.R.Rep. No. 241, 99th Cong., 1st Sess. (1986), reprinted in 1986 U.S.C.C.A.N. 728. The House Judiciary Committee then amended the provision to its present form to clarif[y] that actions for damages may be brought only against the hospital which has violated the requirements of [the EMTALA]. Id. 24 Our holding today is consistent with every appellate court that has decided whether the EMTALA allows a private right of action against physicians. See King v. Ahrens, 16 F.3d 265, 271 (8th Cir.1994); Delaney v. Cade, 986 F.2d 387, 393-93 (10th Cir.1993); Baber v. Hospital Corp. of America, 977 F.2d 872, 877 (4th Cir.1992); Gatewood v. Washington Healthcare Corp., 933 F.2d 1037, 1040 n. 1 (D.C.Cir.1991). 25 The only case that has adopted a contrary view misconstrued the EMTALA's legislative history. In Sorrells v. Babcock, 733 F.Supp. 1189, 1193 (N.D.Ill.1990), the district court held that an individual may maintain a private cause of action against a physician. The court relied on a statement made by the House Judiciary Committee explaining why it rejected a provision which authorized criminal sanctions: 26 The criminal sanction is unnecessary because the other sanctions ... will serve to deter violations of the standards of [the EMTALA], ... and these sanctions may be imposed against both hospitals and doctors. 27 Id. (citing 1986 U.S.C.C.A.N. 729). However, any implication of an intent to authorize a private right of action against physicians is quickly dispelled by reading the next sentence, in which the Committee described these other sanctions: 28 Subsection (d)(1) authorizes stripping a hospital of its medicare certification.... Subsection (d)(2) authorizes the imposition upon a hospital or doctor of a civil penalty.... Finally, subsection (d)(3) authorizes an aggrieved party to sue a hospital, in federal or state court, for damages and other suitable relief. 29 1986 U.S.C.C.A.N. 729. Thus, read in context, the statement upon which the Sorrells court relied shows that the Committee clearly meant that the other sanctions, taken as a whole, may be imposed against both hospitals and doctors, but that a private right of action may be maintained only against hospitals. 30 Accordingly, we affirm the district court's ruling that the EMTALA does not allow private suits against physicians.