Merce v. Greenwood
IN THE UNITED STATES COURT FOR THE DISTRICT OF UTAH
CENTRAL DIVISION
FILED
CLERK, U.S. DISTRICT COURT
December 17, 2004 (12:49pm)
DISTRICT OF UTAH
ADAM MERCE, an individua l, and EMILY
DEMONG, an individual,
Plaintiffs,
vs.
MARK W. GREENWOOD, M.D ., DAVID
M. POPE, M.D., KIRK R. ANDERSON,
M.D., IHC HEALTH SERVICES, INC., dba
SEVIER VALLEY HOSPITAL and IHC
HEALTH SERVICES, INC., dba UTAH
VALLEY REGIONAL MEDICAL CENTER,
Defendants.
ORDER DISMISSING
PLAINTIFFS’ EMTALA CLAIMS
AND DENYING PLAINTIFFS’
MOTION TO AMEND THE
COMPLAINT
Case No. 2:04-CV-00610 PGC
This case presents a statute of limitations question under the Emergency Medical
Treatment and Liability Act (EMTALA). In June 2002, plaintiff Adam Merce was discharged
from emergency room treatment by defendant doctors David M. Pope and Mark W. Greenwood.
Shortly after that discharge, he suffered serious injuries – injuries, he alleges, the doctors should
have discovered in his emergency room visits. More than two years later (in July 2004), Merce
filed the lawsuit alleging several claims, including violations of EMTALA’s anti-dumping
provisions. The doctors moved to dismiss the EMTALA claims, citing EMTALA’s two-year
statute of limitations. Merce responded that the two-year statute had not run because of various
state law tolling provisions, including tolling provisions for pre-litigation screening procedures
and for delayed discovery of an injury.
The court rejects Merce’s argument that EMTALA’s two-year statute of limitations is
tolled by these state law provisions. Congress chose to adopt an iron-clad two-year statute, rather
than allow tolling for such reasons. The court must therefore follow the congressional
determination and dismiss Merce’s EMTALA’s claims.
I.
Background
For purposes of this motion, the court finds the following facts. Plaintiff Adam Merce
began feeling sick on June 15, 2002. On June 18, 2002, during a CT scan, Merce suffered a
grand mal seizure and was taken to the emergency room at Sevier Valley Hospital in Richfield,
Utah. Dr. Pope was the emergency room physician who examined Mr. Merce there. Dr. Pope
diagnosed a grand mal seizure, prescribed Dilantin and told Mr. Merce to go home. Merce went
home as ordered, but his problems continued. In the early morning hours of June 19, 2002,
Merce returned to the emergency room. Dr. Greenwood examined him, gave him a spinal tap
and, diagnosed viral spinal meningitis. Dr. Greenwood prescribed morphine and antibiotics and
admitted Merce to the hospital.
The next day, worried by his apparent lack of improvement and ultimately dissatisfied
with the care at Sevier Valley hospital, Merce’s companion, plaintiff Emily Demong, drove
Merce to Utah Valley Medical Center in Provo. His condition continued to worsen until, on June
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22, 2002, an MRI was finally performed. The MRI revealed that Merce suffered from herpes
simplex encephalitis. Merce slipped into a coma that same afternoon.
Plaintiffs allege that Merce suffered acute brain injury as a result of the failure to
accurately diagnose or treat his condition. Plaintiffs have brought state law medical malpractice
and EMTALA claims against Drs. Pope and Greenwood in connection with these events.
II.
Pope’s and Greenwood’s Motion to Dismiss Plaintiffs’ EMTALA claims
Dr. Pope’s alleged EMTALA violation occurred on June 18, 2002. Dr. Greenwood’s
allegedly occurred on June 19, 2002. But plaintiffs did not file their present EMTALA claims
until July 1, 2004, more than two years after these alleged violations took place. Dr. Pope has
therefore moved to dismiss plaintiffs’ EMTALA claims under EMTALA’s two-year statute of
limitation, and Dr. Greenwood has joined that motion.
In response, plaintiffs argue that EMTALA’s two-year statute of limitations is tolled by
the pre-litigation procedures required under Utah State law and that EMTALA’s statute of
limitations does not run until a claimant “discovers” the violation.
Odd ly, neither defendant has raised a st raightforward challenge to plain tiffs ’ EMTALA
claim against him: namely, that under the plain language of the Act, only hospitals can be sued
for violations.1 A private right of action against an individual doctor does not appear to be
authorized. However, because the court disposes of plaintiffs’ EMTALA claims against Drs.
Pope and Greenwood on statute of limitations grounds, it has no need to further address this
issue.
142 U.S.C. § 1395dd(d)(2)(A).
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EMTALA provides a private cause of action for its violation and contains its own statute
of limitations provision: “[n]o action may be brought under this paragraph more than two years
after the date of the violation with respect to which the action is brought.”2 In addition,
EMTALA contains a preemption provision, which states that nothing in the act “preempt[s] any
State or local law requirement, except to the extent that the requirement directly conflicts with a
requirement of this section.”3 EMTALA is a separate federal statute, not merely an outgrowth of
state malpractice law. As the Tenth Circuit has repeatedly noted, EMTALA “[s]ection 1395dd is
an anti-dumping provision, not a federal medical malpractice law.”4 EMTALA does, however,
incorporate state law provisions regarding available damages.5
Utah state law contains several provisions circumscribing the statute of limitations in
medical malpractice cases. Under Utah law, the two-year limitations period is expressly tolled
while plaintiffs comply with the required pre-litigation screening procedures.6 Pre-litigation
screening and certification of claims is required under Utah law before a medical malpractice
claim can be filed7 and a request for panel review must be made within 60 days after service of
242 U.S.C. § 1395dd(d)(2)(C).
342 U.S.C. § 1395dd(f).
4St. Anthony Hospital v. U.S. Dept. of Health and Human Services, 309 F.3d. 680, 694
(10th Cir. 2002) (citing Bryan v. Rectors & Visitors of University of Virginia, 95 F.3d 349, 351
(4th Cir. 1996); Repp v. Anadarko Municipal Hosp., 43 F.3d 519, 522 (10th Cir. 1994)).
542 U.S.C. § 1395dd(d)(2)(A).
6UTAH CODE ANN. § 78-14-12(3)(a).
7UTAH CODE ANN. § 78-14-12(2)(a).
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the statutorily-required notice of intent to commence a medical malpractice action.8 The
Division of Professional Licensing must complete its pre-litigation hearing within 180 days of
the date a request for review is filed9 or else its jurisdiction terminates and a claimant is held to
have complied with all requirements for commencement of a court action.10 In addition to these
pre-litigation requirements, Utah law also provides that the statute of limitations does not begin
to run unt il “discovery” of the conduct giving rise to the alleged in jury.11
Plaintiffs argue that because EMTALA adopts substantive state law provisions governing
available damages, it also incorporates substantive state law procedural provisions governing
malpractice claims (including provisions tolling the statute of limitations) and that EMTALA’s
two-year statute of limitations is thus tolled by these provisions. While the Tenth Circuit has not
addressed this issue, the Fourth Circuit has squarely rejected plaintiffs’ argument. In Vogel v.
Linde,12 the Fourth Circuit held that EMTALA’s two-year limitations period is not tolled by
infancy or incompetency (as limitations periods would be under Virginia state law) because it is
black letter law that statutes of limitation do not toll unless the statute expressly so provides.
Subsequently, in Power v. Arlington Hospital,13 the Fourth Circuit concluded that pre-litigation
8Id.
9UTAH CODE ANN. § 78-14-12(3)(b)(i).
10UTAH CODE ANN. § 78-14-12(3)(b)(ii).
11UTAH CODE ANN. § 78-14-4(1) (2002).
1223 F.3d 78 (4th Cir. 1994).
1342 F.3d 851 (4th Cir. 1994).
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claim screening provisions required under Virginia state law did not toll EMTALA’s two-year
limitations period because the state law provisions conflicted with the federal statute and were
thus preempted by EMTALA.
Power involved a situation inverse to the situation here; it was the defendant seeking to
incorporate state law restrictions on the statute of limitation, rather than the defendant. But the
principle remains the same: state law does not alter EMTALA’s congressionally-determined
procedural requirements regardless of whom they benefit. Thus, the defendant hospital in Power
had moved to dismiss plaintiff’s EMTALA claim because she had failed to submit her claim for
pre-litigation review by a medical malpractice review panel as required under Virginia law. The
district court denied the hospital’s motion to dismiss and the Fourth Circuit affirmed, holding
that EMTALA does not “expressly or impliedly incorporat[e] state-mandated procedural
requirements for EMTALA claims.”14 The Circuit agreed with a previous ruling by the Virginia
Supreme Court that Virginia’s “notice of claim provision, and its requirement that suits cannot be
filed until after they are reviewed by a malpractice review panel, directly conflicts with
EMTALA.”15 The Circuit then noted that “[n]otwithstanding the fact that the Virginia Act tolls
the statute of limitations during compliance with its procedural prerequisites, these state law
tolling provisions cannot toll the running of EMTALA’s statute of limitations,”16 and cited as
support for this position the U.S. Supreme Court’s recognition that “‘[i]f Congress expressly puts
14Id. at 866.
15Id. (citing Smith v. Richmond Memorial Hosp., 416 S.E.2d 689, 695 (Va. 1992).
16Id.
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a limit upon the time for enforcing a right which it created, there is an end of the matter.’”17 The
Circuit thus concluded that because Virginia’s pre-litigation procedures had the potential to
directly conflict with EMTALA, they were “not applicable to an EMTALA claim.” Failure to
comply with state procedures, in other words, would not bar plaintiff’s EMTALA claim.
The U.S. District Court for the District of Colorado also recently reached a similar
conclusion. In Bird v. Pioneers Hospital,18 plaintiff Bird brought an EMTALA claim against
Pioneers Hospital after she was discharged during labor and told to drive herself to another
hospital in Grand Junction, Colorado. She started to deliver her baby en route and due to
complications that developed, her baby suffered severe injuries and died 15 days later. Pioneers
Hospital moved to dismiss plaintiff’s EMTALA claim on the ground that she had failed to
comply with the notice-of-claim requirements under the Colorado Governmental Immunity Act
(CGIA). The district court rejected this argument. The court held that EMTALA preempts the
state law notice-of-claim requirement “because the state statute . . . is potentially in direct
conflict with EMTALA’s statute of limitations.” In so doing, the district court followed the
Fourth Circuit’s reasoning in Power:
Under the CGIA . . . a plaintiff’s notice requirement is triggered by the
“discovery” of his injury, whereas EMTALA’s statute of limitations commences
as of the date of the violation of the Act. Further, the CGIA tolls statutes of
limitations pending compliance with the CGIA’s procedural requirements where
the time necessary for such compliance would otherwise exceed the limitations
period. Consequently, a plaintiff may discover his injuries and provide notice
within EMTALA’s statute of limitations but still fail to complete the CGIA’s pre-
17Id. (quot ing Holmberg v. Armbrecht, 327 U.S. 392, 395 (1946)).
18121 F.Supp.2d. 1321 (D.Colo. 2000).
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suit compliance procedures and file his complaint within the federal limitations
period. As a result, there is a potential direct conflict between compliance with
the CGIA’s procedural requirements and EMTALA’s statute of limitations.
Accordingly, I conclude that EMTALA preempts the CGIA’s notice of claim
statute because the state procedural requirement stands as an obstacle to the
accomplishments and execution of Congress’ objectives in enacting EMTALA.19
The reasoning of both the Fourth Circuit in Power and the District of Colorado in Bird is
persuasive here. State procedural requirements could stand as an obstacle to the congressional
determination that a two-year statute of limitations is appropriate for EMTALA claims. The
court therefore holds that because a potential direct conflict exists between Utah’s pre-litigation
claim screening requirements and EMTALA’s statute of limitations, EMTALA preempts state
law on this point. As a result, Utah state pre-litigation screening requirements are not
“incorporated” into EMTALA and do not toll EMTALA’s two-year limitations period.
The Second Circuit’s decision in Hardy v. New York City Health & Hospitals Corp.20 and
the Ninth Circuit’s decision in Draper v. Chiapuzio21 do not alter the court’s conclusion. Both
Draper and Hardy involved the interrelationship between state law notice-of-claim provisions
and EMTALA’s statute of limitations. In both cases, the Circuits held that EMTALA did not
preempt the state law notice-of-claim requirements. The Circuits reasoned that compliance with
both EMTALA’s two-year statute of limitations and the state law notice-of-claim provisions at
issue was not an impossibility and thus, that no direct conflict between state and federal law
existed.
19Id. at 1326.
20164 F.3d 789 (2nd Cir. 1999).
219 F.3d 1391 (9th Cir. 1993).
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Draper and Hardy may be incorrectly decided. The New Mexico Court of Appeals came
to this conclusion in Godwin v. Memorial Medical Center.22 In Godwin, the state trial court had
granted summary judgment to the hospital on Godwin’s EMTALA claim finding that Godwin
had not filed a notice-of-claim within 90 days of the event giving rise to the injury as required
under New Mexico’s Tort Claims Act and that this notice-of-claim provision was incorporated
into EMTALA thus barring Godwin’s suit. The Court of Appeals reversed, holding that the
notice-of-claim provision in the state’s Tort Claims Act did not apply to EMTALA actions. The
Court of Appeals thus rejected the reasoning of Draper and Hardy, instead concluding that
[t]he fact of the matter is that if failure to give a 90-day notice bars an Emergency Act
claim, the two-year period given [under EMTALA] is taken away. The two-year
limitations period in effect is reduced to 90 days or less and effectively vitiated. These
circumstances create a direct conflict between the Tort Claims Act notice-of-claim
requirement and the Emergency Act’s statute of limitations and purposes. We hold that
the Tort Claims Act notice-of-claim requirement is preempted by the Emergency Act and
therefore not applicable to an Emergency Act claim.23
The court need not go so far as the New Mexico Court of Appeals, however, because
Draper and Hardy are distinguishable from the case at hand. Both Draper and Hardy involved
state law requirements that at least arguably created no conflict with EMTALA. Both cases
involved state laws requiring merely that a notice of claim be filed – and nothing more – before a
plaintiff could file suit. Such laws are different than Utah’s medical malpractice scheme, which
requires not only the simple filing of a notice-of-claim but also undergoing a pre-litigation panel
review process during which the statute of limitations is tolled. This difference is crucial because
2225 P.3d 273 (N.M. 2001).
23Id. at 282.
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while a state law requiring a plaintiff to give notice of claim does not clearly conflict with
EMTALA’s statute of limitations, an express tolling provision such as Utah’s certainly may in
some circumstances. Thus, Hardy and Draper can ultimately be harmonized with Power and
Bird by recognizing that the simple state law notice-of-claim provisions at issue there were not
inconsistent with EMTALA. As the District Court for the District of Colorado persuasively
explained in Bird,
Hardy and Draper are distinguishable from the circumstances presented here because
unlike the notice-of-claim statute in [CIGA], the statutes in Hardy and Draper only
require timely notice and do not mandate further compliance with any pre-suit
procedures. Therefore, Hardy and Draper did not address tolling provisions similar to
those found in [CIGA], which I conclude are in conflict with EMTALA’s statute of
limitations. I thus find that [CIGA] is more analogous to the Virginia notice-of-claim
statute in Power which contained similar tolling provisions.24
Here, as in Power and Bird, the pre-litigation claim screening requirements – with their
attendant tolling provisions – do pose a potential direct conflict with EMTALA’s statute of
limitations and are therefore preempted by EMTALA.
Plaintiffs would also have the court hold that EMTALA’s two-year statute of limitations
is tolled until the discovery of the conduct giving rise to the injury, just as it is under state law.
Plaintiffs reiterate their “incorporation” arguments and raise equitable concerns in support of this
position. But any state law provision about “tolling until discovery” directly conflicts with the
plain language of 42 U.S.C. § 1395dd(d)(2)(C), which provides that EMTALA’s limitations
period begins to run from the “date of the violation.” And as for plaintiffs’ argument that it
would be unfair to more seriously injured patients not to toll EMTALA’s statute of limitations
24Bird,121 F.Supp.2d at 1324 n.1 (internal citations omitted).
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until discovery of violations, some potential unfairness is inherent in the very conception of a
statute of limitations. That unfairness to the plaintiff must, of course, be balanced against the
need for defendants to know in a timely way whether they will be sued. In enacting EMTALA,
Congress certainly could have expressly provided for tolling of the limitations period until
discovery of the conduct giving rise to the injury. The fact that it chose not do so likely reflects
an attempt to strike the proper balance between the harm to patients and the legitimate concern
providers have in being able to predict their potential liabilities for insurance and other reasons.
In any event, the weighing of the competing concerns is for Congress, and not this court, to
tackle.
Finally, plaintiffs argue that failure to allow tolling of EMTALA’s two-year statute of
limitations until the date of discovery of the injury would violate their rights to due process and
equal protection under the 14th Amendment to the United States Constitution. The court will not
address the merits of these dubious arguments for lack of adequate briefing of the issues.
III.
Plaintiffs’ Motion to Amend the Complaint
Plaintiffs have moved to amend their complaint to add facts establishing that Mr. Merce
was incapacitated until July 7, 2002, and thus could not have discovered the EMTALA violation
prior to that date. But because the court has already rejected plaintiffs’ argument that
EMTALA’s statute of limitation runs from the date of discovery of the injury instead of from the
date of the violation, plaintiffs’ amendment, even if allowed, would not prevent dismissal of the
EMTALA claims and would thus be futile.25 Because plaintiffs’ proposed amendment would be
25See Watson v. Beckel, 242 F.3d 1237 (10th Cir. 2001).
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futile, leave to amend need not be granted26 and p la in ti ffs’ mo tion to amend is, accordingly,
denied.
IV.
Sevier Valley Hospital’s and Utah Valley Regional Medical Center’s Motion to Dismiss
Plaintiff’s EMTALA claims
IHC Health Services, Inc., doing business as both Sevier Valley Hospital and Utah Valley
Regional Medical Center, have also filed a motion to dismiss plaintiffs’ EMTALA claims on
statute of limitations grounds. They filed this motion after briefing and oral argument on Drs.
Pope and Greenwood’s motion had been completed. Although the court fails to see why the
reasoning of this opinion would not apply with equal force to this later-filed motion to dismiss,
the court nonetheless gives plaintiffs three weeks in which to either oppose the motion to dismiss
or to indicate their lack of objection to dismissal of the remaining EMTALA claims.
V.
Conclusion
Because plaintiffs’ EMTALA claims were not filed until more than two years after the
date of the alleged violations of the act, and because the court finds that EMTALA does not
incorporate state law pre-litigation claim screening requirements and that its two-year limitations
period begins to run from the date of the alleged violations, plaintiffs’ EMTALA claims were
26See Foman v. Davis, 371 U.S. 178 (1962).
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untimely filed and defendants Pope and Greenwood’s motion to dismiss (9-1; 12-2) is
GRANTED. Because the proposed amendment would be futile, plaintiffs’ motion to amend the
complaint (14-1) is DENIED. The case will proceed, of course, on the state law medical
malpractice claims.
DATED this _____ day of December, 2004.
BY THE COURT:
_______/S/________________
Paul G. Cassell
United States D istr ict Judge
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