Kauffman v. Franz (Full Text)
IN THE UNITED STATES DISTRICT COURT
FOR THE EASTERN DISTRICT OF PENNSYLVANIA
AARON KAUFFMAN
Plaintiff
vs.
PAMELA FRANZ, ET AL.
Defendants
:
:
: CIVIL ACTION
:
:
: NO. 07-CV-5043
:
:
:
MEMORANDUM OPINION & ORDER
Before the Court are Defendants Pottstown Memorial Medical Center and Pottstown
Hospital Company, LLC.,’s Motion for Judgment on the Pleadings (Doc. No. 23) and the
“Joinder Motions” of Defendants Dr. Pamela Franz, M.D., and Dr. Stephen Spencer, M.D., (Doc.
Nos. 24, 25). The Defendants have asked the Court to determine whether they are entitled to
judgment as a matter of law, based on the pleadings, as to Plaintiff’s sole federal claim, which
1
arises under the Emergency Medical Treatment and Active Labor Act (“EMTALA”), 42 U.S.C. §
1395dd. For the following reasons, the Court will grant Defendants Franz and Spencer’s Joinder
Motions and deny Defendants Pottstown Memorial Medical Center and Pottstown Hospital
2
Company, LLC.,’s Motion for Judgment on the Pleadings.
The Plaintiff’s Complaint contains eight causes of action including negligence claims
1
and claims under Pennsylvania’s Wrongful Death and Survival Acts.
The Joinder Motions are granted only in so far as they seek dismissal of the EMTALA
2
claims against Defendants Franz and Spencer. The Court, however, will continue exercising
supplemental jurisdiction over the remaining claims against Defendants Franz and Spencer
because those claims are “so related to the [pending claims against Defendants Pottstown
Memorial Medical Center and Pottstown Hospital Company, LLC, over which the Court has
original jurisdiction,] that they form part of the same case or controversy under Article III.” 28
U.S.C. § 1367.
-1-
BACKGROUND
At approximately 5:00 a.m. on [March] 23, 2007, John Kauffman (“Kauffman”)
3
contacted a friend to take him to the hospital. (Compl. ¶ 21.) He was complaining of chest pain,
difficulty breathing, clamminess, and swollen feet. (Id. ¶ 21.) Kauffman was fifty-one years old.
(Id. ¶ 4.) By 5:39 a.m., Kauffman arrived in the emergency room at Defendant Pottstown
Memorial Medical Center, seeking treatment for chest pains, breathing difficulties, anxiety,
4
clamminess, and swollen feet. (Id. ¶ 22.) Kauffman’s vital signs were the following:
Temperature: 96.8, Pulse: 87, Respirations: 32, and Blood pressure: 132/88. (Id. ¶ 23.) “He
was anxious, alert, oriented x3, and cooperative.” (Id. ¶ 23.) His skin was warm and dry, and his
lungs were clear. (Id. ¶ 24.)
At 5:45 a.m., Kauffman was seen by Defendant Dr. Franz, who ordered a BAT
(Behavioral Avoidance Test) and a urine drug screen. (Id. ¶ 25.) At 6:00 a.m., Dr. Reeves, who
is not a defendant, performed a multidiscplinary psychiatric assessment on Kauffman. (Id. ¶ 26.)
His report indicated that Kauffman was brought to the emergency room by a female friend for
complaints of “chest pain, high anxiety, hyperventilation, [and] sleeplessness.” (Id. ¶ 27.) Dr.
Reeves recommended that Kauffman set up an appointment with a psychiatrist and follow up
with his primary care physician. (Id. ¶ 31.) No assessment of Kauffman’s chest pain was ever
performed. (Id. ¶ 33.) No electrocardiogram or blood work was ordered. (Id. ¶ 34.) No
It appears that the Plaintiff made an error in dating the occurrence based on his own
3
Motion in Opposition to Defendants’ Motion for Judgment on the Pleadings, (Doc. No. 26), the
Defendants’ Answers, (Doc. Nos. 13, 14), the Motion. for Judgment on the Pleadings, (Doc. No.
23 ), and the Joinder Motions (Doc. Nos. 24, 25).
Defendant Pottstown Hospital Company, LLC d/b/a and a/k/a Pottstown Memorial
4
Medical Center. (Compl. ¶ 9.)
-2-
continuous cardiac monitoring was performed. (Id. ¶ 34.) No ongoing evaluation of his vital
signs was conducted. (Id. ¶ 34.)
At 9:30 a.m., John Kauffman was given one mg. of a sedative, intramuscularly, after his
urine drug screen came back negative. (Id. ¶¶ 38-39.) He was discharged at 9:35 a.m., and his
vital signs upon discharge were the following: Pulse: 85, Respirations: 24, and Blood pressure:
140/106. (Id. ¶ 40.) His blood pressure was elevated, and he remained very anxious. (Id. ¶ 41.)
No clinical impression was documented at the time of discharge. (Id. ¶ 44.)
Fewer than seven hours later, at approximately 4:00 p.m., Kauffman was found lying on
his bed. (Id. ¶ 45.) He was blue in the face, and his heart was not beating. (Id. ¶ 45.) He was
transported by an ambulance to Pottstown Memorial Medical Center with an admitting diagnosis
of cardiac arrest. (Id. ¶ 46.) He was pronounced dead upon arrival. (Id. ¶ 47.) According to the
autopsy, the cause of death was arteriosclerotic cardiovascular disease, hypertrophic
cardiomyopathy, and pneumonitis. (Id. ¶ 48.)
Approximately one month later, on April 27, 2007, an addendum was added to
Kauffman’s chart, which documented his early morning visit to the hospital on March 23, 2007.
The addendum read:
Sent back to me to put Diagnosis on chart. Pt was signed out to me c[sic] [with] Dx
[diagnosis] of Anxiety, Discharge instructions written by P. Franz and on chart. Waiting
for urine to be obtained then D/C [discharged] per instructions. Anxiety is diagnosis at
time.
(Id. ¶ 49.) Under “Clinical Impressions,” the diagnoses of anxiety and hypertension were added.
(Id. ¶ 50.)
The Plaintiff, the administrator of Kauffman’s estate, alleges a violation of EMTALA by
-3-
all of the Defendants, under the heading “First Cause of Action Emergency Medical Treatment
and Active Labor Act EMTALA Violation.” (Id. ¶ 70.) All of the Defendants have answered the
Complaint (Doc. Nos. 13, 14). Now, they move that the Court dismiss the EMTALA claims
under Rule 12(c) of the Federal Rules of Civil Procedure.
STANDARD
The same legal standard that applies to motions filed under 12(b)(6) applies to motions
filed under 12(c). See Patel v. Contemporary Classics of Beverly Hills, 259 F.3d 123, 126 (2d
Cir. 2001) (“The standard for granting a Rule 12(c) motion for judgment on the pleadings is
identical to that of a Rule 12(b)(6) motion for failure to state a claim.”); Turbe v. Government of
V.I.., 938 F.2d 427, 428 (3d Cir. 1991) (applying 12(b)(6) standard to defendant’s 12(c) motion).
“Most of the authority on Rule 12(b)(6) applies to Rule 12(c).” 2 Moore’s Federal Practice, §
12.38 (Matthew Bender 3d ed.). When reviewing the pleadings, “‘[t]he facts presented [therein]
and the inferences to be drawn therefrom [must be viewed] in the light most favorable to the
nonmoving party.’” Rosenau v. Unifund Corp., 539 F.3d 218, 221 (3d Cir. 2008) (quoting
Jablonski v. Pan Am. World Airways, Inc., 863 F.2d 289, 290-91 (3d Cir.1988)). Judgment will
not be granted under Rule 12(c) unless “‘the movant clearly establishes that no material issue of
fact remains to be resolved and that he is entitled to judgment as a matter of law.’” Id.
-4-
ANALYSIS
Although EMTALA was enacted by Congress to address the problems associated with
“patient dumping,” the statute and case law applying the Act make clear that its protections flow
to everyone, not just the indigent or uninsured. See 42 U.S.C. § 1395dd; Gatewood v.
5
Washington Healthcare Corp., 933 F.3d 1037, 1040-41 (D.C. Cir. 1991) (affirming the dismissal
of plaintiff-widow’s EMTALA claim on the rationale that allegations of mis-diagnosis are not
actionable under EMTALA, while rejecting the district court’s rationale that the Act’s
protections did not reach the deceased, who was insured). In order to recover under EMTALA, a
plaintiff may proceed under a screening, stabilization, or stabilization/transfer theory. Here, the
Plaintiff is proceeding under both a screening and a stabilization theory.
The Plaintiff has pleaded facts sufficient to show that Defendants Pottstown Memorial
Medical Center and Pottstown Hospital Company, LLC, are subject to EMTALA’s civil
enforcement provisions. See 42 U.S.C. §§ 1395cc and 1395dd; (Compl. ¶¶ 14-16,18). However,
the Plaintiff has not pleaded any facts to show that Defendants Franz and Spencer are subject to
EMTALA, nor could he. While EMTALA provides for both public and private enforcement of
6
its provisions, the civil enforcement subsection limits private enforcement to claims against
“participating hospitals.” Compare 42 U.S.C. §1395dd(d)(1) (providing for civil money
penalties against participating hospitals and physicians) with 42 U.S.C. §1395dd(d)(2) (providing
The Third Circuit Court of Appeals has yet to rule on the scope of EMTALA liability;
5
however, Torretti v. Paoli Hospital, Slip Copy, 2008 WL 268066 (E.D.Pa. Jan. 29, 2008) is
currently pending at docket number 08-1525. Torretti involves a failure to stabilize claim.
Summary judgment was granted in favor of the defendants.
6
This issue was not addressed by any of the parties.
-5-
for civil enforcement against participating hospitals only); see also Eberhard v. City of Los
Angeles, 62 F.3d 1253, 1256-57 (9th Cir. 1995) (rejecting plaintiff’s theory of an implied private
right of action against physicians under EMTALA, and stating that, “[o]ur holding today is
consistent with every appellate court [e.g. the D.C., Fourth, Eighth, and Tenth Circuit Courts of
Appeals] that has decided whether EMTALA allows a private right of action against physicians”)
(internal citations omitted); Davis v. Twp. of Paulsboro, 424 F. Supp. 2d 773, 779 (D.N.J. 2006)
(dismissing EMTALA claims against individually named physicians and stating that “EMTALA
only creates a private right of action against hospitals, not individual physicians”). Therefore, the
EMTALA claims against Defendants Franz and Spencer, who are both physicians, must be
dismissed and their Joinder Motions granted only in so far as they moved that the Court dismiss
the EMTALA claims. (Doc. Nos. 24, 25.)
I.
EMTALA
–
Screening
EMTALA requires a covered hospital “to provide for an appropriate medical screening
examination within the capability of the hospital’s emergency department . . . to determine
whether or not an emergency medical condition . . . exists,” when “any individual . . . comes to
the emergency department and a request is made on the individual’s behalf for examination or
treatment for a medical condition.” 42 U.S.C. § 1395dd(a). This subsection forms the basis of
the EMTALA “screening” requirement. Although the statute does not define what an
“appropriate medical screening examination” is, the caselaw is clear that the “essence of the
requirement is that there be some screening procedure, and that it be administered even-
handedly.” Cruz-Queipo v. Hosp. Espanol Auxilio Mutuo de Puerto Rico, 417 F.2d 67, 70 (1st
Cir. 2005) (quoting Correa v. Hosp. San Francisco, 69 F.3d 1184, 1189 (1st Cir. 1995)); see also
-6-
Nolen v. Boca Raton Cmty. Hosp. Inc., 373 F.3d 1151, 1155 (11th Cir. 2004) (“So long as the
hospital gave to [plaintiff] the same quality screening that it would have given a similarly
situated outpatient, there is no violation of EMTALA.”); Marshall v. East Carroll Parish Hosp.
Serv. Dist., 134 F.3d 319, 322 (5th Cir.1998) (“[A]n EMTALA ‘appropriate medical screening
examination’ is not judged by its proficiency in accurately diagnosing the patient’s illness, but
rather by whether it was performed equitably in comparison to other patients with similar
symptoms.”); Vickers v. Nash Gen. Hosp. Inc., 78 F.3d 139, 143 (4th Cir. 1996) (EMTALA
obligates hospitals to “‘apply uniform screening procedures to all individuals coming to the
emergency room.’”) (quoting Matter of Baby K, 16 F.3d 590, 595 (4th Cir. 1994)); Davis, 424 F.
Supp. 2d at 778-79 (“[T]he ‘key requirement’ of a hospital’s duty under § 1359dd(a) ‘is that a
hospital apply its standard of screening uniformly to all emergency room patients, regardless of
whether they are insured or can pay. The Act does not impose any duty on a hospital requiring
that screening result in a correct diagnosis.’”) (quoting Power v. Arlington Hosp. Ass’n., 42 F.3d
851, 856 (4th Cir. 1995)).
In support of his screening theory, the Plaintiff alleges, pertinently, that the Defendants:7
Failed to conduct a full and complete medical screening examination . . . [t]reated
Kauffman disparately from other similarly situated patients . . . [d]eparted from their
standard medical screening examination of patients with complaints and symptoms
similar to those of John Kauffman . . . [f]ailed to provide a level of screening examination
reasonably calculated to identify critical conditions that may be afflicting symptomatic
patients uniformly to all those who present with substantially similar conditions . . .
[f]ailed to adhere to their own standard policies, procedures[,] protocols, care paths
and/or critical pathways for patients entering the Emergency Department in similar
medical circumstances . . . [and f]ailed to perform a medical screening examination
within the capabilities of the [D]efendant hospitals’ Emergency Department and ancillary
References to “Defendants” hereinafter refer only to Defendants Pottstown Memorial
7
Medical Center and Pottstown Hospital Company, LLC.
-7-
services.
(Compl. ¶ 70(a),(c)-(d),(f),(h),(i).) In other words, the Plaintiff alleges that the hospital somehow
treated Kauffman differently from other patients with similar conditions or departed its standard
procedures or both.
Accepting the Plaintiff’s factual allegations as true and granting him all reasonable
inferences therefrom, the Court concludes that the Plaintiff pleaded sufficient facts to state a
claim under EMTALA’s screening theory against Defendants Pottstown Memorial Medical
Center and Pottstown Hospital Company, LLC.
II.
EMTALA
–
Stabilization
The stabilization requirement of EMTALA arises from subsection (b) of the statute,
which reads:
If any individual . . . 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) of this section.
42 U.S.C. § 1395dd(b)(1). A plain reading of subsection (b) makes clear that liability on a
stabilization theory turns on whether the hospital knew of a plaintiff’s emergency medical
condition. Indeed, there is ample case law to support the proposition that actual knowledge is a
condition precedent to a stabilization claim. See, e.g., Jackson v. East Bay Hosp., 246 F.3d
8
1248, 1256-57 (9th Cir. 2001) (adopting the “actual detection” rule and noting that it “comports
Again, the Third Circuit has not yet ruled on the scope of EMTALA liability, though
8
Torretti v. Paoli Hospital, Slip Copy, 2008 WL 268066 (E.D. Pa. Jan. 29, 2008), which involves
a failure to stabilize claim, is currently pending before the Third Circuit, at docket number 08-
1525.
-8-
with the law of five other circuits, which requires a showing of actual knowledge of the
emergency medical condition by the hospital as a condition precedent to the stabilization
requirement”); Marshall, 134 F.3d at 324-25 (summary judgment on behalf of defendants
affirmed on stabilization claim where hospital had no knowledge of latent emergency medical
condition).
Here, the Plaintiff alleges that either Kauffman or his friend who took Kauffman to the
hospital told members of the hospital staff about Kauffman’s chest pain. (Compl. ¶ 22.) Chest
pain is considered to be an emergency medical condition under EMTALA. Further, the Plaintiff
9
alleges that Dr. Reeves’ report reflects that Kauffman was brought to the emergency room for
complaints about chest pain. (Id. ¶ 27.) Accepting as true Plaintiff’s allegations and granting
him all reasonable inferences therefrom, the Court concludes that the Plaintiff has pleaded
sufficient facts to state a claim under EMTALA’s stabilization theory against Defendants
Pottstown Memorial Medical Center and Pottstown Hospital Company, LLC. See Cruz-Querpo,
417 F.3d at 71-72 (drawing an inference that hospital knew of chest pain complaints, based on
the stage of proceedings and moving papers of the parties, and determining that the inference was
sufficient to defeat a motion for summary judgment on a stabilization claim).
An appropriate Order follows.
An emergency medical condition is defined as “a medical condition manifesting itself
9
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 . . . in serious jeopardy, (ii) serious impairment to bodily functions, or (iii) serious
dysfunction of any bodily organ or part.” 42 U.S.C. § 1395dd(e)(1)(A).
-9-
IN THE UNITED STATES DISTRICT COURT
FOR THE EASTERN DISTRICT OF PENNSYLVANIA
AARON KAUFFMAN
Plaintiff
vs.
PAMELA FRANZ, ET AL.
Defendants
:
:
: CIVIL ACTION
:
:
: NO. 07-CV-5043
:
:
:
ORDER
AND NOW, this 6th day of March, 2009, upon consideration of the Defendants’ Motion
for Judgment on the Pleadings (Doc. No. 23) and Joinder Motions (Doc. No. 24, 25) as well as
the Plaintiff’s responses thereto, it is hereby ORDERED that the Motion for Judgment on the
Pleadings, (Doc. No. 23), is DENIED and the Joinder Motions, (Doc. Nos. 24, 25), are
GRANTED only in so far as the Defendants Franz and Spencer moved the Court to dismiss the
EMTALA claims against them.
10
BY THE COURT:
/s/ Thomas M. Golden
THOMAS M. GOLDEN, J.
The Court will continue exercising supplemental jurisdiction over the remaining claims
10
against Defendants Franz and Spencer because those claims are “so related to the [pending
claims against Defendants Pottstown Memorial Medical Center and Pottstown Hospital
Company, LLC, over which the Court has original jurisdiction,] that they form part of the same
case or controversy under Article III.” 28 U.S.C. § 1367.