[PUBLISH]
IN THE UNITED STATES COURT OF APPEALS
FOR THE ELEVENTH CIRCUIT FILED
________________________ U.S. COURT OF APPEALS
ELEVENTH CIRCUIT
MAY 16, 2002
No. 99-13205 THOMAS K. KAHN
________________________ CLERK
D. C. Docket No. 99-00786-CV-KMM
BERNIE HARRY, as Personal
Representative of the Estate
of Lisa Normil, deceased,
Plaintiff-Appellant,
versus
WAYNE MARCHANT, M.D.,
ALI BAZZI, M.D., et al.,
Defendants-Appellees.
________________________
Appeal from the United States District Court
for the Southern District of Florida
_________________________
(May 16, 2002)
Before ANDERSON, Chief Judge, and TJOFLAT, EDMONDSON, BIRCH,
DUBINA, BLACK, CARNES, BARKETT, HULL, MARCUS and WILSON,
Circuit Judges.
BLACK, Circuit Judge:
This case involves the Emergency Medical Treatment and Active Labor Act
(EMTALA), 42 U.S.C. § 1395dd. EMTALA was enacted to prevent “patient
dumping,” the publicized practice of some hospitals turning away or transferring
indigent patients without evaluation or treatment. Under EMTALA, when an
individual presents for treatment at the emergency department of a hospital, the
hospital must provide an appropriate medical screening to determine whether an
emergency medical condition exists. If an emergency medical condition is
determined to exist, the hospital ordinarily must provide stabilization treatment
before transferring the patient.1 The issue before this Court is whether EMTALA
imposes a federal statutory obligation on a hospital to provide stabilization
treatment to a patient with an emergency medical condition who is not transferred.
We hold no such duty exists under EMTALA.
I. BACKGROUND
A. Factual Background
The complaint in this case alleges the following facts. At approximately
1:17 a.m. on November 26, 1997, Miami-Dade Fire Rescue brought Lisa Normil to
1
“Transfer” is defined as “the movement (including the discharge) of an
individual outside of a hospital’s facilities.” 42 U.S.C. § 1395dd(e)(4) (1994). We
use the term “transfer” in this opinion as defined in EMTALA. Reference to a
patient who is “transferred,” therefore, will apply equally to a patient who is
discharged.
2
the emergency room at Aventura Hospital and Medical Center (Aventura Hospital)
and requested medical treatment on her behalf. Normil was seen first by Dr.
Wayne Marchant, an emergency room physician, whose notes indicated a
diagnosis of “pneumonia rule out sepsis.”
Dr. Marchant contacted Dr. Kevin Coy, who was acting as the on-call
attending physician on behalf of Normil’s primary care provider, to report his
diagnosis and to request permission to admit Normil into the intensive care unit
(ICU) of the hospital for concentrated care and management.2 Dr. Coy refused to
authorize admission into the ICU and instead directed Dr. Marchant to obtain a
ventilation perfusion scan (VQ Scan). Dr. Marchant advised Dr. Coy a VQ Scan
could not be performed because the hospital had insufficient isotopes to conduct
the scan. Despite the unavailability of a VQ Scan, Dr. Coy continued to deny
authorization for Normil’s admittance into the ICU.
Later that morning, Dr. Marchant was able to contact Normil’s primary care
physician, Dr. Ali Bazzi. Approximately five hours after he was contacted by
2
In most cases, emergency room physicians do not have hospital admitting
privileges and must depend on the approval of the attending or primary care
physician for admittance. S. Rep. No. 99-146, at 471 & 482, reprinted in 1986
U.S.C.C.A.N. 42, 430 & 441 (statement submitted by the American College of
Emergency Physicians); see also Reed v. Good Samaritan Hosp. Ass’n, Inc.,
453
So. 2d 229 (Fla. Dist. Ct. App. 1984).
3
Dr. Marchant, Dr. Bazzi examined Normil in the emergency room, reviewed her
available radiological evidence, and assessed her vital signs. Following Normil’s
examination by Dr. Bazzi, she was admitted into the ICU at Aventura Hospital.
Although Dr. Bazzi prescribed antibiotics, the ICU nurse, Polly Linker, never
administered the medication.
After Normil’s admittance into the ICU, she lapsed into respiratory and
cardiac failure. Dr. Christopher Hanner, a physician working at the hospital,
unsuccessfully attempted to resuscitate Normil. She died at approximately 12:45
p.m.
B. Procedural Background
Following Normil’s death, Appellant Bernie Harry, personal representative
of her estate, filed suit against Dr. Marchant, Dr. Bazzi, Dr. Hanner, Dr. Coy,
Linker, and Aventura Hospital3 (collectively, Appellees). In his complaint,
Appellant alleged Aventura Hospital violated EMTALA by failing to stabilize and
treat Normil’s emergency medical condition.4 Appellant, however, did not allege
3
The complaint named Miami Beach Healthcare Group, Ltd., d/b/a Aventura
Hospital and Medical Center as a defendant.
4
The complaint alleged two additional federal law claims against Aventura
Hospital: violation of EMTALA’s appropriate medical screening requirement and
violation of
42 U.S.C. § 1981. Dr. Bazzi and Linker also were alleged to have
violated § 1981. In addition, the complaint alleged a number of state law claims,
4
Normil was transferred by Aventura Hospital. Rather, Appellant’s primary
allegation under EMTALA was the treatment provided to Normil was negligent
and not sufficiently aggressive to treat and stabilize her condition.
In response to Appellant’s complaint, Aventura Hospital moved to dismiss
for failure to state a claim under EMTALA.5 The district court granted the motion
with prejudice.6 On appeal, a panel of this Court reversed, holding the allegations
contained in Appellant’s complaint supported a claim against Aventura Hospital
under EMTALA for failing to treat and stabilize Normil’s condition. Harry v.
Marchant,
237 F.3d 1315, vacated, reh’g granted en banc,
259 F.3d 1310 (11th
including wrongful death claims against all Appellees, a negligence per se claim
against Aventura Hospital, and a vicarious liability claim against Aventura
Hospital. Drs. Marchant, Coy, and Hanner were sued only under state law.
5
The Appellees sued under § 1981 and the Appellees sued under state law
sought dismissal of those claims.
6
The § 1981 claims also were dismissed with prejudice. Declining
supplemental jurisdiction, the district court dismissed the state law claims without
prejudice. The state law claims were subsequently pursued by Appellant in state
court.
5
Cir. 2001).7 Rehearing en banc was granted solely to determine the scope of
EMTALA’s stabilization requirement.
II. STANDARD OF REVIEW
We review de novo the dismissal of a complaint for failure to state a claim,
accepting all allegations in the complaint as true and construing facts in the light
most favorable to the plaintiff. Brown v. Budget Rent-A-Car Sys., Inc.,
119 F.3d
922, 923 (11th Cir. 1997).
III. DISCUSSION
In 1986, Congress enacted EMTALA in response to widely publicized
reports of emergency care providers transferring indigent patients from one
hospital to the next while the patients’ emergency medical conditions worsened.
EMTALA was designed specifically to address this important societal concern; it
was not intended to be a federal malpractice statute. Under EMTALA, hospital
emergency rooms are subject to two principal obligations, commonly referred to as
the appropriate medical screening requirement and the stabilization requirement.
See 42 U.S.C. § 1395dd (1994). The appropriate medical screening requirement
7
The panel further held the allegations contained in the complaint did not
support a claim against Aventura Hospital for failing to conduct an appropriate
medical screening to determine whether Normil suffered from an emergency
medical condition.
237 F.3d 1319-20. The panel, however, concluded the
complaint did support the claims for violation of § 1981. Id. at 1322.
6
obligates hospital emergency rooms to provide an appropriate medical screening to
any individual seeking treatment in order to determine whether the individual has
an emergency medical condition. Id. §1395dd(a). If an emergency medical
condition exists, the hospital is required to provide stabilization treatment before
transferring the individual. Id. §1395dd(b). The sole issue before this Court is the
extent to which EMTALA requires a hospital to provide stabilization treatment to a
patient with an emergency medical condition who is not transferred.8
In resolving this issue, we begin by scrutinizing the language of the statute.
Then, we review the statute’s legislative history. Finally, we examine the cases
discussing EMTALA’s stabilization requirement.
A. Language of the Statute
As with any question of statutory interpretation, we begin by examining the
text of the statute to determine whether its meaning is clear. See Hughes Aircraft
Co. v. Jacobson,
525 U.S. 432, 438,
119 S. Ct. 755, 760 (1999); Cmty. for Creative
Non-Violence v. Reid,
490 U.S. 730, 739,
109 S. Ct. 2166, 2172 (1989); United
States v. Gilbert,
198 F.3d 1293, 1298 (11th Cir. 1999). “In construing a statute
we must begin, and often should end as well, with the language of the statute
8
In this case, Normil was screened, treated, and eventually admitted.
Consequently, Aventura Hospital did not “transfer” her as defined by EMTALA.
7
itself.” United States v. Steele,
147 F.3d 1316, 1318 (11th Cir. 1998) (en banc)
(quoting Merritt v. Dillard Paper Co.,
120 F.3d 1181, 1185 (11th Cir. 1997)). We
do this because we “presume that Congress said what it meant and meant what it
said.” Steele,
147 F.3d at 1318.
The stabilization requirement of EMTALA provides in relevant part:
(b) Necessary stabilizing treatment for emergency
medical conditions and labor.
(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).9
42 U.S.C. § 1395dd(b)(1) (1994) (emphasis added).
9
Subsection (c) delineates the standards for making an appropriate transfer
and sets forth procedures for transferring patients who are not stabilized. 42
U.S.C. § 1395dd(c).
8
The term “to stabilize” is specifically defined by the statute. Under
EMTALA, the term “to stabilize” means “with respect to an emergency medical
condition . . . [a hospital must] 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 or occur during the transfer of the
individual from a facility.” 42 U.S.C. § 1395dd(e)(3)(A). When a statute includes
an explicit definition, that definition must be followed, even if it varies from the
term’s ordinary meaning. See Stenberg v. Carhart,
530 U.S. 914, 942,
120 S. Ct.
2597, 2615 (2000). Thus, to the extent the definition of “to stabilize” departs from
its common or ordinary usage, the statutory prescription governs.
In order to accurately determine the requirements of EMTALA, we must
insert the definition of the term “to stabilize” where the term is used in the statute.
When the definition of “to stabilize” is inserted into the stabilization requirement,
the statute provides:
(b) Necessary stabilizing treatment for emergency
medical conditions and labor.
(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
9
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 assure, within
reasonable medical probability, that no
material deterioration of the condition is
likely to result or occur during the transfer
of the individual from a facility], or
(B) for transfer of the individual to
another medical facility in accordance with
subsection (c).
42 U.S.C. § 1395dd(b)(1). Reading the statute in its specifically defined context, it
is evident EMTALA mandates stabilization of an individual only in the event of a
“transfer” as defined in EMTALA.10
By limiting application of the stabilization requirement to patient transfers,
the statutory structure of §1395dd(b)(1) makes sense. The statute is logically
structured to set forth two options for transferring a patient with an emergency
medical condition: a hospital must either provide stabilization treatment prior to
transferring a patient pursuant to subsection (A), or, pursuant to subsection (B),
provide no treatment and transfer according to one of the statutorily recognized
exceptions. Hence, the stabilization requirement only sets forth standards for
10
See supra note 1.
10
transferring a patient in either a stabilized or unstabilized condition. By its own
terms, the statute does not set forth guidelines for the care and treatment of patients
who are not transferred.
This construction gives full effect to the language and structure of the
stabilization requirement. “[I]t is an elementary principle of statutory construction
that, in construing a statute, we must give meaning to all the words in the statute.”
Legal Envtl. Assistance Found., Inc. v. EPA,
276 F.3d 1253, 1258 (11th Cir. 2001)
(citing Bailey v. United States,
516 U.S. 137, 146,
116 S. Ct. 501, 507 (1995)); see
also United States v. Canals-Jimenez,
943 F.2d 1284, 1287 (11th Cir. 1991) (“A
basic premise of statutory construction is that a statute is to be interpreted so that
no words shall be discarded as being meaningless, redundant, or mere
surplusage.”). Construing EMTALA to mandate stabilization treatment
irrespective of a transfer renders the words “during the transfer,” contained in the
statutory definition of the term “to stabilize,” superfluous.11 To give effect to the
11
Additionally, interpreting EMTALA to require stabilization treatment
outside the context of a transfer raises questions not answered by Congress, such
as: when the duty to provide stabilization treatment terminates; if treatment is
prolonged, and transfer is not imminent, how long treatment must be provided; and
when the temporal delay between a determination of an emergency medical
condition and the initiation of treatment constitutes a violation of a duty to provide
stabilization treatment. Of course, such an interpretation would lead to the
imposition of arbitrary limits, not supported by the statutory text, in an effort to fill
the patent gaps of legislative direction.
11
clear language of the statute, we must conclude the triggering mechanism for
stabilization treatment under EMTALA is transfer.
B. Legislative History
Where the language of a statute is unambiguous, as it is here, we need not,
and ought not, consider legislative history. See United States v. Gonzales,
520
U.S. 1, 6,
117 S. Ct. 1032, 1035 (1997) (“Given the straightforward statutory
command, there is no reason to resort to legislative history.”); see also Harris v.
Garner,
216 F.3d 970, 976 (11th Cir. 2000) (en banc) (“When the import of the
words Congress has used is clear, . . . we need not resort to legislative history, and
we certainly should not do so to undermine the plain meaning of the statutory
language.”). Even if a statute’s legislative history evinces an intent contrary to its
straightforward statutory command, “we do not resort to legislative history to
cloud a statutory text that is clear.” Ratzlaf v. United States,
510 U.S. 135, 147-48,
114 S. Ct. 655, 662 (1994); see also CBS, Inc. v. Primetime 24 Joint Venture,
245
F.3d 1217, 1229 (11th Cir. 2001); United States v. Weaver,
275 F.3d 1320, 1331
(11th Cir. 2001); Harris,
216 F.3d at 976; United States v. Gilbert,
198 F.3d 1293,
1299 (11th Cir. 1999). Regardless of its clarity or specificity, we do not give
legislative history more weight than unambiguous statutory language because
“[t]he statutory language itself is the principal battlefield where the warring
12
interests struggle against each other, and it is to that battlefield we should look for
the results of the battle.” CBS, Inc.,
245 F.3d at 1228.
Despite this important elementary principle of statutory construction,
“sometimes judges . . . cannot resist the temptation to set out [legislative] history.”
Harris,
216 F.3d at 977; see also Weaver, 275 F.3d at 1332 (“Notwithstanding this
recognized plain meaning rule, judges sometimes have not resisted the temptation
to set out and discuss legislative history. We equally succumb.” (citations
omitted)). We likewise succumb and examine the legislative history of EMTALA.
Gilbert,
198 F.3d at 1299 (“Given the plain meaning of the statutory language, we
could bypass any consideration of legislative history. Nevertheless, for the sake of
completeness, and because this is our first occasion to decide a Hyde Amendment
case, we will look at that history.”) (internal marks, footnote, and citations
omitted).
The legislative history of EMTALA indicates it was intended to prevent
“patient dumping,” the practice of some hospital emergency rooms turning away or
transferring indigents to public hospitals without prior assessment or stabilization
treatment. See H.R. Rep. No. 99-241, pt. 3, at 5 (1986), reprinted in 1986
U.S.C.C.A.N. 726, 726-27; see also Gatewood v. Washington Healthcare Corp.,
933 F.2d 1037, 1039-41 (D.C. Cir. 1991); Cleland v. Bronson Health Care Group,
13
Inc.,
917 F.2d 266, 268-69 (6th Cir. 1990). In enacting EMTALA, Congress was
concerned with widespread reports of emergency rooms “dumping” indigent
patients from one hospital to the next without regard to the patients’ medical
conditions. See 131 Cong. Rec. S13,904 (1985) (remarks of Sens. Durenberger,
Kennedy, Dole, Baucus, Heinz, and Proxmire). Congress’ solution was to
guarantee patient entry into the medical system via mandatory appropriate medical
screenings and stabilization prior to transfer.12 See S. Rep. No. 99-146, at 462, 464
(1986), reprinted in 1986 U.S.C.C.A.N. 42, 421, 423 (letter submitted by the law
firm of Kenny Nachwalter & Seymour) (“Section 124 [of the bill containing an
early version of EMTALA] seeks to prohibit inappropriate patient transfers and to
require a medical screening examination for each patient who requests one.”). The
primary legislative goal of EMTALA was remedying the problem of inappropriate
patient transfers by hospitals. See S. Rep. No. 99-146, at 469-70 (1986), reprinted
in 1986 U.S.C.C.A.N. 42, 428-29 (statement submitted by the American College of
Emergency Physicians) (“The American College of Emergency Physicians shares
the Committee’s concerns and does not condone inappropriate patient transfers,
some of which have recently come to light in the television and newspaper
12
Some limited exceptions to the stabilization requirement exist. See supra
note 9.
14
media. . . . [W]e are in agreement with the objective of the legislation (i.e., to
eliminate inappropriate patient transfers).”); see also S. Rep. No. 99-146, at 475
(1986), reprinted in 1986 U.S.C.C.A.N. 42, 434 (policy statement on transfer of
patients) (“Patients should not be transferred to another facility without first being
stabilized. Stabilization includes adequate evaluation and initiation of treatment to
assure the transfer of a patient will not, within reasonable medical probability,
result in death, or loss or serious impairment of bodily parts or organs.”); 131
Cong. Rec. S13,904 (1985) (remarks of Sen. Kennedy) (“Public hospitals have
reported to us a 400-percent rise in the number of patients who have been sent to
their emergency rooms after visiting another hospital.”).
The legislative history of EMTALA makes clear the statute was not intended
to be a federal malpractice statute, but instead was meant to supplement state law
solely with regard to the provision of limited medical services to patients in
emergency situations. See 131 Cong. Rec. S13,904 (1985) (remarks of Sen.
Kennedy) (“Some States have laws which ensure that no emergency patient is
denied emergency care because of inability to pay. But, 28 States have no such
law. Federal legislation in this area is long overdue.”); see also Hardy v. New York
City Health & Hosps. Corp.,
164 F.3d 789, 792 (2d Cir. 1999); Marshall v. E.
Carroll Parish Hosp. Serv. Dist.,
134 F.3d 319, 322 (5th Cir. 1998); Vickers v.
15
Nash Gen. Hosp., Inc.,
78 F.3d 139, 142 (4th Cir. 1996); Holcomb v. Monahan,
30
F.3d 116, 117 (11th Cir. 1994). EMTALA was not intended to establish guidelines
for patient care, to replace available state remedies, or to provide a federal remedy
for medical negligence. See Bryan v. Rectors & Visitors of the Univ. of Va.,
95
F.3d 349, 350-52 (4th Cir. 1996); Vickers,
78 F.3d at 142-43; Holcomb,
30 F.3d at
116. Indeed, EMTALA expressly contains a non-preemption provision for state
remedies. See 42 U.S.C. § 1395dd(f) (1994) (“The provisions of this section do
not preempt any State or local law requirement, except to the extent that the
requirement directly conflicts with a requirement of this section.”).
The legislative history of EMTALA is consistent with the clear language of
the statute. EMTALA’s main objective was to prevent the practice of “patient
dumping.” By mandating treatment only in the context of a patient transfer, the
stabilization requirement addresses Congress’ concern regarding rejection of
patients without converting EMTALA into a federal malpractice statute. In
prescribing minimal standards for screening and transferring patients, but not for
patient care outside these two narrowly defined contexts, Congress confined
EMTALA solely to address its concerns and, at the same time, avoided supplanting
available state malpractice and tort remedies.
C. Cases Discussing EMTALA’s Stabilization Requirement
16
In the sixteen years since EMTALA’s enactment, there have been relatively
few cases discussing the stabilization requirement imposed by the statute. The
only opportunity we have had to address EMTALA was in Holcomb v. Monahan,
30 F.3d 116 (11th Cir. 1994). Although we did not squarely address whether
EMTALA’s stabilization requirement imposes an obligation on hospitals to
provide treatment to individuals outside the context of a transfer, our discussion in
Holcomb is consistent with our conclusion here.
In Holcomb, a patient was discharged after a hospital provided an
appropriate medical screening and determined there was no emergency medical
condition.
Id. Subsequently, the patient died and the administratix of the patient’s
estate brought suit claiming violations of §§ 1395dd(a) and (b). Id. In addressing
the plaintiff’s claims, we set forth the requirements that must be established to
succeed on a § 1395dd(b) stabilization requirement claim: (1) the patient had an
emergency medical condition; (2) the hospital knew of the condition; (3) the
patient was not stabilized before being transferred; and (4) the hospital neither
obtained the patient’s consent to transfer nor completed a certificate indicating the
transfer would be beneficial to the patient. Id. Although we did not need to, and
did not, discuss the contours of the stabilization requirement, the stated elements
17
could be read to imply that stabilization treatment, and any claim under EMTALA
arising therefrom, arises only in the context of a transfer.
Like this Circuit, no other Circuit has squarely addressed whether
EMTALA’s stabilization requirement imposes an obligation on hospitals to
provide treatment to individuals outside the context of a transfer.13 To date, cases
from other Circuits discussing EMTALA’s stabilization requirement have
addressed only tangential issues arising out of an alleged failure to provide an
appropriate medical screening, an alleged failure to stabilize an emergency medical
13
We recognize the Fourth Circuit opinion in In re Baby “K”,
16 F.3d 590
(4th Cir. 1994) could be interpreted as addressing the contours of the stabilization
requirement. Nonetheless, just two years later, in Bryan v. Rectors & Visitors of
the Univ. of Va.,
95 F.3d 349, 352 (4th Cir. 1996), the Fourth Circuit clarified that
Baby “K” only addressed the issue of whether EMTALA’s stabilization
requirement mandates treatment of the emergency medical condition presented to
the hospital or the general medical condition of the patient. Thus, the Fourth
Circuit has held Baby “K” did not reach the issue of whether the stabilization
requirement only applies in the event of a transfer.
18
condition prior to an actual transfer, or a combination thereof.14 We, therefore, rely
solely on the clear language of the statute in reaching our conclusion.
IV. CONCLUSION
There is no duty under EMTALA to provide stabilization treatment to a
patient with an emergency medical condition who is not transferred. Because
14
See Baker v. Adventist Health, Inc.,
260 F.3d 987 (9th Cir. 2001); Jackson
v. E. Bay Hosp.,
246 F.3d 1248 (9th Cir. 2001); Williams v. United States,
242
F.3d 169 (4th Cir. 2001); Arrington v. Wong,
237 F.3d 1066 (9th Cir. 2001); Battle
v. Mem’l Hosp.,
228 F.3d 544 (5th Cir. 2000); Reynolds v. MaineGeneral Health,
218 F.3d 78 (1st Cir. 2000); Root v. New Liberty Hosp. Dist.,
209 F.3d 1068 (8th
Cir. 2000); Cherukuri v. Shalala,
175 F.3d 446 (6th Cir. 1999); Lopez-Soto v.
Hawayek,
175 F.3d 170 (1st Cir. 1999); Hardy v. New York City Health & Hosps.
Corp.,
164 F.3d 789 (2d Cir. 1999); Marshall v. E. Carroll Parish Hosp. Serv.
Dist.,
134 F.3d 319 (5th Cir. 1998); Roberts v. Galen of Va., Inc.,
111 F.3d 405
(6th Cir. 1997), rev’d by Roberts v. Galen of Va., Inc.,
525 U.S. 249,
119 S. Ct.
685 (1999); Vargas ex rel. Gallardo v. Del Puerto Hosp.,
98 F.3d 1202 (9th Cir.
1996); Bryan v. Rectors & Visitors of the Univ. of Va.,
95 F.3d 349 (4th Cir. 1996);
Summers v. Baptist Med. Ctr. Arkadelphia,
91 F.3d 1132 (8th Cir. 1996); James v.
Sunrise Hosp.,
86 F.3d 885 (9th Cir. 1996); Vickers v. Nash Gen. Hosp., Inc.,
78
F.3d 139 (4th Cir. 1996); Correa v. Hosp. San Francisco,
69 F.3d 1184 (1st Cir.
1995); Eberhardt v. City of Los Angeles,
62 F.3d 1253 (9th Cir. 1995); Urban ex
rel. Urban v. King,
43 F.3d 523 (10th Cir. 1994); Repp v. Anadarko Mun. Hosp.,
43 F.3d 519 (10th Cir. 1994); Holcomb v. Monahan,
30 F.3d 116 (11th Cir. 1994);
In re Baby “K”,
16 F.3d 590 (4th Cir. 1994); King v. Ahrens,
16 F.3d 265 (8th Cir.
1994); Green v. Touro Infirmary,
992 F.2d 537 (5th Cir. 1993); Johnson v. Univ. of
Chicago Hosps.,
982 F.2d 230 (7th Cir. 1993); Baber v. Hosp. Corp. of Am.,
977
F.2d 872 (4th Cir. 1992); Brooker v. Desert Hosp. Corp.,
947 F.2d 412 (9th Cir.
1991); Burditt v. U.S. Dep’t of Health & Human Servs.,
934 F.2d 1362 (5th Cir.
1991); Gatewood v. Washington Healthcare Corp.,
933 F.2d 1037 (D.C. Cir.
1991); Stevison v. Enid Health Sys., Inc.,
920 F.2d 710 (10th Cir. 1990); Cleland v.
Bronson Health Care Group, Inc.,
917 F.2d 266 (6th Cir. 1990); Thornton v. Sw.
Detroit Hosp.,
895 F.2d 1131 (6th Cir. 1990).
19
Normil was not transferred, Appellant’s §1395dd(b) stabilization requirement
claim fails to state a valid cause of action. In so holding, we recognize Appellant is
not without recourse. Remedies provided by state malpractice and tort law remain
available to redress negligent patient care by hospitals. Accordingly, the judgment
of the district court is affirmed with respect to the dismissal of the EMTALA
claims (§§ 1395dd(a) and (b)), and reversed, in accordance with the panel opinion,
with respect to the dismissal of Appellant’s §1981 claim.15
AFFIRMED in part, REVERSED in part, and REMANDED.
15
We reinstate the panel opinion except for Part 1.B., which discusses
EMTALA’s stabilization requirement.
20
BARKETT, Circuit Judge, concurring:
Upon reconsidering the language of EMTALA, I concur in the opinion of
the court and agree that because Lisa Normil was admitted as a patient, redress for
negligence occurring during her emergency room care is available through state
medical malpractice laws, rather than federal law.
21
