Opinion
Civ. No. 00-1176, SECTION "A".
August 25, 2000.
ORDER AND REASONS
Before the Court are a motion to set aside entry of default on account of excusable error and a motion to dismiss plaintiff's state law claims pursuant to FRCP Rule 12(b)(1)(6) filed on behalf of the defendant, Tenet Health System Hospitals, Inc. d/b/a Meadowcrest Hospital ("Meadowcrest"). plaintiff filed formal opposition memoranda to the foregoing motions and there is no reply forthcoming from the defendant. Counsel for Tenet filed a brief reply memorandum regarding its Motion to Dismiss. The matters are deemed submitted for decision. The Court will address the motions serially.
BACKGROUND
On April 17, 2000, the plaintiff Ronald Bauman ("Bauman") filed the subject complaint against the defendant Meadowcrest alleging jurisdiction pursuant to 28 U.S.C. § 1331 (federal question) and bringing his claim for civil penalties and damages under 42 U.S.C. § 1395 (dd), a provision of the Emergency Medical Treatment and Advanced Labor Act ("EMTALA"), for allegedly failing to perform a medical screening, failing to stabilize the complainant, and failing to secure his transfer to another facility, despite his emergency medical condition and allegedly "dumping" him instead of treating him upon failing to ascertain insurance information.
See, Complaint filed April 17, 2000 [Rec.Doc. No. 1].
The defendant Meadowcrest was served on April 21, 2000 through its registered agent for service of process. On July 17, 2000, plaintiff filed a motion for entry of preliminary default alleging no answer had been filed and attached as Exhibit "A" a copy of the Summons and Return of Service.
See, Summons and Return of Service [Rec.Doc. No. 3].
See, Motion and Order for Preliminary Default with attachment [Rec.Doc. No. 4].
On July 27, 2000, the defendant Meadowcrest filed a Motion to Set Aside Entry of Preliminary Default [Rec.Doc. No. 5] along with memorandum in support and supporting documents. On August 4, 2000 defendant filed its Answer [Rec.Doc. No. 6] along with its FRCP Rule 12(b)(1)(6) Motion to Dismiss plaintiff's state law claims. [Rec.Doc. No. 7]
MOTION TO SET ASIDE ENTRY OF DEFAULT
Meadowcrest submits that the entry of default by the deputy clerk on July 17, 2000 because the delay in answering was the result of excusable error, it has a meritorious defense, and the delay will not prejudice the plaintiff. The affidavits of Kim Chisolm and Cathie Desell [Exhibit "A" to defendant's motion] detail the specifics — that is, through apparent inadvertence and mistake, the national corporation headquarters in California neglected to forward the complaint to local counsel. Upon discovering the glitch on July 20, 2000, local counsel contacted plaintiff's counsel who agreed to take no further action toward a default and local counsel promptly obtained a copy of the record from the Clerk of Court and began preparing responsive pleadings.
Affiants testify that had normal procedures been followed the complaint would have been forwarded to the defendant's offices in Santa Barbara, California, then routed to a regional office in Dallas, Texas, which office would have assigned local counsel. Through inadvertence or mistake the pleadings were lost between the headquarters in California and defendant's regional offices in Dallas and despite diligent efforts the original service copy of the plaintiff's Complaint has not yet been located. A representative in the Dallas office was alerted on July 20, 2000 that a complaint was filed and a motion for entry of default had been filed and promptly engaged the local firm, Hemelt and Foshee.
See, Affidavit of Deborah Cunningham Foshee [Exhibit "B" to Meadowcrest's Motion to Set Aside Entry of Default].
Defense counsel submits that there exists a meritorious defense to the plaintiff's EMTALA claims in that her investigation reveals that contrary to the plaintiff's allegations, Meadowcrest's Emergency Department did in fact on the date in question render emergency medical care to the plaintiff — i.e., her investigation revealed that the hospital emergency room staff diagnosed a fractured jaw, administered palliative care, and recommended further treatment which the plaintiff refused, stating his preference to seek treatment at Charity Hospital.
Defense counsel further argues that prompt action was taken upon discovering the inadvertence or mistake in misplacing the summons and service, there was no willful or deliberate error and no prejudice will enure to the detriment of the plaintiff in light of the swift response upon discovering the mistake.
Plaintiff's counsel submits that the defendant correctly states the law applicable to this case. The argument in opposition to the motion to set aside entry of default is that the defendant has failed to demonstrate that defendant's conduct did not rise to the level of willfulness. Plaintiff's counsel's position is that absent an affidavit from Ms. Popp, herself, to the effect that she made a mistake, that defendant has failed to prove that defendant's conduct did not rise to the level of willfulness.
FRCP Rule 55(c) provides that an entry of default may be set aside if the party seeking relief shows good cause. The district court should consider: (1) whether the default was willful; (2) whether setting it aside would prejudice the adversary; and (3) whether a meritorious defense is presented).
CJC Holdings, Inc. v. Wright Lato, Inc., 979 F.2d 60, 64 (5th Cir. 1992) (citing United States v. One Parcel of Real Property, 763 F.2d 181, 183 (5th Cir. 1985)).
The foregoing factors are by no means "talismanic" or exclusive. In Matter of Dierschke, 975 F.2d 181, 184 (5th Cir. 1992), the Fifth Circuit observed that "[c]ourts have been careful to avoid treating them as if they were exclusive, relying on such other factors including whether: (1) the public interest was implicated; (2) there was a significant financial loss to the defendant; and (3) the defendant has acted expeditiously to correct the default." Id. (citations omitted). The Fifth Circuit instructs:
Id.
Whatever factors are employed, the imperative is that they be regarded simply as a means of identifying circumstances which warrant the finding of 'good cause' to set aside a default. That decision necessarily is informed by equitable principles. Id.
In the case at bar, such "good cause" exists even without an affidavit executed by Ms. Popp. This is not a case of willful disregard, arrogance, uncooperativeness and does not involve an obstructionist adversary. The defendant's submissions make it pellucid that there was no intention to ignore the situation. The complaint received at the defendant company's headquarters in Santa Barbara, through inadvertence and/or mistake, failed to reach the regional director in Dallas, and local counsel was thus, not timely assigned.
When the error was discovered swift action was taken by local counsel to correct the default. The Court discerns no prejudice from the record and the defendant asserts potentially meritorious defenses. Additionally, the substantial sum plaintiff sought as a recovery in this matter as damages for failure to follow the dictates of EMTALA merits caution before denying the defendant a defense on the merits.
For all of the above and foregoing reasons, the Court GRANTS the defense Motion to Set Aside Entry of Default.
MOTION TO DISMISS
The gravamen of the defendant's motion to dismiss is that plaintiff's claims are tantamount to allegations of medical malpractice. Defense counsel submits that to the extent that the plaintiff alleges malpractice, those claims must be first passed on by a medical review panel since the defendant is a qualified health care provider under the Louisiana Medical Malpractice Act. Defendant seeks dismissal of the state law malpractice (i.e., negligence) claims without prejudice and a stay of the remaining EMTALA claims pending the results of a the medical review panel on the state law malpractice/negligence claims.
Plaintiff's counsel points out the utter absence of any claims of negligence on the part of the hospital in question. Plaintiff's counsel submits and the complaint bears out that the allegations are strictly intentional acts on the part of the hospital proscribed by the EMTALA (i.e., the Federal Patient Anti-Dumping Act).
Plaintiff's counsel points out that the Louisiana Medical Malpractice Act defines malpractice as "any unintentional tort." In short, plaintiff's counsel argues that Bauman's claims fall squarely under EMTALA — that is, that Meadowcrest failed to meet their obligations under tenets 42 U.S.C. § 1395 (dd) "in that it failed to perform a medical screening, stabilize the complainant, or secure to his transfer to another facility, despite the fact that he was suffering an emergency medical condition" upon failing to discern that he was covered by health insurance. Complaint, at para. IX. In short, the plaintiff's complaint alleges nothing less than a "patient dumping" claim — that is, conduct proscribed by EMTALA.
La.R.S. 40:1299/41(A)(8) provides that "'malpractice' means any unintentional tort . . . based on health care or professional services rendered, or which should have been rendered, by a health care provider, to a patient, including failure to render services timely. . . ." La.R.S. § 1299.47(A)(1) provides that "[a]ll malpractice claims against health care providers covered by this Part . . . shall be reviewed by a medical review panel . . ."
Federal Rule of Civil Procedure 12(b)(6) allows a party to move for a dismissal of a complaint for failure to state a claim upon which relief can be granted. Such a motion is viewed with disfavor and the plaintiff's complaint must be liberally construed. The Court may only dismiss a complaint under an FRCP 12(b)(6) motion when "it appears beyond doubt that the plaintiff can prove no set of facts in support of his claim which would entitle him to relief."
Lowrey v. Texas A M University System, 117 F.3d 242, 247 (5th Cir. 1997) (quoting Conley v. Gibson, 355 U.S. 41, 45-46 (1957)).
The EMTALA is not a federal malpractice action, but was enacted to prevent "patient dumping," i.e., the practice of refusing to treat patients who are unable to pay. The Act "mandates that a hospital must conduct appropriate screening examinations for any individual" who comes to its emergency department." Miller v. Medical Center of Southwest Louisiana, 22 F.3d 626, 628 (5th Cir. 1994). An EMTALA "'appropriate medical screening examination' is not judged by its proficiency in accurately diagnosing the patient's illness, but rather by whether it was performed equitably in comparison to other patients with similar symptoms." Marshall, 134 F.3d at 322. If the ENTALA defendant provided an appropriate medical screening examination, it is not liable under the Act even for misdiagnosis, which conduct could subject the physician and his employer to liability pursuant to the state's medical malpractice act.
Marshall v. East Carroll Parish Hosp., 134 F.3d 319, 322 (5th Cir. 1998).
The gravamen of an EMTALA claim is whether the screening was "appropriate", i.e., whether it was the same as that regularly accorded other patients in similar circumstances. Merely providing some sort of medical attention is not sufficient — EMTALA requires that hospitals ensure screening procedures that are uniformly applied. In addition to the "appropriate screening requirement", the EMTALA also has a stabilization requirement — that is, once the hospital has determined that a patient has an emergency medical condition, the EMTALA requires that the hospital stabilize that patient before transferring him. Under the statute with respect to emergency medical condition the term "to stabilize" means "to provide such medical treatment as may be necessary to assure, within reasonable medical probability, that no material deterioration of the condition is likely to result from or during the transfer of the individual from a facility. . . ." 42 U.S.C. § 1395dd(e)(3)(A) and (3)(B).
EMTALA does not hold hospitals accountable for failing to stabilize conditions which went undetected, even if the condition should have been detected. If such were the case, EMTALA would be coextensive with malpractice claims for negligent treatment. See, Marshall v. East Carroll Parish Hospital Service District, 134 F.3d 319, 325 (Th Cir. 1998) (affirming summary judgment in favor of the Hospital because there was no material issue of fact regarding the physician's determination that Ms. Marshall did not have a medical emergency condition). The sum and substance of the Marshall court's opinion was that once the physician made his determination that no medical emergency condition existed, whether the determination was right or wrong, at that point the Hospital did not have a duty under EMTALA to provide further medical treatment or to stabilize conditions since the Hospital was aware of no medical emergency condition.). In short, the stabilization and transfer provisions of EMTALA are triggered only after the hospital determines that an individual has an emergency medical condition.
Plaintiff's counsel submits that the Louisiana Medical Malpractice Act does not apply to the instant case, since the plaintiff only alleges claims pursuant to the EMTALA and not negligence (i.e., conduct that fell below any standard of care The Court agrees that plaintiff need not conform to the pre-suit requirements of Louisiana's Medical Malpractice Act since his claims are pursuant to the EMTALA and there are no allegations of medical negligence (i.e., professional conduct which falls below the applicable standard of care). The purpose of convening a medical review panel would be to discern whether or not there was any professional negligence.
Medical malpractice actions are separate and distinct from EMTALA actions. Malpractice actions are based on negligence and seek to compensate victims for injuries suffered when health care providers breach the applicable standard of care. As noted earlier, the EMTALA targets the evil of "patient dumping" and is not a "fault" based determination. The focus of this case is whether the hospital complied with the dictates of 42 U.S.C. § 1395dd regarding affording the patient an "appropriate" screening and "stabilization" of any emergency medical condition discerned before transferring the patient to another facility. EMTALA narrowly defines sanctionable conduct and holds hospitals alone liable.
Accordingly, and for all of the above and foregoing reasons,
IT IS ORDERED that the defendant's Motion to Dismiss is DENIED since the complaint does not allege any malpractice/negligence claims.
IT IS FURTHER ORDERED that the defendant's Motion to Set Aside Entry of Default is GRANTED.