Ingram v. Muskogee Regional Medical Center
PUBLISH
UNITED STATES COURT OF APPEALS
TENTH CIRCUIT
| HELEN INGRAM, Special Administration of the Estate of LaTasha Cherie Ingram, deceased, Plaintiff-Appellant, v. MUSKOGEE REGIONAL MEDICAL CENTER, Defendant-Appellee, and JAY A. GREGORY, M.D.; RUSSELL T. SHEPHEARD, M.D.; BERRY E. WINN, Defendants. | No. 99-7126 |
APPEAL FROM THE UNITED STATES DISTRICT COURT
FOR THE EASTERN DISTRICT OF OKLAHOMA
(D.C. No. 99-CV-262-S)
Submitted on the briefs:
John F. McCormick, Jr., Harry A. Parrish, of Pray, Walker, Jackman,
Williamson & Marlar, Tulsa, Oklahoma, for Plaintiff-Appellant.
Terry Todd, Leslie C. Weeks, Elizabeth K. Hall, of Rodolf & Todd, Tulsa,
Oklahoma, for Defendant-Appellee.
Before TACHA, EBEL, and
BRISCOE, Circuit Judges.
EBEL, Circuit Judge.
This suit arises from the death of LaTasha Ingram after she suffered
a gunshot wound to the chest. The following facts are not disputed. Ms.
Ingram was shot in the early hours of the morning and taken to the emergency
room at Muskogee Regional Medical Center (MRMC) in Muskogee, Oklahoma. The
emergency room physician, Dr. Russell Shepheard, initiated treatment and called
the on-call surgeon, Dr. Jay Gregory. Dr. Gregory ordered Ms. Ingram
transferred to the intensive care unit over the phone, and determined later at
the hospital that she needed cardiovascular surgery. Because MRMC lacked the
necessary surgeons, Dr. Gregory arranged for Ms. Ingram to be transferred
to St. Francis Hospital in Tulsa. The risks were explained to plaintiff,
Ms. Ingram’s mother, who then requested the transfer in writing. Ms. Ingram died
shortly after she was transferred from MRMC.
Plaintiff sued MRMC and three physicians, asserting claims of wrongful death
under theories of common law medical malpractice and violation of the Emergency
Medical Treatment and Active Labor Act (EMTALA), 42 U.S.C. ? 1395dd.
Plaintiff alleged that MRMC inappropriately transferred Ms. Ingram under EMTALA
because defendants failed to first stabilize her condition and minimize the risk
of transfer by inserting chest tubes. The district court granted summary
judgment to MRMC on plaintiff’s EMTALA claim and dismissed the pendent medical
malpractice claims for lack of jurisdiction. Plaintiff appeals from the grant of
summary judgment to MRMC, but does not challenge the dismissal of her pendent
claims against defendants. We have jurisdiction under 28 U.S.C.
? 1291, and affirm.(1)
On appeal, plaintiff argues that the district court erred: (1) in granting
summary judgment to MRMC when plaintiff presented evidence that
Ms. Ingram’s transfer was not appropriate under EMTALA; (2) in holding that
a difference of opinion on appropriate treatment supported only a state medical
malpractice issue; and (3) in requiring plaintiff to present proof of
a violation of MRMC’s procedures or requirements regarding
Dr. Gregory’s failure to insert chest tubes to support her claim that Ms.
Ingram’s transfer was not appropriate under EMTALA.
We review the grant of summary judgment de novo, using the same standard as
the district court under Fed. R. Civ. P. 56(c). Ford v. West,
222 F.3d 767, 774 (10th Cir. 2000). A summary judgment is appropriate “if
the pleadings, depositions, answers to interrogatories, and admissions on file,
together with the affidavits, if any, show that there is no genuine issue as to
any material fact and that the moving party is entitled to a judgment as a
matter of law.” Rule 56(c).
EMTALA was enacted to prevent hospitals from “dumping” patients that they
could treat but who could not pay for services. See, e.g., Bryan v.
Rectors & Visitors of the Univ. of Va., 95 F.3d 349, 351-52 (4th Cir.
1996); Summers v. Baptist Med. Ctr. Arkadelphia, 91 F.3d 1132, 1136-37
(8th Cir. 1996); Delaney v. Cade, 986 F.2d 387, 391 n.5 (10th Cir.
1993); Thornton v. S.W. Detroit Hosp., 895 F.2d 1131, 1134 (6th Cir.
1990); see generally 131 Cong. Rec. 28568-28570. A hospital governed
by EMTALA is faced with two basic requirements. First, “the hospital must
provide for an appropriate medical screening . . . to determine whether or not
an emergency medical condition . . . exists.” 42 U.S.C. ? 1395dd(a).
Plaintiff did not allege that MRMC’s initial medical screening was not
appropriate.
Second, EMTALA also requires that “[i]f an individual at a hospital has an
emergency medical condition which has not been stabilized . . ., the hospital
may not transfer the individual unless” certain conditions are met.
? 1395dd(c)(1). An initial condition is that the individual, or a
responsible person acting on his or her behalf, after being informed of the
hospital’s EMTALA obligations, must request a transfer in writing,
? 1395dd(c)(1)(A)(i), or a physician must determine that the risks of
transfer are outweighed by the medical benefits reasonably expected to be
provided at another medical facility, and this determination must be documented
in a signed certification, ? 1395dd(c)(1)(A)(ii), (iii).
In addition, however, the transfer must be “appropriate,” as defined by
the statute. ? 1395dd(c)(1)(B). “An appropriate transfer to a medical
facility is a transfer–(A) in which the transferring hospital provides the
medical treatment within its capacity which minimizes the risks to the
individual’s health.” ? 1395dd(c)(2).
The district court determined that there is a dispute of material fact as to
whether Ms. Ingram’s condition was stable when she was transferred. Because
summary judgment was sought against plaintiff, the district court therefore
appropriately completed its analysis under EMTALA assuming that Ms. Ingram’s
condition was not stable and that the limitations of ? 1395dd(c) on
transferring her to another hospital applied. The court correctly determined
that defendants had satisfied the written request and signed certification
conditions for transfer under ? 1395dd(c)(1)(A). The parties dispute
whether the transfer was “appropriate” within the meaning of
? 1395dd(c)(2)(A).
There was no dispute that MRMC could have inserted chest tubes prior to
transfer. However, there was a sharp dispute as to whether insertion of chest
tubes would have been helpful or harmful. The court noted that plaintiff
produced evidence that the insertion of chest tubes prior to Ms. Ingram’s
transfer would have reduced the risks of transfer, while MRMC presented evidence
that insertion of chest tubes would have created the possibility that Ms. Ingram
would bleed to death. Thus, the question is whether plaintiff raised
a factual dispute as to whether MRMC “provide[d] the medical treatment
within its capacity [to] minimize[] the risks to [Ms. Ingram’s] health.”
? 1395dd(c)(2)(A).
We hold that plaintiff’s evidence is insufficient to create a material
dispute of fact within the meaning of the statute. We have found no cases from
any jurisdiction interpreting ? 1395dd(c)(2)(A). However, in Repp v.
Anadarko Municipal Hospital, 43 F.3d 519, 522 (10th Cir. 1994),
this court construed similar language in EMTALA’s screening provision,
? 1395dd(a). Section 1395dd(a) states that “the hospital must provide for
an appropriate medical screening examination within the capability of the
hospital’s emergency department, including ancillary services routinely
available to the emergency department.” We stated that the phrase “appropriate
medical screening” was ambiguous, and then concluded that each hospital
determines its own capabilities by establishing a standard procedure, which is
all the hospital needs to follow to avoid liability under EMTALA. 43 F.3d at
522. This narrow interpretation ties the statute to its limited purpose, which
was to eliminate patient-dumping and not to federalize medical malpractice.
See, e.g., Bryan, 95 F.3d at 351-52; Summers, 91 F.3d
at 1136-37; Thornton, 895 F.2d at 1134; see generally
131 Cong. Rec. 28568-28570.
We conclude that sections (a) and (c)(2)(A) should be interpreted similarly,
considering the similarity of the language in those sections and the lack of any
meaningful distinction between the terms “capability” and “capacity.” Therefore,
in light of this court’s prior decision in Repp, MRMC’s capacity to
provide medical treatment to minimize the risks of transfer should be measured
by its standard practices, and plaintiff was required to produce evidence that
Dr. Gregory violated an existing hospital procedure or requirement by
failing to insert chest tubes in order to show that the transfer was not
appropriate under ? 1395dd(c)(2)(A). Because she did not, the grant of
summary judgment to MRMC was proper, and the district court judgment is
affirmed.
AFFIRMED.
FOOTNOTES
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corresponding location in the text.
1. After examining the briefs and appellate record,
this panel has determined unanimously to grant the parties’ request for a
decision on the briefs without oral argument. See Fed. R. App. P. 34(f);
10th Cir. R. 34.1(G). The case is therefore ordered submitted without oral
argument.