Opinion ID: 2221406
Heading Depth: 1
Heading Rank: 6

Heading: directed verdict on emtala claim

Text: The personal representative asserts in her second assignment of error that the district court erred in partially sustaining Mary Lanning's motion for a directed verdict. The district court granted Mary Lanning's motion for a directed verdict with regard to the wrongful death cause of action, reasoning that EMTALA precluded an action against Mary Lanning for wrongful death and provided only for causes of action seeking redress for personal injuries suffered by a patient prior to his or her death. For the following reasons, we conclude that the district court erroneously granted the directed verdict in Mary Lanning's favor. In partially sustaining Mary Lanning's motion for a directed verdict, the district court reasoned: The [EMTALA] statutes however provide the following, that any individual who suffers personal harm as a direct result of a participating hospital's violation of requirements of this section may in a civil action against the participating hospital obtain those damages available for permanent injury under the law of the state in which the hospital is located and such equitable relief as is appropriate. That language makes the hospital responsible for permanent injuries caused to Mr. Gestring because of the violations if there are violations of the EMTALA statute. That language specifically does not include any obligation or recovery to any other party through a wrongful death action or any other type of action against the hospital for an EMTALA violation, therefore the hospital is only responsible for the injuries caused to the decedent which essentially will be when we get through this from the time that transfer is started until the time of the death of the decedent. They're not responsible for any wrongful death recovery to which other persons might be entitled as a result of that death. The district court further reasoned that there was no evidence on which to conclude that the negligence of Mary Lanning contributed to Gestring's death and concluded that Mary Lanning should not remain as a defendant in the wrongful death cause of action. EMTALA provides that [a]ny individual who suffers personal harm as a direct result of a participating hospital's violation of a requirement of this section may ... 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. 42 U.S.C. § 1395dd(d)(2)(A). In Nebraska, when a person dies as a result of the negligent or wrongful act of another and the conduct is such that if death had not occurred, the deceased would have had a cause of action to recover damages, then the person or entity whose conduct brought about the death is liable to the surviving next-of-kin, regardless of the death. See Neb.Rev.Stat. §§ 30-809 and 30-810 (Reissue 1995). Thus, the law of the State in which [Mary Lanning] is located provides an avenue through which the personal representative of Gestring's estate may seek redress for personal harm she has suffered by being the wife deprived of the society, comfort, and companionship of Gestring as a direct consequence of an EMTALA violation inflicted upon Gestring. See, e.g., Correa v. Hospital San Francisco, 69 F.3d 1184 (1st Cir. 1995); Lane v. Calhoun-Liberty County Hosp. Ass'n Inc., 846 F.Supp. 1543 (N.D.Fla.1994); Griffith v. Mt. Carmel Medical Center, 842 F.Supp. 1359 (D.Kan. 1994). The mere fact that the personal representative has rested her wrongful death cause of action, at least in part, upon an alleged EMTALA violation does not justify a directed verdict as to the entire cause of action. A cause of action consists of the fact or facts which give one a right to judicial relief against another; a theory of recovery is not itself a cause of action. Bargmann v. State, 257 Neb. 766, 600 N.W.2d 797 (1999). Thus, two or more claims in a petition arising out of the same operative facts and involving the same parties constitute separate legal theories, either of liability or damages, and not separate causes of action. Id. Whether more than one cause of action is stated depends mainly upon (1) whether more than one primary right or subject of controversy is presented, (2) whether recovery on one ground would bar recovery on the other, (3) whether the same evidence would support the different counts, and (4) whether separate causes of action could be maintained for separate relief. Id. The crucial inquiry in regard to the district court's grant of the directed verdict is whether the personal representative's EMTALA claim constitutes a separate cause of action or merely a theory of recovery under which she can recover for the wrongful death of Gestring. The U.S. Court of Appeals for the Eighth Circuit has stated that `EMTALA is not a federal malpractice statute and it does not set a national emergency health care standard; claims of misdiagnosis or inadequate treatment are left to the state malpractice arena.' Summers v. Baptist Medical Center Arkadelphia, 91 F.3d 1132, 1137 (8th Cir.1996). Accord Brooks v. Maryland General Hosp., Inc., 996 F.2d 708 (4th Cir.1993). Thus, a hospital's liability under EMTALA is not grounded upon tort concepts. An EMTALA plaintiff's claim does not rest on any proof that a hospital was negligent; it is predicated on the hospital's violation of a federal statute, making the hospital strictly liable for any personal harm that directly results from that violation. Griffith v. Mt. Carmel Medical Center, supra . Therefore, state malpractice law and general principles of negligence provide one theory of recovery against a hospital where the alleged substandard treatment results in wrongful death, and EMTALA provides a separate and distinct theory of recovery, either of which may be invoked by a plaintiff in a cause of action for wrongful death. The personal representative's petition contains a prayer in which she seeks recovery against Mary Lanning on a negligence theory, in addition to her claim based upon Mary Lanning's alleged EMTALA violations. As the trial progressed, the personal representative's counsel withdrew the issue of Mary Lanning's negligence from the case, conceding that there was no evidence upon which the jury could conclude that Mary Lanning was negligent. Such a concession does not, however, result in the automatic dismissal of the wrongful death claim against Mary Lanning based upon alleged violations of EMTALA. EMTALA provides a separate theory of recovery under which a plaintiff may seek relief in a wrongful death cause of action. While the district court may have properly disposed of the personal representative's negligence theory of recovery against Mary Lanning, it should not have sustained the motion for a directed verdict in regard to the entire wrongful death action. This court has long adhered to the principle that a proper result will not be reversed merely because it was reached for the wrong reason. Corcoran v. Lovercheck, 256 Neb. 936, 594 N.W.2d 615 (1999). We have also stated that a trial court should direct a verdict as a matter of law only when the facts are conceded, undisputed, or such that reasonable minds can draw but one conclusion therefrom. Nelson v. Lusterstone Surfacing Co., 258 Neb. 678, 605 N.W.2d 136 (2000). Consequently, the directed verdict on the EMTALA claim may still have been appropriate if the evidence at trial was such that reasonable minds could draw but one conclusion in regard to the EMTALA claim against Mary Lanning. The following analysis of the EMTALA requirements demonstrates that such is not the case: Upon discovery of an emergency medical condition, EMTALA usually requires hospitals to treat the discovered condition. Under certain circumstances, however, EMTALA allows hospitals to transfer patients instead of treating them. See 42 U.S.C. § 1395dd(b)(1)(B). If a hospital elects to transfer the patient under 42 U.S.C. § 1395dd(b)(1)(B), that hospital can [still] violate § 1395dd through the operation of its emergency room by failing to stabilize a patient's emergency medical condition before transferring or releasing the patient. Delaney v. Cade, 986 F.2d 387, 391-92 (10th Cir.1993). With respect to an emergency medical condition described in 42 U.S.C. § 1395dd(e)(1)(A), the term stabilized means that no material deterioration of the condition is likely to result from or occur during the transfer of the individual from a facility. 42 U.S.C. § 1395dd(e)(3)(A). Because there is no dispute that Gestring suffered from an emergency medical condition or that Mary Lanning decided to transfer Gestring rather than provide treatment, the critical inquiry is whether Gestring's condition was stabilized at the time of transfer. `[T]he definition of to stabilize asks whether the medical treatment and [transfer were] reasonable under the circumstances. This is obviously a factual inquiry....' Delaney v. Cade, 986 F.2d at 392. To determine whether the defendants stabilized [Gestring's] medical condition before transfer, all the expert testimony submitted to the district court ... must be considered. See id. Thus, if the testimony at trial denotes a genuine dispute concerning whether material deterioration was likely to occur during transfer, a jury should consider whether Gestring was stabilized as defined in EMTALA. See id. At trial, Steven Tilles, M.D., testified that Gestring was not stable at the time he was transferred from Mary Lanning. Tilles testified that while Gestring may have been stabilized for transfer earlier on the day he was transferred, his condition had not been stabilized at the time the decision was made to transfer him to Lincoln. Bruce Hutson, M.D., stated that there was 100 per cent chance ... that [Gestring] was going to deteriorate during transit. Simply put, the jury could have accepted Tilles' and Hutson's testimony and found that because Gestring was not stabilized at the time of transfer, Mary Lanning was in violation of EMTALA and that such a violation was a cause of Gestring's death. The evidence places into question whether at the time of Gestring's transport, no material deterioration of [his] condition [was] likely, within reasonable medical probability. See 42 U.S.C. § 1395dd(e)(3)(B). Gestring's stabilization notwithstanding, a hospital may legally transfer someone who has an emergency medical condition which has not been stabilized if one of several conditions has been satisfied. If an individual at a hospital has an emergency medical condition which has not been stabilized, the hospital may not transfer the patient unless (1) the patient requests the transfer in writing or (2) a physician has signed a certification that based upon the reasonable risks and benefits to the patient and the information available at the time, the medical benefits reasonably expected from the provision of appropriate medical treatment at another facility outweigh the increased risks to the individual's medical condition from effecting the transfer. EMTALA also allows such a transfer if, in the absence of a physician, a qualified person signs such a certification, which is subsequently countersigned by a physician. See 42 U.S.C. § 1395dd(c)(1)(A). In addition to the obligation of certifying the medical need for transferring patients protected by EMTALA, hospitals also have an obligation to appropriately transfer such patients. See 42 U.S.C. § 1395dd(c)(2). The statutory definition of appropriate transfer requires, inter alia, that transfer [be] effected through qualified personnel and transportation equipment, as required including the use of necessary and medically appropriate life support measures during the transfer. 42 U.S.C. § 1395dd(c)(2)(D). See, also, Burditt v. U.S. Dept. of Health and Human Services, 934 F.2d 1362 (5th Cir. 1991). This statutory requirement has been interpreted as requiring personnel and transportation equipment that a reasonable physician would consider appropriate to safely transport the patient in question. 934 F.2d at 1372. At trial, the personal representative argued that Mary Lanning inappropriately transferred Gestring because he was not stabilized at the time of transfer; the personal representative further contended that had Barth properly certified that Gestring's condition was not stabilized at the time of transfer, the proper personnel and life support measures would have accompanied Gestring to Lincoln. Hutson testified that the box checked by Barth on the certificate of transfer form was not indicative of Gestring's condition at the time of transfer. Tilles testified that had Barth properly certified Gestring's condition as unstable, the awareness of the ambulance crew would have been heightened, and Gestring might possibly have survived the trip to Lincoln. Because the evidence is in dispute as to whether Gestring's transfer complied with EMTALA, the question whether Mary Lanning appropriately transferred Gestring was a question to be resolved by the jury. See id. In summary, there was sufficient evidence upon which a finder of fact could have based the conclusion that Mary Lanning was in violation of EMTALA and, further, that the violation was a cause of Gestring's death. Due to the highly technical nature of the definitions contained within EMTALA, the district court should properly instruct the jury thereon prior to submitting any EMTALA issues for decision. We conclude that the district court improperly sustained Mary Lanning's motion for a directed verdict on the wrongful death action.