Green v. Touro Infirmary ( 1993 )

United States Court of Appeals,
Fifth Circuit.
No. 92-9521
Summary Calendar.
Joyce Smith GREEN, et al., Plaintiffs-Appellants,
v.
TOURO INFIRMARY, et al., Defendants,
Touro Infirmary, Defendant-Appellee.
June 4, 1993.
Appeal from the United States District Court for the Eastern District of Louisiana.
Before JOLLY, DUHÉ, and BARKSDALE, Circuit Judges.
E. GRADY JOLLY, Circuit Judge:
In this case, several plaintiffs brought suit under the Emergency Medical Treatment and Active
Labor Act, 42 U.S.C. § 1395dd, alleging that a hospital failed to stabilize an individual's emergency
medical condition before discharging her. The hospital presented sufficient summary judgment
evidence that it had stabilized the individual's medical condition. The plaintiffs, however, chose not
to offer any evidence contradicting the hospital's contention that it had fulfilled its obligations under
the statute. The district court granted the hospital's motion for summary judgment, and we now
affirm.
I
On April 6, 1990, at approximately 4:00 p.m., Christeen Robertson went to the Touro
Infirmary ("Touro") emergency room complaining of swelling in her extremities, pain in her right
shoulder, dizziness, headaches, and numbness in her right hand. The emergency room staff took her
vital signs. All were within normal limits except for her blood pressure, which was slightly elevated.
The emergency room staff also took her medical history and learned that Robertson had spent the last
three days at Charity Hospital in New Orleans. Robertson had left Charity Hospital without waiting
for her test results. Touro's staff contacted Charity Hospital and obtained Robertson's test results.
In the emergency room, both Dr. Harry Hersey and Dr. Edward Dees examined Robertson.
Ultimately, Dr. Jairo Barona was her treating physician. Touro's medical records indicate that Dr.
Barona concluded that Robertson was "having acute nephrotic syndrome and needs to be admitted."
Dr. Barona told Robertson "to go to the Charity Hospital due to her insurance status for evaluation
and admission." Touro's medical staff treated Robertson in the emergency room and followed her
condition for approximately seven hours. The hospital discharged Robertson at about 11 p.m. At
that time, Robertson's vital signs were stable, she was not in acute distress, and she was ambulatory.
Touro's staff instructed her to go to Charity Hospital as soon as possible. Later Robertson died. She
was survived by her children Joyce Smith Green, Michael Smith, Eric Robertson, Felita Robertson
and her husband Charles Robertson, Jr.
II
Robertson's surviving spouse and children brought this suit against Touro for an alleged
violation of the Emergency Medical Treatment and Active Labor Act, 42 U.S.C. § 1395dd
("EMTALA"). Touro moved for summary judgment arguing that there was no evidence supporting
the plaintiffs' allegation that Touro violated EMTALA. Touro argued that it had not violated the act
because when it discharged Robertson her vital signs were normal, she was ambulatory, and she was
in a stable condition. In support of its motion for summary judgment, Touro submitted its medical
records and affidavits from Dr. Barona and Dr. Dees. Both Dr. Barona and Dr. Dees agreed that
Touro's staff had stabilized Robertson and that her condition was not life threatening when Touro
discharged her.
Although this case has been pending since 1990, the plaintiffs have undertaken virtually no
discovery and they have not produced a medical expert. The plaintiffs did not submit any competent
evidence to rebut Touro's contention that it had complied with the statute. The only evidence the
plaintiffs presented was a letter from Dr. Lawrence Levy.1 The district court determined that Dr.
1
Dr. Levy's letter stated only that
it would have been appropriate [for Touro] to repeat her [Robertson's] renal
function tests. In situations like this, renal function can deteriorate rapidly, over a
mater of days, although such deterioration of function would be unusual.
Levy's letter was not competent summary judgment evidence because it was not submitted through
an affidavit. Finding that the plaintiffs had failed to rebut Touro's evidence that it had stabilized
Robertson's condition as required by EMTALA, the district court granted Touro's motion. The
plaintiffs appeal.
III
On appeal from a district court's summary judgment, we review the record de novo to
ascertain whether any genuine issues exist as to any material fact. If the record is devoid of a genuine
issue of material fact, we review the evidence to determine whether the moving party was entitled to
a judgment as a matter of law. Fed.R.Civ.P. 56(c); FDIC v. Myers, 955 F.2d 348, 349 (5th
Cir.1992). Once a motion for summary judgment has been made and adequately supported, the
non-movant cannot rest on the pleadings. The non-movant "must bring forth significant probative
evidence to prevent summary judgment." Stine v. Marathon Oil Co., 976 F.2d 254, 265 (5th
Cir.1992) (citing Union Planters Nat'l Leasing Inc. v. Woods, 687 F.2d 117 (5th Cir.1982)).
The plaintiffs contend that they have a cause of action against Touro under EMTALA
because 1) Touro failed to perform appropriate tests to determine whether Robertson's renal failure
presented an emergency condition, 2) Touro failed to stabilize Robertson's renal condition before
discharging her, and 3) Touro failed to transfer Robertson to another medical facility. The plaintiffs'
arguments fail. As we explain below, the only evidence in the record leads to the inescapable
inference that Touro's staff had stabilized Robertson's condition before discharging her. EMTALA
requires only that a hospital stabilize an individual's emergency medical condition; it does not require
a hospital to cure the condition.
EMTALA strictly sets out a hospital's responsibilities toward individuals who enter their
emergency rooms requesting care. The statute provides that when such a person requests medical
attention, the hospital must first screen the individual "to determine whether an emergency medical
Dr. Levy's letter is remarkable for what is does not contain. No where in it does Dr. Levy
suggest that Touro's staff failed to stabilize Robertson's condition before discharging her.
condition (within the meaning of subsection (e)(1) of this section) exists." 42 U.S.C. § 1395dd(a).2
If the individual suffers from an emergency conditions the hospital must provide either:
(A) with 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.
42 U.S.C. § 1395dd(b)(1) (emphasis added).3 Under EMTALA an emergency medical condition is
"stabilized" if "no material deterioration of the condition is likely, within reasonable medical
probability, to result from or occur during the transfer of the individual from a facility." 42 U.S.C.
§ 1395dd(e)(3)(B). Transfer "means the movement (including the discharge) of an individual outside
a hospital's facilities at the direction of any person employed by (or affiliated or associated, directly
or indirectly, with) the hospital." 42 U.S.C. § 1395dd(e)(4). The hospital's responsibility under the
statute ends when it has stabilized the individual's medical condition. See Brooker v. Desert Hosp.
Corp., 947 F.2d 412, 415 (9th Cir.1991).
The district court found that Touro met its obligations under the statute when it stabilized
Robertson's condition. The district court based this conclusion on Touro's medical records and the
affidavits from Dr. Dees and Dr. Barona. Dr. Dees states in his affidavit that he "treated and followed
Christeen Robertson for approximately four hours prior to her discharge and that she was stable and
able to be discharged home at approximately 23:00." Dr. Dees goes on to say that Robertson was
2
EMTALA defines an emergency medical condition as
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
(i) placing the health of the individual (or, with respect to a pregnant
woman, the health of the woman or the child) in serious jeopardy,
(ii) serious impairment of bodily functions, or
(iii) serious dysfunction of any bodily organ or part.
42 U.S.C. § 1395dd(e)(1).
3
The district court assumed, without deciding, that Robertson suffered from an emergency
medical condition.
"ambulatory[,] with no acute distress[,] and with stable vital signs." Dr. Barona states that he "was
aware of her [Robertson's] condition[,] which was not life threatening[,] and of her need for further
evaluation and treatment of nephritis and hypertension," and that "he recommended follow-up
treatment at Charity Hospital New Orleans." This evidence leads to the inescapable inference that
Robertson was in a stable condition when Touro discharged her and, thus, Touro adequately
supported its motion for summary judgment. Since the plaintiffs failed to present any evidence to
contradict Touro's evidence, it was appropriate for the district court to grant Touro's motion for
summary judgment.
IV
For all of the foregoing reasons, the decision of the district court is AFFIRMED.
AFFIRMED.