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Utech v. Bynum et al.: US Disrict Court : MED - Emergency Medical Treatment and Active Labor Act claims dismissed with prejudice; supplemental jurisdiction not exercised over state-law claims

Terry Utech as trustee for the Civil No. 07-4712 (DWF/RLE)
heirs and next-of-kin of
Sandra Ann Utech, deceased,
Gaither Bynum, Jr., MD;
Connie Johnson Schaeffer, RN;
and Stevens Community Medical
Chad William Schulze, Esq., Milavetz Gallop & Milavetz, counsel for Plaintiff.
Richard J. Thomas, Esq., and Bryon G. Ascheman, Esq., Burke & Thomas PLLP, counsel
for Defendant Bynum.
David D. Alsop, Esq., and Lynn Schmidt Walters, Esq., Gislason & Hunter LLP Mpls,
counsel for Defendants Johnson Schaeffer and Stevens Community Medical Center.
This matter is before the Court upon the Motion to Dismiss for Lack of
Jurisdiction and Motion for Partial Summary Judgment brought by Gaither Bynum, Jr.,
MD (Dr. Bynum) and the Second Amended Motion to Dismiss brought by Connie
Johnson Schaeffer, RN (Johnson Schaeffer)1 and Stevens Community Medical Center
(SCMC, and together with Dr. Bynum and Johnson Schaeffer, Defendants).
Plaintiff has asserted claims under the federal Emergency Medical Treatment and
Active Labor Act (EMTALA), 42 U.S.C. 1395dd, against SCMC.2 Plaintiff also has
alleged state law claims for negligent care, treatment, and wrongful death against all three
defendants and for negligent credentialing against SCMC. For the reasons set forth
below, the Court grants the Defendants motions as to Plaintiffs EMTALA claims.3
Plaintiff was the husband of Sandra Ann Utech (Utech), who is deceased. The
night before she died, Utech was brought to SCMC by ambulance suffering respiratory
distress, chest pain, and right arm pain. She received medical treatment from Dr. Bynum
and Johnson Schaeffer while at SCMC. Utech underwent a physical examination and
was given a number of tests and treatments, including a gastrointestinal (GI) cocktail,
cardiac enzyme tests and an arterial blood gas test, an electrocardiogram (EKG), and a
chest x-ray. Dr. Bynum diagnosed Utech with anxiety/depression syndrome with
multiple life stressors and hyperventilation. Dr. Bynum also noted chronic pain in
1 Johnson Schaeffers name is spelled differently in various documents before the
Court. The Court uses the spelling adopted by the Plaintiff in the Complaint.
2 Plaintiff originally asserted his EMTALA claim against Dr. Bynum and Johnson
Schaeffer as well, but has stipulated to dismissal of the EMTALA claim against these
3 The Court does not address the Plaintiffs other claims and, therefore, does not
rule on any additional issues raised in the Defendants motions.
Utechs right shoulder and arm pain with associated numbness, which he thought was
related to her cervical spine. Dr. Bynum also believed Utech was suffering from gastritis.
Utech had a family history of cardiac problems. According to Dr. Bynum, he
advised Utech that he could not definitively rule out a cardiac problem as the cause of her
symptoms and recommended that she be admitted to stay overnight.4 According to both
Dr. Bynum and Johnson Schaeffer, Utech declined to be admitted and was discharged.
Kim Bouressa (Bouressa) picked Utech up from the hospital. Utech went to
Bouressas house to spend the night and was found dead there in the morning. An
autopsy determined that Utech died from bilateral pulmonary edema and congestion,
likely due to congestive heart failure, and underlying coronary artery disease.
The Court must first determine whether Plaintiff has stated a claim under
EMTALA. If so, this Court has subject-matter jurisdiction because the Plaintiff has
presented a federal question and the Court may consider Plaintiffs state-law claims
pursuant to its supplemental jurisdiction. 28 U.S.C 1367(a) (providing that the district
courts shall have supplemental jurisdiction over all other claims that are so related to
claims in the action within such original jurisdiction that they form part of the same case
or controversy under Article III of the United States Constitution). If not, then
4 Dr. Bynum testified that he made this recommendation but it does not appear in
his notes. Johnson Schaeffer testified at her deposition that she had written a nursing
note stating Utech was offered to stay in the hospital overnight if she did not want to go
home and would feel more comfortable staying to be observed overnight. (Doc. No. 44
XI, Doc. No. 48 Ex. J at 95.)
Plaintiffs EMTALA claim must be dismissed and the Court may decline to hear the
remaining claims asserted under state law. 28 U.S.C. 1367(c)(3).
I. Standard of Review
Summary judgment is proper if there are no disputed issues of material fact and
the moving party is entitled to judgment as a matter of law. Fed. R. Civ. P. 56(c). The
Court must view the evidence and the inferences that may be reasonably drawn from the
evidence in the light most favorable to the nonmoving party. Enter. Bank v. Magna Bank
of Mo., 92 F.3d 743, 747 (8th Cir. 1996). However, as the Supreme Court has stated,
[s]ummary judgment procedure is properly regarded not as a disfavored procedural
shortcut, but rather as an integral part of the Federal Rules as a whole, which are designed
to secure the just, speedy and inexpensive determination of every action. Celotex
Corp. v. Catrett, 477 U.S. 317, 327 (1986) (quoting Fed. R. Civ. P. 1).
The moving party bears the burden of showing that there is no genuine issue of
material fact and that it is entitled to judgment as a matter of law. Enter. Bank, 92 F.3d
at 747. The nonmoving party must demonstrate the existence of specific facts in the
record that create a genuine issue for trial. Krenik v. County of Le Sueur, 47 F.3d 953,
957 (8th Cir. 1995). A party opposing a properly supported motion for summary
judgment may not rest upon mere allegations or denials but must set forth specific facts
showing that there is a genuine issue for trial. Anderson v. Liberty Lobby, Inc., 477 U.S.
242, 256 (1986).
EMTALA was intended to address a distinct and rather narrow problem-the
dumping of uninsured, underinsured, or indigent patients by hospitals who did not want
to treat them. Summers v. Baptist Med. Ctr. Arkadelphia, 91 F.3d 1132, 1136 (8th Cir.
1996); Cleland v. Bronson Health Care Group, Inc., 917 F.2d 266, 268 (6th Cir. 1990)
(noting that enactment of EMTALA followed highly publicized incidents in which
hospital emergency rooms allegedly failed to provide a medical screening or transferred
or discharged patients based only on a patients financial inadequacy). EMTALA
provides that:
[i]n the case of a hospital that has a hospital emergency department, if any
individual (whether or not eligible for benefits under this subchapter)
comes to the emergency department and a request is made on the
individuals behalf for examination or treatment for a medical condition,
the hospital must provide for an appropriate medical screening examination
within the capability of the hospitals emergency department, including
ancillary services routinely available to the emergency department, to
determine whether or not an emergency medical condition (within the
meaning of subsection (e)(1) of this section) exists.
42. U.S.C. 1395dd(a). The appropriate medical screening requirement has been
interpreted to require a hospital to provide a medical examination consistent with that
offered to other similarly situated patients. Summers, 91 F.3d at 1138 ([a]n
inappropriate screening examination is one that has a disparate impact on the plaintiff).
If an individual is determined to have an emergency medical condition, the
hospital must either provide such further medical examination and such treatment as
may be required to stabilize the medical condition, or must transfer the individual to
another medical facility after the emergency medical condition has been stabilized. 42
U.S.C. 1395dd(b)(1) and (c). EMTALA requires a hospital to stabilize the patient, but
it does not require the hospital to cure the patients condition. Green v. Touro Infirmary,
992 F.2d 537, 539 (5th Cir. 1993) (holding that no EMTALA violation occurred when
patient left hospital with normal vital signs, was ambulatory, and was not in acute
distress). The hospitals responsibility under EMTALA ends when the patient is
stabilized. Id. Further, hospitals are not liable under EMTALA for failing to stabilize
conditions of which they are unaware or even of which they should have been aware.
Kenning v. St. Paul Fire & Marine Ins. Co., 990 F. Supp. 1104, 1110 (W.D. Ark. 1997)
(quoting Vickers v. Nash Gen. Hosp., Inc., 78 F.3d 139, 145 (4th Cir. 1996)); Summers,
91 F.3d at 1140 (stating that a hospital must have actual knowledge of the patients
unstabilized emergency medical condition to show an EMTALA claim). To hold
otherwise would make an EMTALA claim the equivalent of a malpractice claim for
negligent treatment. Kenning, 990 F. Supp. at 1110.
Courts have made clear that EMTALA is not a federal malpractice statute, and
claims of misdiagnosis or inadequate treatment are not actionable under EMTALA.
Summers, 91 F.3d at 1136; see also Hunt v. Lincoln County Mem. Hosp., 317 F.3d 891
(8th Cir. 2003) (holding no EMTALA claim existed where patients condition was
undetected during medical screening). Therefore, EMTALA does not entitle patients to
correct or non-negligent treatment, but instead only requires that they receive uniform
treatment. Summers, 91 F.3d at 1138.
SCMC argues that Dr. Bynum did not perceive Utech to be suffering from an
emergency medical condition. The record is unclear as to this issue. At the time he
examined Utech, Dr. Bynum did not clearly identify that Utech was undergoing a cardiac
event and diagnosed her with other conditions. At his deposition, however, when read
EMTALAs definition of emergency medical condition, Dr. Bynum stated that he
thought that Utech had an emergency medical condition when she arrived at the
emergency room. (Doc. No. 57 3, Ex. 3 at 148.) Dr. Bynums statement at his
deposition was general; he did not identify any particular condition he believed Utech
had. At this stage of the case, the Court must view the evidence in the light most
favorable to the Plaintiff. Though the evidence is not overwhelming, the Court
determines that there is sufficient evidence in the record to show that Dr. Bynum believed
Utech was suffering from some sort of emergency medical condition at the time she
arrived at SCMC. SCMC, therefore, had an obligation under the statute to stabilize
Utechs condition before discharging or transferring her.
Dr. Bynum testified in his deposition that, at the time Utech was discharged, her
condition was stable; he stated that Utechs tests were negative and all of her vital signs
were unremarkable or did not seem to be threatening. (Id. Ex. 3 at 147.) Dr. Bynum
did not believe that there would be any material deterioration in Utechs condition. (Id.
Ex. 3 at 149.) Dr. Bynum also testified that SCMC did not have the equipment necessary
to do additional tests, other than the ones Utech had been given, to diagnose a cardiac
condition. (Doc. No. 44 XII, Doc. No. 48 Ex. K at 160-61.) If Dr. Bynum had
determined it was necessary for her to see a cardiologist for a consultation, he would have
been required to send her to another facility. (Doc. No. 57 3, Ex. 3 at 168.)
Nonetheless, Dr. Bynum recommended to Utech that she stay overnight to
undergo re-testing because he thought it possible that she had a cardiac condition not
identified by the tests she had been given.5 During the testing, Dr. Bynum had identified
a right bundle branch block, and he explained to her that she had some abnormalities,
but they werent ischemic. (Id. Ex. 3 at 138.) Dr. Bynum testified that he asked Utech
to remain in the hospital, but that she declined to do so.6 (Id. Ex. 3 at 138.) Johnson
Schaeffers notes reflect that Utech stated she preferred to go home and sit in her rocking
chair. (Doc. No. 44 XI, Doc. No. 48 Ex. J at 95.)
Plaintiff argues that there is a genuine issue of material fact as to whether SCMC
knew that Utech was suffering from an unstabilized emergency medical condition. First,
Plaintiff contends that Dr. Bynum knew that Utech was suffering from symptoms
associated with cardiac disease, that her family history put her at risk of cardiac disease,
and that she was a smoker. Therefore, according to Plaintiff, because Dr. Bynum had
knowledge of her symptoms and risk, there is an issue of facts as to whether Dr. Bynum
knew that Utech had an emergency medical condition. Further, Plaintiff argues that his
expert, Dr. David R. Peterson, identifies numerous signs that Utech presented with a
cardiovascular problem and that she should have been admitted for treatment rather than
being discharged. (Doc. No. 57 3, Ex. 9.) In essence, however, Plaintiffs arguments
5 Dr. Bynum wanted to give Utech additional blood tests and monitor her heart
further. (Doc. No. 57 3, Ex. 3 at 145.)
6 The Court notes that a hospital meets EMTALAs stabilization requirement if
treatment is offered to a patient along with information about risks and benefits and the
patient refuses additional treatment. 42 U.S.C. 1395dd(b)(2).
are that Dr. Bynum should have known that Utech had an emergency medical condition.
The record before this Court, even viewed in the light most favorable to the Plaintiff,
does not show that Dr. Bynum had actual knowledge of an unstabilized emergency
medical condition at the time Utech was discharged .
Dr. Bynum did not diagnose Utech with cardiac disease and did not identify that
she was having a cardiac event at the emergency room. Dr. Bynum thought that there
could be a cardiac cause for her symptoms, but believed that Utech was stable, based on
her negative tests and vital signs, at the time she was discharged. Viewing the record in
the light most favorable to the Plaintiff, Dr. Bynum failed to determine that Utech was
suffering from an unstabilized emergency medical condition. The failure to determine
that a patient has an emergency medical condition may be the basis for a medical
malpractice claim, but does not create a claim under EMTALA. See Kenning, 990 F.
Supp. at 1109 (stating that EMTALA is not concerned with the standard of care or with
a misdiagnosis).
Plaintiff also provided the deposition testimony of Bouressa regarding a
conversation she had with Utech when she picked Utech up from SCMC. According to
Bouressa, while they were in the car, Utech stated that she believed she was having a
heart attack. (Doc. No. 57 3, Ex. 4 at 30.) Bouressa questioned why Utech was leaving
the hospital and linked the discharge to Utechs lack of insurance. (Id. Ex. 4 at 30-31.)
Bouressas deposition testimony on this point is somewhat lacking because the majority
of the information was supplied by the attorney taking the deposition. Nevertheless,
Bouressa testified that, when Bouressa asked Utech why she was not in the hospital,
Utech stated I do not have insurance. (Id. Ex. 4 at 30.) According to Bouressas
Q: You said, Is it a question of your paying the bill? and she said,
No, I can pay the bill. Is that - -
A. Yes.
Q. Is that what youre understanding her to say?
A. Yes.
Q. But youre concluding that the hospital said it was anxiety because
they didnt do what they should have done to find out of it was a
heart attack? Is that what youre understanding?
A. Yes. Yes.
Q. All right. So [Utech] thought they were doing the care on the cheap?
A. Yes.
Q. So they didnt do the tests they needed to do to figure it out?
A. Yes.
Q. Thats what you understand this to mean?
A. Yes.
(Id. Ex. 4 at 31). Bouressa also testified that she suggested that Utech go back in to
SCMC or be taken to Alexandria or St. Cloud, Minnesota, so that she could be seen at
other hospitals. (Id., Ex. 4 at 32, 36-37.) According to Bouressa, Utech refused to return
to SCMC or to go to another hospital, and Utech extracted a promise from Bouressa that
Bouressa would not make Utech go to see any quacks. (Id.)
Leaving aside the question of whether Bouressas testimony as to her
understanding of Utechs subjective belief would be admissible at trial, and viewing this
evidence in the light most favorable to the Plaintiff, the Court will assume that Utech
believed that she was discharged because she lacked insurance. Evidence of improper
motivation is not essential to an EMTALA claim. Summers, 91 F.3d 1137-38. Evidence
of disparate treatment, however, is required. Plaintiff has not shown that Utech received
treatment different from that which SCMC offered to other patients. It is the Plaintiffs
burden to show disparate treatment. Williams v. Birkeness, 34 F.3d 695, 697 (8th Cir.
1994) (stating that is not the hospitals obligation to disprove a plaintiffs claim by
showing that all patients are treated uniformly).
The Court, therefore, must dismiss Plaintiffs EMTALA claim. This claim is the
basis for federal jurisdiction in this case, and the Court may decline to exercise
jurisdiction over Plaintiffs remaining state law claims. Most often, when federal and
state claims are joined and the federal claims are dismissed on a motion for summary
judgment, courts dismiss the remaining state-law claims without prejudice in order to
avoid making needless decisions of state law, as a matter of comity, and to promote
justice between the parties. Ivy v. Kimbrough, 115 F.3d 550, 552-53 (8th Cir. 1997). The
Court declines to exercise jurisdiction over Plaintiffs remaining claims. The Court,
therefore, dismisses these claims without prejudice so that they may be heard by a
Minnesota state court.
The Court concludes that Plaintiff has not shown that Utech received disparate
treatment at SCMC and, therefore, that Plaintiffs EMTALA claim fails. The Court
dismisses Plaintiffs EMTALA claim with prejudice. The Court also declines to exercise
its supplemental jurisdiction and dismisses, without prejudice, Plaintiffs pendant
state-law claims against the Defendants.
Accordingly, IT IS HEREBY ORDERED that:
1. The Motion to Dismiss for Lack of Jurisdiction and Motion for Partial
Summary Judgment of Defendant Gaither Bynum, Jr. (Doc. No. 35) is GRANTED.
2. The Second Amended Motion to Dismiss of Defendant Connie Johnson
Schaeffer (Doc. No. 41) is GRANTED IN PART and DENIED IN PART as follows:
a. Defendant Johnson Schaeffers motion is GRANTED as to
Plaintiffs EMTALA claim;
b. Defendant Johnson Schaeffers motion is DENIED AS
MOOT with respect to Plaintiffs other claims.
3. The Complaint (Doc. No. 1) is DISMISSED as follows:
a. Count 2 of the Complaint alleging violation of EMTALA is
to SCMC regarding Count 2.
b. Counts 1 and 3 of the Complaint are DISMISSED
Dated: December 17, 2008 s/Donovan W. Frank
Judge of United States District Court


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