Court Opinion

ID: 9488667
Source: CourtListenerOpinion
Date Created: 2023-08-05 12:51:58.535031+00
Date Added: 2024-06-11T17:53:01.502330
License: Public Domain

RICHARD S. ARNOLD, Chief Judge,
dissenting.
I think the District Court was right to dismiss this complaint, and write briefly to explain why.
This Court’s reason for reversal is simple and easily grasped: Mr. Summers says he complained of chest pain. Dr. Ferrell does not remember any such complaint, but concedes that patients who complain of chest pain are normally given a chest x-ray. Mr. Summers was given no such x-ray. Therefore, if in fact he did complain of chest pain (a dispute of fact that would require a trial if it is material), Mr. Summers was treated differently from the hospital’s normal practice.
The syllogism is neat — in my view, too neat, because it converts the Emergency Medical Treatment and Active Labor Act (EMTALA), 42 U.S.C. § 1395dd, into a federal malpractice statute, a result disavowed by the plaintiff and this Court alike. Consider the following: a hospital’s normal screening procedure for emergency patients is to treat them with due care. (Presumably every hospital would say this.) There is a genuine issue of material fact as to whether a certain patient was treated with due care. Therefore the patient is entitled to go to trial on the issue whether he was treated differently from other patients. I take it that all would acknowledge the error of this proposition, as it would completely obliterate any distinction between EMTALA and a state-law claim for negligence.
This statement of the issue is at the highest level of generality, of course. The problem with the Court’s approach in this case is that it will always, if logically applied, convert any malpractice claim into an EMTALA case, with the possible exception of cases (of which this is not one) in which there is a substantive disagreement about the appropriate standard of care in given factual circumstances. Take an example at what may be an intermediate level of generality, an example taken from the very case before us. Dr. Ferrell testified, as any physician would, that it is “necessary to obtain a complete, accurate history,” App. A-25 (emphasis mine), from patients who fall and are brought in immobilized. The history obtained here did not contain the fact (or what Mr. Summers says is a fact) that the plaintiff complained of chest pain. Therefore, this patient was not given the screening normally given to other patients. Q.E.D. This very argument, or something very near to it, appears in the Appellant’s Reply Brief, p. 4. It is only a variation of the reasoning adopted by the Court in its opinion today. Yet, it would allow an EMTALA action any time a plaintiffs medical history is inaccurately taken.
The fact is that Mr. Summers was treated (whether correctly or not) exactly as any other patient would have been. Let’s assume he complained of chest pain. There is no proof that anyone else complaining of chest pain would have been given a chest x-ray on this particular day. If Dr. Ferrell didn’t hear Mr. Summers, or if he ignored his patient’s complaint, the doctor may be guilty of malpractice (a question on which I express no view), but, so far as this record shows, he would have made the same mistake with any other patient.
The Court concedes that under Williams v. Birkeness, 34 F.3d 695 (8th Cir.1994), an EMTALA plaintiff must show “that the hospital treated [him] ... differently from other patients.” Id. at 697. Williams claimed a heart condition was not correctly diagnosed. Exactly the same argument that the Court accepts here could be made in the Williams situation: “I was seen at the emergency room and diagnosed with a non-life-threatening inflammation of my chest cartilage; in fact, I had a heart condition that later caused a heart attack; patients with such a heart condition are normally treated more intensively than I was.” The Court’s rationale in the present case, as a matter of logic, is inconsistent with the holding in Williams “that § 1395dd(a) requires uniform treatment of all patients but does not require correct diagnosis.” 34 F.3d at 697.
*906Maybe Dr. Ferrell isn’t remembering correctly what Mr. Summers said. This would be understandable in view of the fact that the doctor was working 80 hours a week at four different hospital emergency rooms. Reply Brief 3. But if a mistake was made, it should have been pursued in a tort action in the state courts (there being no diversity of citizenship). Mr. Summers was not dumped. He was not discriminated against for financial or any other reasons. I believe he has no claim under EMTALA as that statute has, until now, been uniformly interpreted. I respectfully dissent.
ORDER
Jan. 18, 1996
Appellee’s petition for rehearing with suggestion for rehearing en banc has been considered by the court and is granted. The opinion and judgment of the court entered on November 9,1995, are vacated.
The en banc argument will be Tuesday, April 9, 1996, at 3:00 p.m. in St. Louis, MO.