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Cervantes v. El Paso Healthcare System, Ltd.

United States District Court, W.D. Texas, El Paso Division

April 25, 2019




         On this day, the Court considered Defendant El Paso Healthcare System LTD d/b/a Del Sol Medical Center's [hereinafter "Defendant"] "Motion for Summary Judgment" (ECF No. 21) [hereinafter "Motion"], filed on March 14, 2019; Plaintiff Consuelo Cervantes's [hereinafter "Plaintiff'] "Response to Defendant's Motion for Summary Judgment" (ECF No. 24), filed on April 1, 2019; and Defendant's "Reply in Support of its Motion for Summary Judgment" (ECF No. 26), filed on April 5, 2019, in the above-captioned cause. After due consideration, the Court is of the opinion that the Motion should be granted for the reasons that follow.


         This case centers around whether Plaintiff was properly screened and stabilized in compliance with the Emergency Medical Treatment and Active Labor Act after she presented at the Del Sol Medical Center (Del Sol) with abdominal pain. On April 9, 2016, at approximately 6:50 PM, Plaintiff sought emergency care for abdominal pain at the Del Sol emergency room. Mot. 1; Resp. 1. At approximately 6:51 PM, Plaintiffs vital signs were taken. Resp. Ex. A., at 5. Dr. Shariq Khan was assigned to examine Plaintiff. Mot. 2; Resp. Ex. A. Plaintiff previously had an abdominal surgery, specifically, an umbilical hernia[1] repaired with mesh. Resp. Ex. A, at 3, 9, 25. At approximately 7:12 PM, Dr. Khan completed a focused physical examination[2]and ordered laboratory tests, including a CT scan. Mot. Ex. A, at 30:2-37:19. The CT scan confirmed that Plaintiff had a recurrent ventral hernia containing bowel loops.[3] Id. at 39:11-14. No radiologist contacted Dr. Khan regarding an emergent finding based on the CT scan. Id. at 39:17-21. Additionally, according to Plaintiffs medical records, Plaintiff was found to have a non-reducible hernia. Resp. Ex. C, at 1; Resp. Ex. A, at 5. Dr. Khan determined that the hernia was non-reducible when he palpated the hernia during his physical examination of Plaintiff. Mot. Ex. A, at 38:23-39:10. However, Dr. Khan did not formally attempt to reduce the hernia. Id.

         According to the affidavit of William Allen Gibson, M.D., which Plaintiff attaches to Plaintiffs Response, "[a] non-reducible hernia containing loops of bowel indicates the bowel is trapped, incarcerated in medical jargon." Resp. Ex. C, at 2. Furthermore, if the incarcerated hernia causes ischemia[4] of the intestine, it is a "strangulated hernia" and is a "surgical emergency" because it could permanently injure the bowel.[5] Id. Dr. Gibson further testified that "[o]n April 9, 2016, [Plaintiff] was documented to have a non-reducible supra-umbilical hernia that was causing her severe abdominal pain." Id. In addition, the doctor testified that "[s]evere abdominal pain is an emergency medical condition." Id.

         Dr. Khan gave Plaintiff Valium to relax her abdominal rectus muscle for any possible muscle spasm. Mot. Ex. A, at 39:22-41:3. In addition, Plaintiff was provided the narcotic hydromorphone and maintenance fluid. Id. at 41:4-42:19. At 9:43 PM, Dr. Khan reevaluated Plaintiff and found that her abdominal pain had improved. Id. at 43:14-24. In addition, Dr. Khan determined that there was no evidence of an incarcerated hernia. Id. at 45:5-11. Following his screening examination of Plaintiff and treatment of Plaintiff, Dr. Khan determined that Plaintiff did not have an emergency medical condition and diagnosed Plaintiff with a "recurrent hernia." Id. at 94:2-9, 94:18-20. At 9:46 PM, Plaintiff was discharged with prescriptions for pain and nausea medication. Id. at 51:16-24; Resp. Ex. A, at 10. Dr. Khan believed that, at the time that Plaintiff was discharged, her condition had stabilized and he expected no material deterioration of her condition. Mot. Ex. A, at 94:10-17.

         However, after Plaintiff was discharged, Plaintiff was still in pain. Resp. Ex. D. Accordingly, Plaintiff returned to the Del Sol emergency room around 1:50 AM on April 10, 2016. See id.; Resp. Ex. B; Compl. 3. Dr. Khan again performed a medical screening examination on Plaintiff. Mot. Ex. A, at 94:24-95:8. After the medical screening examination and speaking with the treating surgeon who was on call for the surgeon who had performed Plaintiffs prior hernia surgery, Dr. Khan determined that Plaintiff had an emergency medical condition. Id. at 95:6-96:23; Mot. 3 n.3.

         Around 6:30 AM, Plaintiff was discharged from Del Sol. Id. at 97:21-23. Thereafter, she arrived at Providence East's emergency department at approximately 7:00 AM. Resp. Ex. D. Plaintiff alleges that, at that time, her vital signs indicated that she was in shock. Compl. 3. Plaintiff further alleges that, at Providence East, "Plaintiff was found to have a perforated bowel that caused her to develop sepsis."[6] Id. Additionally, she alleges that "[s]he underwent surgeries and had a long and complicated hospital stay." Id. Finally, "[s]he was discharged on May 15, 2016 and transferred to a nursing facility where she remained until mid-July, 2016." Id.

         On April 2, 2018, Plaintiff filed her Complaint, bringing suit pursuant to 42 U.S.C. § l395dd, the Emergency Medical Treatment and Active Labor Act ("EMTALA"). Plaintiffs claims in this case appear to be limited to her April 9, 2016, medical screening examination. See Compl. Though the factual allegations in her Complaint describe both Plaintiffs April 9th and April 10th visits to Del Sol Medical Center, and her cause of action does not specify the date of the alleged EMTALA violations, she only alleges that "Defendant's EMTALA violation of April 9, 2016 is a proximate cause of [Plaintiffs] injuries and damages." Id. at 3. Notably, she does not explicitly allege an April 10, 2016, EMTALA violation. See Id. Furthermore, Defendant states in its Motion that Plaintiff "does not allege that the examination she was given on April 10 violated EMTALA. Rather, her complaint is limited to the screening examination performed on April 9." Mot. 3. n.3.[7] Plaintiff does not dispute Defendant's statement in her Response. Furthermore, in its Motion, Defendant only argues that the Court should enter summary judgment regarding Plaintiffs April 9, 2016, claims. Accordingly, in considering Defendant's Motion, the Court will only consider Plaintiffs claim related to Plaintiffs April 9, 2016, visit.


         A. Summary Judgment

         Pursuant to Federal Rule of Civil Procedure 56(a), a court "shall grant summary judgment if the movant shows that there is no genuine dispute as to any material fact and the movant is entitled to judgment as a matter of law." A genuine dispute exists "if the evidence is such that a reasonable [finder of fact] could return a verdict for the nonmoving party." Rogers u. Bromac Title Servs., LLC, 755 F.3d 347, 350 (5th Cir. 2014) (quoting Anderson v. Liberty Lobby, Inc., 477 U.S. 242, 248 (1986)). "A dispute 'is material if its resolution could affect the outcome of the action."' Exxon Mobil Corp. v. United States, 108 F.Supp.3d 486, 504 (S.D. Tex. 2015) (quoting DIRECTV, Inc. v. Robson, 420 F.3d 532, 536 (5th Cir. 2005)).

         "Under Federal Rule of Civil Procedure 56(c), the party moving for summary judgment bears the initial burden of. . . Identifying those portions of [the record] which it believes demonstrate the absence of a genuine issue of material fact."' Norman v. Apache Corp., 19 F.3d 1017, 1023 (5th Cir. 1994) (quoting Celotex Corp. v. Catrett, 477 U.S. 317, 323 (1986)). When the moving party has met its initial burden, "the nonmovant must identify specific evidence in the record and articulate the manner in which that evidence supports that party's claim." Johnson u. Deep E. Texas Reg'l Narcotics Trafficking Task Force, 379 F.3d 293, 301 (5th Cir. 2004). In adjudicating a motion for summary judgment, a court "consider[s] evidence in the record in the light most favorable to the non-moving party and draw[s] all reasonable inferences in favor of that party." Bluebonnet Hotel Ventures, LLC v. Wells Fargo Bank, N.A., 754 F.3d 272, 276 (5th Cir. 2014). However, if the non-moving party fails to respond or otherwise "fails to properly address another party's assertion of fact as required by Rule 56(c), the court may . . . grant summary judgment if the motion and supporting materials- including the facts considered undisputed-show that the movant is entitled to it." Fed.R.Civ.P. 56(e)(3).

         B. The Emergency Medical Treatment and Active Labor Act

         The Emergency Medical Treatment and Active Labor Act ("EMTALA") "was not intended to be used as a federal malpractice statute, but instead was enacted to prevent 'patient dumping', which is the practice of refusing to treat patients who are unable to pay." Marshall on Behalf of Marshall v. E. Carroll Par. Hosp. Serv. Dist., 134 F.3d 319, 322 (5th Cir. 1998). Pursuant to EMTALA, if an individual comes to the emergency department of a hospital and requests medical treatment, then "the hospital must provide for an appropriate medical screening examination within the capability of the hospital's emergency department, including ancillary services routinely available to the emergency department, to determine whether or not an emergency medical condition . . . exists." 42 U.S.C. § l395dd(a). If the hospital determines that the individual has an "emergency medical condition," then the hospital must either (A) provide, at the hospital, "further medical examination and such treatment as may be required to stabilize the medical condition," or (B) appropriately transfer the individual to another medical facility in accordance with EMTALA's requirements for transfer. Id. § 1395dd(b)(1).

         III. ANALYSIS

         Pursuant to EMTALA, Plaintiff brings a screening claim, alleging that Defendant failed to provide Plaintiff with an appropriate medical screening examination to determine if she had an emergency medical condition. See Compl.; Joint Case Management Plan ¶ 3. In addition, Plaintiff brings a failure to stabilize claim, alleging that Defendant was aware of her emergency medical condition but failed to stabilize her prior to discharge. See id.

         A. Failure to Provide Appropriate Medical Screening Claim

         Plaintiff argues that Defendant failed to provide an appropriate medical screening examination, as required by EMTALA. What constitutes an "appropriate medical screening examination" is not defined by EMTALA. Marshall, 134 F.3d at 323. However, most courts have defined the phrase "as a screening examination that the hospital would have offered to any other patient in a similar condition with similar symptoms." Id. (collecting cases). The burden is on the plaintiff to demonstrate that the hospital failed to provide an appropriate medical examination pursuant to EMTALA. Id. at 323-24. The plaintiff may carry its burden by demonstrating one of the following:

(1) the hospital failed to follow its own standard screening procedures; or (2) there were "differences between the screening examination that the patient received and examinations that other patients with similar symptoms received at the same hospital"; or (3) the hospital offered "such a cursory screening that it amounted to no screening at all."

Fewins v. Granbury Hosp. Corp., 662 Fed.Appx. 327, 331 (5th Cir. 2016) (quoting Guzman v. Memorial Hermann Hosp. Sys., 409 Fed.Appx. 769, 773 (5th Cir. 2011)). "[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." Marshall, 134 F.3d at 322. "Negligence in the screening process or providing a faulty screening or making a misdiagnosis, as opposed to refusing to screen or providing disparate screening, does not violate EMTALA, although it may violate state malpractice law." Guzman v. Mem'l Hermann Hosp. Sys., 637 F.Supp.2d 464, 482 (S.D. Tex. 2009), affd, 409 Fed.Appx. 769 (5th Cir. 2011). In short, "[t]he essence of [the screening] requirement is that there be some screening procedure, and that it be administered even-handedly." Correa v. Hosp. San Francisco, 69 F.3d 1184, 1192 (1st Cir. 1995).

         Here, Defendant cites to evidence in the record demonstrating that Dr. Khan performed a medical screening examination on Plaintiff and that the medical screening examination was the same screening examination that other patients presenting with similar symptoms would have received. See Mot. 5. In particular, Dr. Khan testified that he performed a medical screening examination, which involved lab work, a CT scan, a physical exam, and obtaining vital signs, and that this medical screening examination performed on Plaintiff was similar to that any other patient would have received if they presented with similar symptoms. Mot. Ex. A, at 92:24- 93:21. Accordingly, Defendant has provided evidence establishing that Defendant, through Dr. Khan, performed a medical screening ...

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