William Byrne v. Cleveland Clinic , 519 F. App'x 739 ( 2013 )

BLD-137 NOT PRECEDENTIAL
UNITED STATES COURT OF APPEALS
FOR THE THIRD CIRCUIT
___________
No. 12-4033
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WILLIAM F. BYRNE, ON HIS OWN BEHALF
AND FOR THOSE SIMILARLY SITUATED
v.
THE CLEVELAND CLINIC;
CHESTER COUNTY HOSPITAL
William Byrne,
Appellant
____________________________________
On Appeal from the United States District Court
for the Eastern District of Pennsylvania
(E.D. Pa. Civ. No. 09-cv-00889)
District Judge: Honorable Gene E.K. Pratter
____________________________________
Submitted for Possible Summary Action Pursuant to
Third Circuit LAR 27.4 and I.O.P. 10.6
February 28, 2013
Before: SCIRICA, HARDIMAN and GREENAWAY, JR., Circuit Judges
(Opinion filed: March 19, 2013)
_________
OPINION
_________
PER CURIAM
Pro se appellant, William Byrne, entered the emergency department of Chester
County Hospital in West Chester, Pennsylvania, around 5:00 p.m. on February 15, 2007,
experiencing chest pains and shortness of breath. Within 20 minutes of his arrival,
emergency department personnel drew blood and requested an EKG. A chest x-ray was
performed approximately 30 minutes later. According to Byrne, it took several hours
before he was actually examined by the emergency department physician. That
examination was followed by a visit from a cardiologist, Dr. Lewis, who presented Byrne
with the choice of having a “clot busting drug” administered or having a stent put in place
through a “catheterization procedure.” On Dr. Lewis‟ recommendation, Byrne opted for
the catheterization. The procedure was performed that same evening at Chester County
Hospital and concluded around 11:30 p.m.
Byrne filed a complaint against The Cleveland Clinic (“Clinic”) and Chester
County Hospital (“Hospital”) on March 12, 2012, which he subsequently amended on
April 22, 2009. In his amended complaint, Byrne set forth claims under the Emergency
Medical Treatment and Active Labor Act (“EMTALA”), 42 U.S.C. § 1395dd, as well as
a claim for breach of implied contract under Pennsylvania law. Byrne asserted that the
Clinic and the Hospital (acting as an agent and/or representative of the Clinic) “entered
into an implied contract” with him and the public providing that a stent procedure would
be conducted within 90 minutes or less from the time that a person enters into an
emergency room. Byrne alleged that, due to his delayed treatment, the Hospital breached
that contractual agreement. He thus sought to hold defendants liable for the resulting
heart damage and mental duress he allegedly suffered.
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Defendants moved separately to dismiss Byrne‟s amended complaint pursuant to
Fed. R. Civ. P. 12(b)(1) and 12(b)(6). The District Court granted those motions in part,
and denied them in part. Recognizing that EMTALA was “not intended to create a
federal malpractice statute or cover cases of hospital negligence,” see D. Ct. Mem. Op.
entered 2/5/10 at 11 (quoting Torretti v. Main Line Hosps., Inc., 580 F.3d 168, 178 (3d
Cir. 2009)), the District Court noted that the statute “simply „requires hospitals to provide
medical screening and stabilizing treatment to individuals seeking emergency care in a
nondiscriminatory manner.‟” Id. (quoting Torretti, 580 F.3d at 173).
While the allegations in Byrne‟s amended complaint were found sufficient to
withstand defendants‟ motion to dismiss with respect to a cause of action under
EMTALA‟s screening provision, the District Court determined that the allegations did
not provide a basis for a stabilization claim since Byrne did not allege that he was
transferred or discharged from the Hospital prior to receiving the catheterization
procedure and being stabilized. Byrne‟s breach of implied contract claim fared no better
insofar as a claim based on an alleged delay in treatment – as opposed to the treatment or
specific result itself – is not an actionable claim under Pennsylvania law. The court
concluded that further amendment of his complaint would be futile, and thus dismissed
Byrne‟s stabilization and breach of implied contract claims with prejudice.
A substantial period of discovery ensued, and both defendants filed motions for
summary judgment. Having determined that the screening duties imposed by 42 U.S.C. §
1395dd(a) are only triggered if a patient seeks treatment from a participating hospital, and
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that Byrne never physically entered the Clinic in Cleveland, Ohio, nor did he request
treatment from the Clinic, the District Court granted the Clinic‟s motion and entered
judgment in its favor. The court further determined that Byrne‟s documentary evidence
contained no indicia of a principal-agent relationship between the two establishments,
and that the affiliation between the Hospital and the Clinic was merely associative in
nature and limited to the Hospital‟s Cardiac Surgery Program (not the emergency
department). The court thus concluded that Byrne‟s documentary submissions “cannot
provide a sufficient evidentiary basis on which a reasonable jury could find that the
„affiliation‟ relationship between the Hospital and the Clinic is one that could impute
liability to the Clinic for the Hospital‟s alleged screening violation.” See D. Ct. Mem.
Op. entered 3/31/11 at 7.
Summary judgment was likewise subsequently found to be warranted in favor of
the Hospital. In accordance with 42 U.S.C. § 1395dd(a), the District Court initially noted
that “EMTALA imposes screening obligations that require a hospital‟s emergency
department to provide „an appropriate medical screening examination within the
capability of the hospital‟s emergency department … to determine whether or not an
emergency medical condition … exists.‟” See D. Ct. Mem. Op. entered 9/19/12 at 5.
The court thereafter determined that the record evidence demonstrated that the Hospital
applied the two policies it had in place governing the screening of emergency room
patients who complained of chest pain to Byrne, and that he did, in fact, receive similar
treatment in comparison to other persons who came to the Hospital‟s emergency
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department complaining of chest pain. Moreover, that screening procedure was not
found to be so cursory as to allow Byrne to prevail on his EMTALA‟s screening claim.
Judgment was accordingly entered in favor of the Hospital. Byrne timely appealed the
District Court‟s entry of summary judgment in favor of the Hospital.
We have jurisdiction under 28 U.S.C. § 1291, and our review is plenary.
See Howley v. Mellon Fin. Corp., 625 F.3d 788, 792 (3d Cir. 2010) (plenary review of
orders granting summary judgment). Summary judgment is granted when viewing the
evidence in the light most favorable to the nonmoving party, there is no genuine dispute
as to any material fact and the movant is entitled to a judgment as a matter of law. Fed.
R. Civ. P. 56(a); Beers-Capitol v. Whetzel, 256 F.3d 120, 130 n.6 (3d Cir. 2001). We
may summarily affirm the District Court‟s judgment if the appeal fails to present a
substantial question. See LAR 27.4; I.O.P. 10.6.
The District Court properly granted summary judgment on Byrne‟s cause of action
under EMTALA‟s screening provision. “Congress enacted EMTALA in the mid-1980s
based on concerns that, due to economic constraints, hospitals either were refusing to
treat certain emergency room patients or transferring them to other institutions.” Torretti,
580 F.3d at 173. EMTALA requires hospitals to provide appropriate medical screening
and stabilizing treatment to individuals seeking emergency care in a nondiscriminatory
manner. Id. As the Eighth Circuit Court of Appeals stated, “[p]atients are entitled under
EMTALA, not to correct or non-negligent treatment in all circumstances, but to be
treated as other similarly situated patients are treated within the hospital‟s capabilities. It
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is up to the hospital itself to determine what its screening procedures will be. Having
done so, it must apply them alike to all patients.” Summers v. Baptist Med. Ctr.
Arkadelphia, 91 F.3d 1132, 1138 (8th Cir. 1996).
The District Court correctly noted that EMTALA does not define what constitutes
“appropriate medical screening,” and we have not had occasion to specifically address
the issue. What is clear, however, is that EMTALA does not create a federal cause of
action for malpractice. The statute was aimed at disparate patient treatment and
“[l]iability is determined independently of whether any deficiencies in the screening or
treatment provided by the hospital may be actionable as negligence or malpractice.”
Torretti, 580 F.3d at 173-74 (citing Summers, 91 F.3d at 1137). While we find it
unnecessary in the instant appeal to embark on an exhaustive analysis of what constitutes
an “appropriate medical screening” under EMTALA, we note our agreement with the
District Court‟s determination that the record evidence demonstrates that the Chester
County Hospital‟s screening examination is not so cursory that it would fail “to identify
acute and severe symptoms that alert the physician of the need for immediate medical
attention to prevent serious bodily injury.” See D. Ct. Mem. Op. entered 9/19/12 at 7
(quoting Jackson v. E. Bay Hosp., 246 F.3d 1248, 1256 (9th Cir. 2001)).
The Hospital had two policies in place to govern the screening of persons arriving
in the emergency department with complaints of chest pain and those policies were
administered to Byrne indiscriminately. Having presented himself at the emergency
department of the Hospital, emergency personnel provided Byrne with a physical exam,
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obtained his medical history, and administered an EKG, cardiac work-up and chest x-
rays. The record evidence demonstrated that the Hospital applied its screening policies
uniformly at the time Byrne sought care. See Marshall ex rel. Marshall v. E. Carroll
Parish Hosp. Serv. Dist., 134 F.3d 319, 323 (5th Cir. 1998) (Noting that most courts have
defined an “appropriate medical screening examination” as “a screening examination that
the hospital would have offered to any other patient in a similar condition with similar
symptoms.”). Insofar as Byrne did not raise a genuine issue of material fact on the issue
of whether the Hospital failed to follow the two policies it has in place in screening him,
the District Court did not err in granting summary judgment.1
For the foregoing reasons, we will summarily affirm the District Court‟s
judgment.
1
Byrne limits his challenge to the District Court‟s grant of summary judgment in
favor of the Hospital on his EMTALA screening claim. See Appellant‟s Informal Br.
attached to Notice of Appeal. We would nonetheless have affirmed the
determinations set forth in the orders entered on 2/8/10 and 3/31/11 as well for
essentially the same reasons set forth by the District Court.
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