Opinion ID: 1821924
Heading Depth: 1
Heading Rank: 4

Heading: Intentional tort of improper transfer

Text: While the trial court granted Dr. Deno's exception of no cause of action as to Coleman's patient dumping allegations, the court of appeal characterized the claim as an intentional tort of improper patient transfer based on Louisiana tort law, La. C.C. art. 2315. As such, the court reasoned that it was not malpractice under the MMA. In so holding, the appellate court concluded that Coleman plead two distinct causes of action: (1) negligent failure to treatmalpractice, and (2) an intentional tort based on EMTALA for transfer to CHNO because of lack of fundsnot malpractice. For the following reasons, we reverse the appellate court's conclusion that Dr. Deno was additionally at fault under general tort law for the intentional tort of patient dumping. The nature of the claim of improper transfer in this case is really a claim of failure to properly diagnose, failure to stabilize, or both. That is what the petition alleges, and that is what the evidence suggests to be the basis of Coleman's claim. The court of appeal, with little analysis and citing no authority, characterized such a claim as outside the scope of malpractice under the MMA and thus justified the entire $4,900,000 jury award. In so doing, we hold that the appellate court erred both procedurally and substantively. Procedurally, neither Coleman's original nor amended petition alleges an intentional tort. The original petition alleges only medical malpractice; the amended petition alleges only negligence per se based on EMTALA. Nor were the pleadings expanded at trial, as provided for in La. C. Civ. P. art. 1154, to include such an alleged intentional tort. To the contrary, the effect of the trial court's granting of Dr. Deno's combined exception of no cause of action and motion in limine was to exclude any mention before the jury of either the financial reasons for the transfer or the EMTALA claim. [11] The court of appeal thus crafted an intentional tort that was not plead, not prayed for in relief, not argued, not tried, and not submitted to the jury. Substantively, the court of appeal reasoned that [t]he `patient dumping' cause of action refers to an intentional tort where Dr. Deno directed plaintiff's transfer to Charity for lack of finances or insurance although it conflicted with JoEllen Smith Hospital's written policy. 99-2998 at p. 19, 787 So.2d at 463. [12] Acknowledging that neither EMTALA nor the Louisiana statutory counterpart provides a private cause of action against a physician for patient dumping, [13] the court reasoned that it could find no express state law that excludes recovery under La. C.C. art. 2315, general tort law, or La. R.S. 40:2113.4-40:2113.6 [the Louisiana anti-dumping statute] against physicians for the intentional tort of patient dumping. Id. (emphasis added). Stated otherwise, the court reasoned that no statutory provision precludes a finding of liability under Louisiana tort law when a physician engages in the exact misconduct targeted by those anti-dumping statutes. While the court of appeal reasoned that plaintiffs reference to anti-dumping statutes in his amended petition sufficed to state a cause of action under Article 2315, the issue before us is whether that characterization of plaintiffs assertions and the evidence in support thereof as outside the scope of malpractice under the MMA was correct. In resolving that issue, we begin by distinguishing this case from our prior two decisions in which we have addressed patient dumping [14] claims under the EMTALA and the Louisiana statutory counterpart. Spradlin v. Acadia-St. Landry Medical Foundation, 98-1977 (La.2/29/00), 758 So.2d 116; Fleming v. HCA Health Services of Louisiana, Inc., 96-1968 (La.4/8/97), 691 So.2d 1216. In both those prior cases the defendant was a hospital; the defendant in this case is an emergency room physician. The significance of this distinction is two-fold. First, the statutory duties imposed by EMTALA, and the Louisiana statutory counterpart, apply only to participating hospitals, not physicians. [15] Second, hospitals are distinct legal entities that do not, in the traditional sense of the term, practice medicine; whereas, physicians do practice their profession, and their negligence in providing such professional services is termed malpractice. Frank L. Maraist & Thomas C. Galligan, Jr., Louisiana Tort Law § 21-2 (1996). The significance of the term malpractice is that it is used to differentiate professionals from nonprofessionals for purposes of applying certain statutory limitations of tort liability. Id. The limitation of tort liability at issue in this case is the MMA. The MMA applies only to malpractice; all other tort liability on the part of a qualified heath care provider is governed by general tort law. Spradlin, supra . Malpractice is defined by La.Rev. Stat. 40:1299.41A(8) as follows: Malpractice means any unintentional tort or any breach of contract based on health care or professional services rendered, or which should have been rendered, by a health care provider, to a patient.... (Emphasis added). La.Rev.Stat. 40:1299.41 A(7) and (9) further define tort and health care as follows: Tort means any breach of duty or any negligent act or omission proximately causing injury or damage to another. The standard of care required of every health care provider, except a hospital, in rendering professional services or health care to a patient, shall be to exercise the degree of skill ordinarily employed, under similar circumstances, by the members of his profession in good standing in the same community or locality, and to use reasonable care and diligence, along with his best judgment, in the application of his skill. Health care means any act, or treatment performed or furnished, or which should have been performed or furnished, by any health care provider for, to, or on behalf of a patient during the patient's medical care, treatment or confinement. Both statutory patient dumping claims and medical malpractice claims are simply particularized forms of torts that often overlap. However, even though all medical malpractice claims are personal injury claims, the opposite is not true: every personal injury claim is not a medical malpractice claim. Scott E. Hamm, Note, Power v. Arlington Hospital: A Federal Court End Run Around State Malpractice Limitations, 7 B.Y.U. J. Pub. L., 335, 347-48 (1993). It follows then that the court of appeal in this case legally erred in characterizing a claim for patient dumping as always giving rise to an intentional tort and in reasoning that a bright line can be drawn between medical malpractice claims and patient dumping claims. Recognizing that the two claims can overlap, we determine in this case that Coleman's claim of dumping improper transferis one of malpractice governed by the MMA.