Opinion
No. 89C 6952.
October 16, 1990
MEMORANDUM OPINION AND ORDER
The plaintiff in this case has asked the court to reconsider its opinion announced on March 9, 1990 granting the defendants' motion to dismiss the complaint. The opinion was oral and sought a request for reconsideration in the interest of more in depth research. Now, that additional research has yielded the instant and final ruling in the matter.
It turns out that the real issue for resolution is whether this court has subject matter jurisdiction over the case pursuant to the Emergency Medical Treatment and Active Labor Act, 42 U.S.C. § 1395dd (1988), or whether the case should be relegated to state court as a medical malpractice claim. Because of the unique facts of this case, the court must determine more effectively than it did at first the scope of the statute to resolve the case. Title 42 U.S.C. § 1395dd is more commonly, and hereinafter, to be referred to as "COBRA", an acronym for the Consolidated Omnibus Budget Reconciliation Act of 1986 of which § 1395dd is a part.
As was alleged in the complaint, we will begin out with the scenario of the plaintiff Tracy Loss being presented to the defendant, St. Joseph Hospital, in active labor in fact and as that term is defined under 42 U.S.C. § 1395dd(e)(2). This occurred on September 12, 1987. She was admitted to the hospital on that date in need of care and treatment of her pregnancy and labor. Later on that same day, the plaintiff gave live birth to now the plaintiff's decedent, Brent Loss, and, as is alleged, from the time of his birth he suffered with severe congenital cardiac disease. Dr. Song, the named doctor defendant, was the one in charge of the care and treatment, and then of the discharge of both the plaintiff and her baby Brent Loss. This happened on the next day, September 13, 1987. During that day the plaintiff and her newborn, now an additional person, were discharged from the care and treatment of St. Joseph Hospital.
It is alleged in the complaint that prior to and at the time of this discharge, the plaintiff's decedent, the newborn Brent Loss, exhibited blue discoloration from its waist and thighs to its toes, it ate poorly, and it was lethargic, symptoms which according to the complaint indicated an emergency medical condition, such that the absence of immediate medical attention could reasonably be expected to have resulted in placing the baby's health and life in serious jeopardy. At the time of the discharge, according to the allegations, the now decedent, Brent Loss, was not stabilized as that term is defined by 42 U.S.C. § 1395dd(e)(4)(B), and the discharge, it is urged, was in violation of the provisions of 42 U.S.C. § 1395dd(c)(1). Finally, the complaint charges that as a direct and proximate result of the next-day discharge of the mother and child, the plaintiff's decedent, Brent Loss, suffered severe complications of a congenital cardiac disease which resulted in his death on September 15, 1987.
Thus, it becomes clear that with respect to whether the plaintiff has a COBRA claim which can be heard in this court, the focus must be on what actually happened to the newborn infant baby once born, as well as the condition he was in at the time he was born. With regards to the care and treatment of the mother, it is obvious that she herself does not have a COBRA claim and she does not assert one. Rather, she brings this one suit on behalf of the deceased child. What makes this case different from those surveyed by this court earlier is that here, we do not have a mother in active labor who shows up at the emergency room for delivery of the baby and is turned away. Here, we do not have a case in which a person shows up in the emergency room with an emergency medical condition and is either turned away without a proper screening or, is admitted and then discharged without having been stabilized. This case presents something of a combination of both scenarios: (a) where the mother in active labor goes to a hospital and is admitted, gives birth to the child who is born with an emergency medical condition; and (b) where the child once found there is medically treated but released before a serious condition is stabilized. Does this situation give rise to a COBRA claim?
Section 1395dd, as modified in 1986 by the Emergency Treatment and Active Labor Act, Pub.L. 99-272, 100 Stat. 82 (1986), was enacted to alleviate the problem of "patient dumping." This term refers to a hospital's refusal to treat an emergency patient, even though the hospital is physically capable of doing so, simply because the patient does not have adequate medical insurance to cover the costs of the treatment and is otherwise unable to pay for it, or for some other reason is considered undesirable as an extended patient. Section 1395dd states in relevant part:
(a) Medical screening requirement
In the case of a hospital that has a hospital emergency department, if any individual (whether or not eligible for benefits under this subchapter) comes to the emergency department and a request is made on the individual's behalf for examination or treatment for a medical condition, the hospital must provide for an appropriate medical screening examination within the capability of the hospital's emergency department to determine whether or not an emergency medical condition . . . exists. . . .
(b) Necessary stabilizing treatment for emergency medical conditions . . .
(1) In general
If any individual (whether or not eligible for benefits under this subchapter) comes to a hospital and the hospital determines that the individual has an emergency medical condition . . ., the hospital must provide either
(A) within the staff and facilities available at the hospital, for such further medical examination and such treatment as may be required to stabilize the medical condition . . ., or
(B) for transfer of the individual to another medical facility in accordance with subsection (c) of this section.
Subsection (e) defines some terms which are relevant here:
(1) The term "emergency medical condition" means a medical condition manifesting itself by acute symptoms of sufficient severity (including severe pain) such that the absence of immediate medical attention could reasonably be expected to result in
(A) placing the patient's health in serious jeopardy,
(B) serious impairment to bodily functions, or
(C) serious dysfunction of any bodily organ or part,
(4)(A) The term "to stabilize" means, with respect to an emergency medical condition, to provide such medical treatment of the condition as may be necessary to assure, within reasonable medical probability, that no material deterioration of the condition is likely to result from the transfer of the individual from a facility.
(5) The term "transfer" means the movement (including the discharge) of a patient outside the hospital's facilities at the direction of any person employed by . . . the hospital. . . .
From these recitations of the language of the statute it is evident that there are two ways in which a hospital can violate § 1395dd through the operation of its emergency room: (1) it can do so by failing to detect the nature of the emergency condition through inadequate screening procedures under subsection (a), or; (2) it can do so under subsection (b), if the emergency nature of the patient's condition is detected, by failing to stabilize that condition before releasing the plaintiff. Based on the court's review of the language of the complaint, this case becomes concerned with the second situation.
With respect to a pleading standard for this kind of COBRA case, Judge Kocoras of this court in Deberry v. Sherman Hospital Assoc., 741 F. Supp. 1302, 1305 (N.D.Ill. 1990), made the following statement:
Combining the legal elements with the liberal federal rule of notice pleading, we conclude that the would-be COBRA plaintiff must allege that he (1) went to the defendant's emergency room (2) with an emergency medical condition, and that the hospital either (3) did not adequately screen him to determine whether he had such a condition, or (4) discharged or transferred him before the emergency condition had been stabilized.
As stated earlier, the focus of the plaintiff's complaint is on what happened to the newborn child, not the mother. With respect to him, if he is a proper party under the statute, though he was born — came into legal existence after admittance, the complaint meets all of the elements listed by Judge Kocoras in Deberry save that one. The plaintiff cannot allege that Brent Loss went to the emergency room of St. Joseph's Hospital because he was yet unborn. He came into the hospital by virtue of his mother's giving birth to him. The fact that this case does not deal with the simplistic emergency room situation, however, turns out not to be fatal to the plaintiff's complaint.
In an interesting case, Thornton v. Southwest Detroit Hosp., 895 F.2d 1131 (6th Cir. 1990), the plaintiff brought an action against the defendant hospital alleging that after having suffered a stroke outside the hospital and then having been admitted to the hospital, her condition remained unstabilized and then she was released. The court went into the legislative history of COBRA, making repeated references to the use of the phrase "emergency room." Id. at 1135. The defendant had argued that the repeated use of the term "emergency room" indicated that "Congress intended that the requirement to care for a patient not extend to where the patient was admitted to the hospital." Id. The court commented on this argument stating:
A fairer reading is that Congress sought to insure that patients with medical emergencies would receive emergency care. Although emergency care often occurs, and almost invariably begins, in an emergency room, emergency care does not always stop when a patient is wheeled from the emergency room into the main hospital. Hospitals may not circumvent the requirements of the Act merely by admitting an emergency room patient to the hospital, then immediately discharging that patient. Emergency care must be given until the patient's emergency medical condition is stabilized.Id.
This court thinks it only logical that if a mother in active labor is admitted to a hospital and then gives birth to a child with an emergency medical condition then that same emergency care would extend forward and adopt that newborn child and cover it until it too is stabilized. This court also notes that conveniently the American College of Emergency Physicians has defined "medical emergency" as including "[c]ongenital defects or abnormalities in a newborn infant best managed by prompt intervention." See Note, Preventing Patient Dumping: Sharpening the COBRA's Fangs, 61 N.Y.U.L.Rev. 1186, 1210-1211, n. 169-70 (1986). It is obvious that the field of medicine considers that a hospital admitting to its emergency room a pregnant woman in labor is also admitting as a separate person the yet to be born child.
CONCLUSION
The plaintiff here has alleged that Brent Loss, from the moment he was born in the defendant hospital, suffered from a severe congenital cardiac disease which was an emergency medical condition that was not stabilized before he was discharged from the hospital. The court must consider plaintiff's language as charging that the hospital knowingly admitted him even though he had not yet been born when it admitted his pregnant mother. The court finds that these allegations of the complaint, as they are, suffice to fit within the language of 42 U.S.C. § 1395dd et. seq., and give the infant the instant cause of action. The defendant's motion to dismiss for lack of federal subject matter jurisdiction and for failure to state a claim upon which relief can be granted must in finality be denied. The court's previous orders orally granting the defendant's motion and then requiring the plaintiff to amend her pleadings are vacated. The complaint may stand as it is alleged (unless the plaintiff voluntarily determines to more realistically state the case). It is so ordered.