Court Opinion

ID: 9489414
Source: CourtListenerOpinion
Date Created: 2023-08-05 13:15:29.679928+00
Date Added: 2024-06-11T17:53:31.528629
License: Public Domain

HEANEY, Circuit Judge,
with whom McMILLIAN, Circuit Judge, joins, dissenting.
In affirming the dismissal of Summers’ claim, the majority assumes facts against Summers’ position and significantly limits the scope of the statute. Under EMTALA, as plainly written, an individual who suffers harm as a direct result of a hospital emergency room’s failure to follow appropriate medical screening procedures has a cause of action against the hospital. 42 U.S.C. §§ 1395dd(a), (d)(2)(A). For the reasons *1141stated in my original majority opinion, Summers v. Baptist Medical Center Arkadelphia, 69 F.3d 902 (8th Cir.1995), I believe that Summers’ claim presents a genuine issue of material fact that the district court should have permitted to go to the jury. Thus, I respectfully dissent. .
I.
It has never been my position that EMTA-LA establishes a vast range of claims for medical negligence. EMTALA has a much more limited application than state malpractice law: it applies only to emergency rooms of hospitals that have provider agreements under the Medicare program. EMTALA also does not establish a national standard of care. Rather, it requires hospitals to develop screening procedures to detect emergency medical conditions. As the majority recognizes, the statute does not mandate that the procedures be written and a hospital may make its procedures as detañed or as general as it sees fit. It is the hospital’s obligation, however, to follow its established screening procedures for all patients who present with complaints to the emergency room. Fañure to do so constitutes a prima facie violation of the federal statute. The more a hospital’s established procedures are unwritten and loosely-defined — or essentiaUy equivalent to “due care” — the more an EMTALA cause of action may overlap with a state medical malpractice claim.
The only evidence in this record of a hospital standard applicable to Summers' complaint is Dr. Ferreñ’s deposition testimony that had Summers complained- of pain in the sternum or pain in the ribs, he would have x-rayed those regions. (R. 149.) As the majority notes, Baptist agrees that patients complaining of pain in the front of their chest, or of snapping or popping noises when breathing, would normally be given a chest x-ray. Maj.Op., supra at 1136. The majority, considering the facts in a light most favorable to the non-moving party, accepts as true that Summers complained to the doctor about his chest pains and throbbing chest, Baptist even concedes this point. The majority assumes, however, that the physician:
through inadvertence or inattention, did not perceive Summers to have cracking or popping noises in his chest, or pain in the front of his chest.' This is why no chest x-rays were taken. In the medical judgment of the physician, Summers did not need a chest x-ray. Summers did receive substantial medical treatment.
Maj.Op., supra at 1139.
With these few assumptions, the majority effectively usurps the role of the jury and makes the factual findings necessary to dismiss Summers’ claim as one of mere negligence. It was for the jury, not the district Court or this court, to determine the relative credibility of the parties and what occurred in the emergency room that day. We should not assume that the doctor did not hear Summers or forgot about his complaints. Nor should we assume that it was the physician’s medical judgment that prompted his fañure to give Summers a chest x-ray. It is possible that the doctor heard Summers’ complaints and, for no legitimate reason, faded to do anything about them. That alternative would establish the essentials of an EMTALA cause of action.
As the majority recognizes, Summers’ claim is factually similar to the plaintiffs claim in Power v. Arlington Hosp. Ass’n, 42 F.3d 861 (4th Cir.1994),1 in which the Fourth Circuit affirmed a jury’s award of damages under- EMTALA.2 In Power, the plaintiff was examined in the emergency room by two nurses and a doctor and was given various tests. Id. at 854. At trial, the doctor testi*1142fied unequivocally that he treated Power as he would have treated any other patient with the same complaints and vital signs. Id. at 855. There was also testimony, however, that the doctor did not follow the usual hospital procedures in attending to Power. Id. Specifically, there was testimony that a blood test was a necessary component of an appropriate medical screening examination for a patient who presented at the emergency room with Power’s symptoms. Id. The Fourth Circuit determined that Power presented evidence from which a jury could conclude she was treated differently from other patients and that the hospital did not apply its standard screening procedures uniformly. Id. at 856. Similarly, Summers presented sufficient evidence of an EMTALA violation for the district court to permit his claim to go to the jury.
II.
The majority’s inappropriate resolution of this appeal from a grant of summary judgment is driven by its fear of giving EMTALA too “expansive” an interpretation such that it would apply in situations traditionally covered only by state malpractice law. Not only is this fear unwarranted, it cannot justify significantly altering the plain language of the statute.
The statute clearly states that an individual has a cause of action against a hospital whenever the hospital’s emergency room personnel fails to provide an appropriate medical screening examination and the individual is harmed as a direct result of that failure. 42 U.S.C. §§ 1395dd(a), (d)(2)(A). The personal harm provision of the statute does not require a plaintiff to prove the hospital’s intent in violating a statutory requirement, but rather permits recovery for all violations, regardless of the. hospital’s motivation. In contrast, the statute provides for a civil money penalty against a hospital for a negligent violation ' of a statutory requirement. § 1395dd(d)(l)(A). This distinction — the explicit negligence requirement for a civil penalty — reinforces the plain statutory language of the personal harm provision. An EMTA-LA plaintiff need not demonstrate any level of intent on the part of the hospital, but only that the hospital failed to give him an appropriate screening examination.3
The majority gives lip service to following the literal language of the statute by not requiring proof of bias on the part of the hospital. Yet its strained definition of “appropriate,” (i.e., “uniform” or that which would be given to a similarly situated patient) effectively limits the statute’s application to only those cases that involve bias or discrimination. I see no way for a plaintiff to prove non-uniform or disparate treatment without evidence of the hospital’s bias against a particular group to which he belongs. In this respect, our court is following the lead of almost every circuit that has examined this issue. While the Sixth Circuit is the only circuit that admits to requiring bias evidence for an EMTALA violation, see Cleland v. Bronson Health Care Group, Inc., 917 F.2d 266, 272 (6th Cir.1990), the only circuit court decisions that permit an EMTA-LA claim to go forward involve evidence of bias. See Correa v. Hosp. San Francisco, 69 F.3d 1184, 1189 (1st Cir.1995) (affirming jury verdict for plaintiff where “datum suggesting [hospital] tried to shunt [patient] as soon as it scrutinized her insurance card”), cert. denied, — U.S. -, 116 S.Ct. 1423, 134 L.Ed.2d 547 (1996); Power, 42 F.3d at 854 (affirming jury verdict for unemployed and uninsured plaintiff).
In light of Congress’ intent to address patient “dumping” in enacting EMTALA the *1143majority is understandably frustrated by the plain language of the statute. Its limitation of the statute’s application perhaps even meets Congress’ objective better than the law enacted by Congress. It is not our role, however, to re-draft the statute and to alter its plain language. See Vickers v. Nash General Hosp., Inc., 78 F.3d 139, 146 (4th Cir.1996) (Ervin, J., dissenting) (“Regardless of what we divine the congressional intent to. have been, the statute is perfectly clear about what a plaintiff must allege in order to state a claim.”).
Under the statute as written, credible allegations that a hospital has failed to follow its own established screening procedures in the treatment of a particular patient constitute a threshold showing of an EMTALA violation. Summers has made adequate allegations to survive summary judgment. Whether the doctor acted within the parameters of a hospital’s loose, unwritten screening procedures is a factual question to be determined by the jury. I refuse to assume facts against Summers’ position in an effort to limit EMTALA claims generally. Thus, I adhere to my original position and would reverse the district court’s grant of summary judgment in this case.

. The only notable factual difference is that Power involved a patient who most likely was unable to pay for her care. She was unemployed and had no health insurance. 42 F.3d at 854. Like most circuits, however, the Power court explicitly held that an EMTALA plaintiff need not offer proof of an improper motive on the part of the hospital. Id. at 859.

. The majority "observes” that Power supports Summers’ position, Maj.Op., supra at 1139 n. 4, but not surprisingly finds the Fourth Circuit’s later opinion more persuasive. See Vickers v. Nash General Hospital, Inc., 78 F.3d 139 (4th Cir.1996). In Vickers, the Fourth Circuit does not discuss Power and relies heavily on the dissenting opinion from our original panel decision. Id. at 143-144.

. The statute is not to be read so strictly as to preclude a medical judgment defense on the .part of the hospital, however. The Fourth Circuit in Power, 42 F.3d at 858, recognized that the application of a screening procedure necessarily requires the exercise of medical training and judgment. The court set out a framework for EMTALA litigation to address those considerations. Id. at 858. Once a plaintiff makes a threshold showing of differential treatment, the hospital may offer rebuttal evidence by demonstrating either that the patient was accorded the same level of treatment that all other patients receive, or that a test or procedure was not given because the physician did not believe that the test was reasonable or necessary under the particular circumstances. Id. The plaintiff then has the opportunity to challenge the physicians' medical judgment through her own expert testimony. Id.