Opinion
98 Civ. 7922 (DAB)
February 2000
ORDER
Plaintiff asserts eleven causes of action against Defendants Maimonides Medical Center ("Maimonides") and Dr. Joachim Kapalanga ("Dr. Kapalanga") including violations of the Emergency Medical Treatment and Active Labor Act ("EMTALA") 42 U.S.C. § 1395dd, medical malpractice, negligence, negligent infliction of emotional distress, and intentional infliction of emotional distress. Defendants Maimonides and Dr. Kapalanga move to dismiss the First Amended Complaint in its entirety.
None of the remaining Defendants, including New York City Health and Hospitals Corporation, Coney Island Hospital, Dr. Tan, and Dr. Yousef, join in this motion to dismiss.
For the following reasons, Defendants' Motion to Dismiss is GRANTED.
I. BACKGROUND
On May 29, 1998 at 4:30 a.m., Plaintiff Lilliemae Vazquez ("Vazquez") noticed that her four year-old son, Peter Salinas ("Salinas"), had a fever. (Am. Compl. 66 14-15.) After realizing that her son's fever was not coming down, Vazquez called her health care provider and was advised to take her son to a hospital emergency room. (Am. Compl. ¶ 16.) At 8:00 a.m. Vazquez brought her son to non-moving Defendant Coney Island Hospital's emergency room. (Am. Compl. ¶ 17.) Coney Island Hospital is a hospital that receives federal funds, including Medicaid funds. (Am. Compl. ¶ 8.)
Vazquez was advised to take her son to the pediatric section within the emergency room. (Am. Compl. ¶ 18.) There, nurse's aides attended to Salinas by taking his temperature and drawing blood. (Id.) Vazquez then spoke with a Dr. Kappi and pointed out that her son had red spots below his knees.
Although named as a Defendant in Plaintiffs' original Complaint, claims against Dr. Kappi appear to have been voluntarily dismissed pursuant to Plaintiffs' First Amended Complaint.
While at Coney Island Hospital, Plaintiff alleges that Dr. Kappi and a Dr. Tan refused to test her son for meningitis, explaining that it would require a spinal tap, which would put Salinas at risk of becoming paralyzed or crippled. (Am. Compl. 66 21 35.) Moreover, Plaintiff alleges that her son was placed in a storage room, hypodermic needles were left on his bed, alcohol pads were left on his bed, and the bed he was in was filthy. (Id. at 25 44.) In addition, Vazquez contends that while her son was in the alleged storage room, an unnamed doctor, Dr. Jane Doe, entered and took Salinas' temperature, which registered 104 degrees Fahrenheit. (Id. at 26.) Plaintiff contends further that not one of the doctors who treated Salinas believed he had meningitis, it was suggested to Vazquez that her son had an airborne bacteria rather than meningitis, and some time before Salinas was to be transferred to Maimonides his body turned black but no one would tell Vazquez what was wrong with him. (Id. at 19, 20, 29, 35, 39 43.)
Eventually, a specialist from moving Defendant Maimonides arrived and began speaking with Dr. Tan. (Am. Compl. ¶ 49.) Dr. Tan told Vazquez that her son would have to be transferred to Maimonides. (Am. Compl. ¶ 52.) Defendant Maimonides is a hospital that receives federal funds, including Medicaid funds. (Am. Compl. ¶ 9.)
In the ambulance ride to Maimonides, Vazquez asked the specialist from Maimonides what was wrong with her son and he told her to ask Dr. Tan. (Am. Compl. ¶ 53.) When Salinas arrived at Maimonides he was taken to the K-2 Pediatric Special Care Unit. (Am. Compl. ¶ 54.)
Defendants contend in their Motion to Dismiss that Salinas was brought into the Pediatric Intensive Care Unit at Maimonides Medical Center, not the Pediatric Special Care Unit. (Defs.' Mot. Dismiss at 4.)
Vazquez went to meet her son and alleges that she saw an orderly poking at him while looking for a good vein from which to take blood. (Am. Compl. ¶ 55.) Around that time, Plaintiff alleges that moving Defendant Dr. Kapalanga entered the room wearing blue jeans and a t-shirt, without a protective mask, and introduced himself. (Am. Compl. ¶ 56.) At this time Vazquez was asked to leave the room. (Id.)
Once Vazquez was allegedly "forced" from the room, Plaintiff claims several individuals spoke to her, including a counselor who informed her that her son had meningitis, but would be fine. (Am. Compl. ¶ 57.)
Plaintiff further alleges that her son was placed on a machine to sedate or stabilize him. (Am. Compl. ¶ 58.) She was told her son was fighting the machine, his tongue was hanging out of his mouth, and he was convulsing (Id.)
Vazquez suggested to individuals present that her son be taken off the machine and that the tube be removed but was informed that her son would bleed to death if these requests were granted. (Am. Compl. ¶ 59.)
Apparently, Vazquez reentered the room, began to talk to her son, and held his hand in an attempt to calm him down. (Am. Compl. ¶ 60.) Plaintiff was initially told to leave the room and then was allegedly "forced" out again. (Id.) Some time after Vazquez was allegedly "forced" from the room, she heard screaming, returned to the room, and found that various machines were turned off and the machine indicating a heart beat was flat. (Am. Compl. ¶ 61.)
According to Plaintiff, her son suffered from respiratory failure and/or cardiac arrest before he passed away. (Am. Compl. 6 63.) On Salinas' death certificate, Dr. Kapalanga stated that he had died of "natural causes" at 5:34 a.m. (Am. Compl. ¶ 64.)
II. DISCUSSION
"On a motion to dismiss under Rule 12(b)(6), the court must accept as true the factual allegations in the complaint, and draw all reasonable inferences in favor of the plaintiff." Harris v. City of New York, 186 F.3d 243, 247 (2d Cir. 1999). "The district court should grant such a motion only if, after viewing plaintiff's allegations in this favorable light, it appears beyond doubt that the plaintiff can prove no set of facts in support of his claim which would entitle him to relief." Id.
A. Emergency Medical Treatment and Active Labor Act (EMTALA): 42 U.S.C. § 1395dd
It is well settled that EMTALA is not a federal malpractice statute. "Congress did not intend to expose defendant hospitals to attack along a new flank. Nor did it intend to turn the federal courts into fora for state malpractice claims." Hart v. Mazur, 903 F. Supp. 277, 280 (D.R.I. 1995). See also Correa v. Hospital of S.F., 69 F.3d 1184, 1192 (1st Cir. 1995) ("EMTALA does not create a cause of action for medical malpractice."). In fact, "Congress enacted EMTALA in 1986 `in response to a growing concern that hospitals were "dumping" patients unable to pay, by either refusing to provide emergency medical treatment or transferring patients before their emergency conditions were stabilized.'" Reynolds v. Mercy Hosp., 861 F. Supp. 214, 219 (W.D.N.Y. 1994) (citing Brooks v. Maryland Gen. Hosp. Inc., 996 F.2d 708, 710 (4th Cir. 1992)). See also Marshall v. East Carroll Parish Hosp. Serv. Dist., 134 F.3d 319, 322 (5th Cir. 1998); Correa, 69 F.3d at 1189 (1st Cir. 1995), (citing H.R. Rep. No. 241(I), 99th Cong., 1st Sess. 27 (1986), reprinted in U.S.C.C.A.N. 42, 605).
EMTALA requires hospitals to adopt certain screening and stabilization procedures. Moreover, an "appropriate medical screening examination" under EMTALA "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." See Marshall 134 F.3d at 322. Also, if a hospital determines that an individual has an emergency medical condition, pursuant to EMTALA, the hospital is required to provide further examination and treatment in an effort to "stabilize" the patient before discharging or transferring the individual to another medical facility. See Jones v. Garcia, 936 F. Supp. 929 (M.D.Fla. 1996). Plaintiffs allege Defendants violated EMTALA's screening and stabilization requirements.
42 U.S.C. § 1395dd, in relevant part states:
(a) In the case of a hospital that has a hospital emergency department, if 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, 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.
(b)(1) 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 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. . . .
(c) If an individual at a hospital has an emergency medical condition which has not been stabilized . . ., the hospital may not transfer the individual [accept in limited circumstances not applicable in the instant action].
a. Screening
Each hospital must develop screening procedures to assess emergency medical conditions. "Having done so, it must apply them alike to all patients." See Summers v. Baptist Med. Ctr. Arkadelphia, 91 F.3d 1132, 1138 (8th Cir. 1996). Furthermore, the medical screening requirement applies only to patients who seek treatment from an emergency department. Baber v. Hospital Corp. of Am., 977 F.2d 872, (4th Cir. 1992). The term "appropriate medical screening examination", as used in EMTALA, has been interpreted to require hospitals to apply uniform screening procedures to all individuals coming to the emergency room to determine if an emergency medical condition exists; essentially, the screening provision aims to prevent disparate treatment. See Summers, 91 F.3d at 1138 ("Patients are entitled under EMTALA, not to correct or non-negligent treatment in all circumstances, but to be treated as other similarly situated patients are treated, within the hospital's capabilities.") (additional citations omitted). Moreover, Plaintiffs must allege that the hospital and physician departed from standard screening procedures in their treatment of the patient. See Hutchinson v. Greater Southeast Community Hosp., 793 F. Supp. 6 (D.D.C. 1992).
In other words, EMTALA's screening requirement applies to patients who were treated differently in a hospital's emergency room than other patients with the same or similar illness. Vazquez acknowledges her son was not treated in the Maimonides emergency room but was brought directly to intensive care. Further, Vazquez does not allege any disparate medical treatment by Maimonides or disparate medical treatment by any Maimonides Doctor towards her son. The Complaint does no more than allege that Defendants failed to screen adequately Plaintiff's son but provides no facts to suggest disparate treatment.
b. Stabilization
Plaintiff further alleges that Defendant Maimonides failed to "stabilize" Salinas' condition as set forth in 42 U.S.C. § 1395dd(e)(a)(3). The statute makes clear that a patient must be "stabilized" before being transferred to another hospital or released from a hospital. 42 U.S.C. § 1395dd(c); (e)(a)(3). (emphasis added). Furthermore, even where the facts may support a finding of gross misdiagnosis, no claim is stated under EMTALA absent allegations that the hospital deviated from its standard screening or stabilizing procedures. Vickers v. Nash Gen. Hosp., 875 F. Supp. 313, 317 (E.D.N.C. 1995), aff'd 78 F.3d 139 (4th Cir. 1996).
The term "stabilize" means: . . . to provide such medical treatment of the condition as may be necessary to assure, within reasonable medical probability, that no material deterioration of the condition is likely to result from or occur during the transfer of the individual from a facility . . . . 42 U.S.C.A. § 1395dd(e)(3)(A).
Vazquez alleges that her son was transferred to Defendant Maimonides, that her son was treated there and, unfortunately, passed away. Vazquez does not allege any facts of disparate treatment by Defendant Maimonides towards her son, nor does she allege that Defendant Maimonides transferred or released Salinas. Plaintiffs' Amended Complaint, though relating tragic events, is devoid of any facts alleging that Defendants deviated from their standard procedures in any way.
Consequently, for the reasons stated, Plaintiff has failed to state a claim under EMTALA as to Defendants Maimonides and Dr. Kapalanga. Accordingly, Plaintiff's federal claims against Defendants Maimonides and Dr. Kapalanga are hereby DISMISSED.
B. Supplemental Jurisdiction
The Court having dismissed all federal claims now dismisses the Plaintiffs' state law claims pursuant to 28 U.S.C. § 1367(c). Although section 1367(a) provides this Court with supplemental jurisdiction, the Court declines to exercise its jurisdiction pursuant to 1367(c) for lack of any remaining federal claims. The decision to dismiss state law claims is left to the sound discretion of the district judge. Ametex Fabrics, Inc. v. Just In Materials, Inc., 140 F.3d 101, 105 (2d Cir. 1998) (citing Purgess v. Sharrock, 33 F.3d 134, 138 (2d Cir. 1994)). Furthermore, when claims are dismissed before trial, the balance of factors will lean towards declining to exercise jurisdiction. See Carnegie-Melon Univ. v. Cohill. 484 U.S. 343, 350 n. 7 (1988). Accordingly, as this Court has dismissed Plaintiffs' federal claim, Plaintiffs' pendant state claims are hereby DISMISSED.
III. CONCLUSION
For the reasons stated above, Defendants' Motion to Dismiss is GRANTED. Plaintiffs have failed to state a claim under the Emergency Medical Treatment and Active Labor Act 42 U.S.C. § 1395dd. The Court declines to exercise supplemental jurisdiction over Plaintiffs' remaining state law claims. Accordingly, this action is DISMISSED as against Defendants Maimonides and Dr. Kapalanga.
SO ORDERED.