Torres et al v. Santa Rosa Memorial Hospital et al
Filing
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ORDER by Judge Hamilton granting in part and denying in part 43 Motion to Dismiss; granting in part and denying in part 44 Motion to Dismiss (pjhlc2, COURT STAFF) (Filed on 8/20/2013)
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UNITED STATES DISTRICT COURT
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NORTHERN DISTRICT OF CALIFORNIA
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MICHAEL JENE TORRES, et al.,
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Plaintiffs,
v.
No. C 12-6364 PJH
ORDER DISMISSING FIRST
AMENDED COMPLAINT
SANTA ROSA MEMORIAL HOSPITAL,
et al.,
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For the Northern District of California
United States District Court
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Defendants.
_______________________________/
Defendants’ motions to dismiss came on for hearing before this court on August 14,
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2013. Plaintiffs Michael Jene Torres, Jr., Robert Sexton, and Zenaida Stilley (“plaintiffs”)
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appeared through their counsel, Douglas Fladseth. Defendants Santa Rosa Memorial
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Hospital and St. Joseph Health System (“the Hospital defendants”) appeared through their
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counsel, Brett Schoel. Defendant Glenn T. Meade, M.D. (“Meade”) appeared through his
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counsel, Sonja Dahl. Having read the papers filed in conjunction with the motions and
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carefully considered the arguments and the relevant legal authority, and good cause
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appearing, the court hereby GRANTS in part and DENIES in part the Hospital defendants’
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motion to dismiss, and GRANTS in part and DENIES in part Meade’s motion to dismiss as
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follows.
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According to the first amended complaint (“FAC”), the facts are as follows. On
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September 19, 2011 at about 3:30pm, the decedent, Michael Jene Torres (“Torres”) was
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brought by ambulance to the emergency room at Santa Rosa Memorial Hospital. FAC, ¶ 1.
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Torres was suffering from neck pain and severe shaking/seizures due to alcohol withdrawal
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and pneumonia. Id., ¶ 23. Torres was diagnosed with alcohol withdrawal and given one
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milligram of a sedative (Lorazepam), and instructed to go to a clinic the next day. Id., ¶ 1.
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Torres was discharged from the hospital at 7:30pm, but did not leave the hospital’s
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premises. Id., ¶ 3. Instead, Torres went to the hospital’s cafeteria until 9:45pm, when he
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was “forced to leave.” Id. At 2:00am, Torres was again found on hospital premises,
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“seated on the floor in a hallway,” and was again “forced to leave the building.” Id., ¶ 33.
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At 7:00am the next morning, Torres was found “lying in the parking lot moaning and in
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apparent distress.” Id., ¶ 3. However, the hospital’s nursing supervisor allegedly told
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hospital staff that Torres was “not our problem,” and to call 911 if anyone thought that he
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needed help. Id., ¶ 36. Torres died in the hospital parking lot later that morning. Id., ¶ 8.
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In the FAC, plaintiffs assert three causes of action: (1) violation of the Emergency
Code § 15657; and (3) general negligence. As a threshold matter, the court notes that the
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For the Northern District of California
Medical Treatment and Active Labor Act (“EMTALA”); (2) violation of Welfare & Institutions
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United States District Court
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first amended complaint (“FAC”) is no clearer than the original complaint in specifying
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which claims are brought against which defendants, and instead appears to assert all
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claims against “defendants.” At the hearing, plaintiffs made clear that their first cause of
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action (under EMTALA) is asserted against only the Hospital defendants.
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EMTALA imposes two requirements on hospital emergency departments: (1) if any
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individual comes to the emergency department requesting examination or treatment, a
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hospital must provide for “an appropriate medical screening examination within the
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capability of the hospital’s emergency medical department” (this is referred to as the
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“screening” prong); and (2) if the hospital determines that an emergency medical condition
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exists, it must provide “such treatment as may be required to stabilize the medical
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condition” (the “stabilization” prong). See 42 U.S.C. § 1395dd. The FAC alleges generally
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that the Hospital “both fail[ed] to screen and fail[ed] to stabilize,” but does not provide any
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factual support for these allegations, thus making it impossible to discern what specific
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conduct underlies plaintiffs’ claim. In their opposition brief, plaintiffs explained that they
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allege four violations of EMTALA: (1) the Hospital failed to screen Torres for bacterial
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pneumonia when he first arrived at the emergency department, (2) the Hospital failed to
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stabilize Torres’ alcohol withdrawal because he was given only one dose of Lorazepam, (3)
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the Hospital failed to stabilize Torres’ bacterial pneumonia, and (4) the Hospital failed to
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screen Torres for any medical condition when he remained on hospital premises through
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the following morning. The court will address each of these theories separately.
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As to (1), plaintiffs admit that the Hospital did actually screen the decedent upon
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presentation at the emergency department, but they argue that the screening was “at most
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a cursory lung exam.” FAC, ¶ 26. Plaintiffs do not provide any facts regarding this
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“cursory” lung exam, but instead reason that, because the decedent’s bacterial pneumonia
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was not actually detected, any screening exam must have been inadequate. In order to
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state a claim for “failure to screen” under EMTALA, plaintiffs must allege that the decedent
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was not provided with “an examination comparable to the one offered to other patients
presenting similar symptoms,” or that the “examination was so cursory that it is not
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For the Northern District of California
United States District Court
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designed to identify acute and severe symptoms that alert the physician of the need for
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immediate medical attention to prevent serious bodily injury.” Jackson v. East Bay
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Hospital, 246 F.3d 1248, 1256 (9th Cir. 2001). Plaintiffs do allege that the lung exam was
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“cursory,” but that allegation is wholly conclusory, and does not permit the court to infer
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more than the mere possibility of misconduct. While plaintiffs can state a plausible claim
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that the examination should have identified the bacterial pneumonia (which is relevant to
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their negligence cause of action), they appear unable to state a plausible claim that the
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examination was so cursory that it was not designed to identify the bacterial pneumonia.
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Thus, to the extent premised on theory (1), plaintiffs’ EMTALA claim is DISMISSED. Given
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that plaintiffs were previously given leave to amend this claim, the dismissal is with
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prejudice.
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As to (2), the court first notes that the FAC contains no allegations supporting this
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theory. The FAC states only that the decedent was “given 1 mg. of a sedative and
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instructed to go to a clinic the next day,” and that “[d]efendants knew the 1 mg. of
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Lorazepam would only be effective for at most a few hours.” FAC, ¶ 1, 7. Nowhere in the
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FAC do plaintiffs allege that the Hospital failed to stabilize the decedent’s alcohol
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withdrawal. However, in their opposition brief, plaintiffs did argue that the decedent’s
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alcohol withdrawal was “never stabilized” and that was “limited for a few hours at most.”
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Under EMTALA, to “stabilize” means “to provide such medical treatment of the condition as
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may be necessary to assure, within reasonable medical probability, that no material
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deterioration of the condition is likely to result from or occur during the transfer of the
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individual from a facility.” Bryant v. Adventist Health System/West, 289 F.3d 1162, 1165
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(9th Cir. 2002) (quoting EMTALA). Again, plaintiffs rely on wholly conclusory allegations
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without providing any support for their argument that the administered dose of Lorazepam
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was insufficient to stabilize the decedent’s alcohol withdrawal. Thus, to the extent
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premised on theory (2), plaintiffs’ EMTALA claim is DISMISSED. However, because
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plaintiffs have not yet had an opportunity to amend this claim, the dismissal shall be without
prejudice. Plaintiffs will have one more opportunity to state a claim, under EMTALA, that
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For the Northern District of California
United States District Court
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the Hospital failed to stabilize the decedent’s alcohol withdrawal.
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As to (3), plaintiffs overlook the fact that the “duty to stabilize the patient does not
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arise until the hospital first detects an emergency medical condition.” Eberhardt v. City of
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Los Angeles, 62 F.3d 1253, 1259 (9th Cir. 1995). If an emergency medical condition is not
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detected, then no duty to stabilize arises. As explained in the discussion of theory (1)
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above, plaintiffs allege that the Hospital failed to diagnose the decedent’s bacterial
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pneumonia. Thus, there was no duty to stabilize the undiagnosed bacterial pneumonia,
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and plaintiffs cannot state a claim for failure to stabilize that undiagnosed condition.
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Accordingly, to the extent premised on theory (3), plaintiffs’ EMTALA claim is DISMISSED
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with prejudice.
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As to (4), plaintiffs allege that the Hospital had a duty to perform a second screening
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of the decedent when he remained on Hospital premises, but they do not explain whether
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this duty was triggered when the decedent was found in the hospital’s cafeteria, or when
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the decedent was found in the hospital’s hallway, or when he was found in the hospital’s
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parking lot the next morning. Nor do plaintiffs provide any authority for this “second
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screening” theory. Again, it appears that plaintiffs’ actual complaint is that the first
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screening examination was improperly performed (which supports plaintiffs’ allegation of
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negligence), not that the Hospital was obligated to continue screening the decedent as long
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as he remained on hospital premises. Although the court does DISMISS plaintiffs’
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EMTALA claim to the extent premised on theory (4), the dismissal is without prejudice, so
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that plaintiffs may attempt to more clearly state a claim under this theory. Any amended
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complaint must make clear when this alleged second duty to screen was triggered.
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Plaintiffs’ second cause of action is brought under Welfare & Institutions Code
neglect as defined in Section 15610.57.” The FAC purports to assert a claim under both
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the “physical abuse” prong and the “neglect” prong, but the “physical abuse” prong covers
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such conduct as assault, battery, sexual assault, and rape - none of which are alleged in
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the FAC. Nor do plaintiffs allege that the decedent was subject to a “physical or chemical
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For the Northern District of California
§ 15657, which imposes liability “for physical abuse as defined in Section 15610.63, or
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United States District Court
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restraint or psychotropic medication.” Thus, the court construes this claim as arising under
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the “neglect” prong. Section 15610.57 imposes liability for the “negligent failure of any
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person having the care or custody of an elder or a dependent adult to exercise that degree
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of care that a reasonable person in a like position would exercise.” Plaintiffs admit that the
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decedent was not an “elder” within the statute’s meaning, as he was 49 years old at the
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time of his death. However, plaintiffs do allege that the decedent was a “dependent adult.”
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The statute defines “dependent adult” as one who either (1) has “physical or mental
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limitations that restrict his ability to carry out normal activities or to protect his rights, but not
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limited to persons who have physical or developmental disabilities or whose physical or
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mental abilities have diminished because of age,” or (2) “is admitted as an inpatient to a 24-
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hour health facility.” Cal. Welf. & Inst. Code § 15610.23.
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Plaintiffs cite two cases in support of their argument that the decedent was a
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dependent adult. However, both can be distinguished from the present case. In George v.
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Sonoma County Sheriff’s Dept., the decedent was a prison inmate who had been admitted
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as an inpatient to a 24-hour health facility. 732 F.Supp.2d 922, 928 (N.D. Cal. 2010). Thus,
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the George decedent was a “dependent adult” under the second definition above, whereas
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plaintiffs in this case admit that Torres was not admitted as an inpatient. Plaintiffs also rely
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on People v. Mayte, in which the victim was found to be a “dependent adult” under the first
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definition above. 158 Cal.App.4th 921, 926 (2008). However, in that case, the victim had
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suffered a stroke which left her partially paralyzed and with impaired mental abilities similar
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to those of a 10 year old. Id. at 925. In this case, plaintiffs allege only that the decedent’s
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emergency conditions rendered him a “dependent adult,” arguing that “[o]ne can not
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become much more dependent on others than when one is transferred emergently by
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ambulance to an acute care emergency department.” Dkt. 48 at 5-6; Dkt. 49 at 8. Under
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plaintiffs’ definition of “dependent adult,” any individual between the ages of 18 to 64 who is
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taken by ambulance to a hospital would fall within the definition. Plaintiffs provide no
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authority for this expansive definition, and the court declines to adopt it here. Because the
decedent did not qualify as a dependent adult, there can be no liability under section
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For the Northern District of California
United States District Court
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15657, and plaintiffs’ second cause of action is DISMISSED with prejudice.
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Next, the Hospital defendants and Dr. Meade move to dismiss plaintiffs’ “claim” for
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punitive damages. As a procedural matter, plaintiffs’ request for punitive damages is part
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of their damages prayer and is not pled as a cause of action. Regardless, while defendants
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argue that their conduct “does not arise to the level of recklessness, oppression, fraud, or
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malice necessary for punitive damages,” the court finds that such a conclusion is premature
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at this stage of the case. Thus, the court DENIES defendants’ motion to dismiss plaintiffs’
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punitive damages prayer. However, as noted above, the FAC does fail to differentiate
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among defendants, so any amended complaint must allege which specific defendants’
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conduct (and which specific conduct) gives rise to any claim for punitive damages.
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Finally, defendants move to dismiss plaintiff Stilley from the case for lack of
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standing. As the court noted in its previous order, plaintiffs must allege that Ms. Stilley was
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financially dependent on the decedent. As pled, the FAC alleges that Ms. Stilley received
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financial assistance from the decedent, but does not allege actual financial dependence.
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However, plaintiffs’ opposition briefs do add facts sufficient to show Ms. Stilley’s financial
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dependence. Thus, while defendants’ motion to dismiss Ms. Stilley is GRANTED, leave to
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amend shall be granted so that plaintiffs may incorporate these more specific allegations
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into the complaint.
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Plaintiffs have until September 17, 2013 to file a second amended complaint in
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accordance with this order. The amended complaint must specifically identify which claims
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are brought by which plaintiffs against which defendants. Plaintiffs must also clearly
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separate their remaining two theories of relief under EMTALA - explaining which facts
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underlie their “failure to screen” theory, and which facts underlie their “failure to stabilize”
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theory. Plaintiffs are also directed to remove the decedent’s name from the case caption,
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as they admit that his name was inadvertently included. No new causes of action or parties
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may be added without leave of court or a stipulation of all parties. Defendants have until
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October 8, 2013 to answer or otherwise respond to the amended complaint. If the
response is another motion to dismiss, it should be noticed in accordance with the local
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For the Northern District of California
United States District Court
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rules, but the court will likely not hold any further hearings on the pleadings.
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IT IS SO ORDERED.
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Dated: August 20, 2013
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______________________________
PHYLLIS J. HAMILTON
United States District Judge
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