United States District Court, W.D. Texas, El Paso Division
MEMORANDUM OPINION AND ORDER GRANTING DEFENDANTS
MOTION FOR SUMMARY JUDGMENT
R. MARTINEZ UNITED STATES DISTRICT JUDGE.
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.
FACTUAL AND PROCEDURAL BACKGROUND
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 repaired with mesh. Resp. Ex. A, at 3, 9,
25. At approximately 7:12 PM, Dr. Khan completed a focused
physical examinationand 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. 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.
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 of the intestine, it is a
"strangulated hernia" and is a "surgical
emergency" because it could permanently injure the
bowel. 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.
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.
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.
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." 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,
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. 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.
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)).
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).
The Emergency Medical Treatment and Active Labor Act
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).
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.
Failure to Provide Appropriate Medical Screening
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).
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