Brown v. St. Mary's Hospital et al
Filing
42
MEMORANDUM OF DECISION denying 22 Motion to Dismiss. Signed by Judge Dominic J. Squatrito on 1/12/15. (Glynn, T.)
UNITED STATES DISTRICT COURT
DISTRICT OF CONNECTICUT
LATASHA M. BROWN,
ADMINISTRATRIX OF THE ESTATE
OF CHRISTOPHER STEVENSON,
Plaintiff,
v.
No. 3:14CV228 (DJS)
ST. MARY'S HOSPITAL,
ET AL.,
Defendants.
MEMORANDUM OF DECISION
In her amended complaint, the plaintiff, Latasha M. Brown, Administratrix of the Estate
of Christopher Stevenson, alleges that the defendant St. Mary's Hospital ("the Hospital") violated
the Emergency Medical Treatment and Active Labor Act ("EMTALA"), 42 U.S.C. § 1395dd(b),
by failing to provide the plaintiff's decedent, Christopher Stevenson, Jr. ("Stevenson"), with
treatment necessary to stabilize his emergency medical condition prior to discharging him into
the community. The amended complaint also includes common law negligence claims against
both the Hospital and the defendant Adam D. Corrado, M.D. ("Dr. Corrado"). Pursuant to Fed. R.
Civ. P. 12 (b)(6), the Hospital has filed a motion to dismiss the plaintiff's EMTALA claim,
contending that the amended complaint fails to state a claim upon which relief can be granted.
For the reasons stated below, the defendant Hospital's motion to dismiss (doc. # 22) is denied.
FACTS1
At approximately 6:30 p.m. on June 7, 2013, Stevenson presented at the Hospital's
1
For purposes of considering the motion to dismiss, the Court "accept[s] all factual
allegations in the [amended] complaint as true, and draw[s] all reasonable inferences in the
plaintiff's favor." Chambers v. Time Warner, Inc., 282 F.3d 147, 152 (2d Cir. 2002).
emergency department. He stated, "I think I'm in DKA2," and complained of extreme thirst,
weakness, and frequent urination. Stevenson had a history of insulin-dependent diabetes mellitus
with poor medication compliance and poor access to care. He had previous interactions with the
Hospital.
Stevenson was treated in the emergency department by Dr. Corrado, whose impression
was "hyperglycemia, rule out diabetic ketoacidosis, no coma." (Doc. # 18, at 3-4, ¶ 12). Dr.
Corrado's plan called for intravenous fluids, potassium repletion as necessary, and insulin as
needed. Stevenson remained in the Hospital until his discharge at approximately 6:30 a.m. on
June 8, 2013. During that time the Hospital provided various types of treatment to Stevenson,
including the administration of normal saline, insulin, and potassium chloride. Laboratory testing
was done and then repeated, and a chest x-ray and electrocardiogram were also completed.
Stevenson's vital signs and urinary output were taken and recorded and a urinalysis was
completed.
At the time of his discharge, Stevenson was still in diabetic ketoacidosis. At
approximately 10:35 p.m. on June 9, 2013, Stevenson was found to be unresponsive at his
residence and was pronounced dead at 10:45 p.m. that same day. The results of an autopsy
revealed abnormal laboratory testing including high glucose and a large concentration of ketones
2
The parties agree that "DKA" stands for diabetic ketoacidosis, which is "a lifethreatening problem that affects people with diabetes. It occurs when the body cannot use sugar
(glucose) as a fuel source because there is no insulin or not enough insulin. Fat is used for fuel
instead. When fat breaks down, waste products called ketones build up in the body. . . . In high
levels, ketones are poisonous." http://www.nlm.nih.gov/medlineplus/ency/article/000320.htm.
-2-
in the urine. The cause of death was identified as complications from diabetes mellitus with
diabetic ketoacidosis as another significant condition.
DISCUSSION
"To survive a motion to dismiss, a complaint must contain sufficient factual matter,
accepted as true, to state a claim to relief that is plausible on its face. A claim has facial
plausibility when the plaintiff pleads factual content that allows the court to draw the reasonable
inference that the defendant is liable for the misconduct alleged." Ashcroft v. Iqbal, 556 U.S. 662,
678 (2009) (internal quotation marks and citation omitted). Dismissal is appropriate "only if it
appears beyond doubt that the plaintiff can prove no set of facts in support of his claim which
would entitle him to relief." Harper v. City of New York, 424 F. App'x 36, 38 (2d Cir. 2011)
(internal quotation marks omitted).
The Hospital contends that the plaintiff's EMTALA claim lacks facial plausibility, and
consequently fails to state a claim under that statute, because it "contains no allegation of
disparate treatment." (Doc. # 23, at 9). According to the Hospital, "plaintiff has essentially
alleged a medical malpractice claim cloaked in the guise of an EMTALA claim. " (Id. at 6). The
plaintiff, on the other hand, argues that her amended complaint alleges facts sufficient to state a
plausible "stabilization" claim under EMTALA (42 U.S.C. § 1395dd(b)).3
EMTALA "imposes two relevant obligations on a hospital receiving an emergency
patient. First, the hospital 'must provide for an appropriate medical screening examination . . . to
3
Although the plaintiff's objection to motion to dismiss characterizes her EMTALA claim
as a "screening" claim in several instances, it is clear to the Court that the amended complaint
asserts a "stabilization" claim, and the Hospital's reply to opposition to motion to dismiss
acknowledges that "on the whole she is alleging and characterizing her claim as a 'stabilization'
claim falling under 42 U.S.C. § 1395dd(b)." (Doc. # 31, at 1 n.1).
-3-
determine whether or not an emergency medical condition . . . exists.'" Perez v. Brookdale
University Hospital & Medical Center, 981 F. Supp. 2d 175, 177 (E.D.N.Y. 2013) (quoting 42
U.S.C. § 1395dd(a)). Second, if it is determined that the patient has an emergency medical
condition, the hospital "'must provide . . . such treatment as may be required to stabilize the
medical condition . . . . '" Id. (quoting 42 U.S.C. § 1395dd(b)). An individual suffering personal
harm as a result of a hospital's violation of either the screening or stabilization obligation may
pursue a civil action against the hospital. See 42 U.S.C. § 1395dd(d)(2)(A).
The Hospital argues that "[i]t is only the failure to provide uniform treatment to all people
coming to the emergency room with a similar condition - - disparate treatment- - that is
actionable under EMTALA." (Doc. # 23, at 8). A number of the cases the Hospital cites in
support of this argument discuss disparate treatment in the context of EMTALA screening
claims, as opposed to EMTALA stabilization claims. See, e.g., Brenord v. Catholic Medical
Center of Brooklyn & Queens, Inc., 133 F. Supp. 2d 179, 185 (E.D.N.Y. 2001); Fisher v. New
York Health & Hospitals Corp., 989 F. Supp. 444, 449 (E.D.N.Y. 1998). Courts have
consistently held that the EMTALA screening requirement imposes a duty "to provide uniform or
even-handed screening examinations for emergency conditions, consistent with [a hospital's]
own policies and based on the hospital's capabilities and the medical circumstances and
symptoms presented." Macamaux v. Day Kimball Hospital, Civil Case No. 3:09-CV-164 (JCH),
2011 U.S. Dist. LEXIS 105449, at *8-9 (D. Conn. Sept. 16, 2011).
There is language in some of the case law that seems to support the Hospital's argument.
See Vickers v. Nash General Hospital, Inc., 875 F. Supp. 313, 317 (E.D.N.C. 1995) ("The facts
do not support a finding that the stabilizing procedure violated the statute. . . . There is no
-4-
indication that the defendant hospital released the decedent with any bad faith or purpose of
disparate treatment."). On the other hand, the Hospital has not cited any binding precedent in this
regard, and the statute plainly states that the hospital must provide "such treatment as may be
required to stabilize the medical condition." 42 U.S.C. § 1395dd(b). See Perez, 981 F. Supp. 2d
at 177 ("A patient is 'stabilized' when 'no material deterioration of the [emergency medical]
condition is likely, within reasonable medical probability, to result from or occur during the
transfer [including the discharge] of the individual from a facility . . . .'"). The Court recognizes
that EMTALA was not intended "to provide a federal remedy for misdiagnosis or medical
negligence." Hardy v. New York City Health & Hospitals Corp., 164 F.3d 789, 792 (2d Cir.
1999) (internal quotation marks omitted). At the same time, EMTALA screening and
stabilization requirements are two distinct obligations, and it has been determined by some courts
that "the stabilization requirement is not met by simply dispensing uniform stabilizing treatment,
but rather, by providing the treatment necessary 'to assure, within reasonable medical probability,
that no material deterioration of the condition is likely to result . . . .'" Eberhardt v. City of Los
Angeles, 62 F.3d 1253, 1259 n.3 (9th Cir. 1995) (quoting 42 U.S.C. § 1395dd(e)(3)(A)); see also
In re Baby "K", 16 F.3d 590, 595 (4th Cir. 1994) ("the duty of the Hospital to provide stabilizing
treatment for an emergency medical condition is not coextensive with the duty of the Hospital to
provide an 'appropriate medical screening'").
The plaintiff alleges in her amended complaint that Stevenson presented at the Hospital's
emergency department and stated that he believed he was "in DKA." (Doc. # 18, at 3, ¶ 9). Dr.
Corrado, who was Stevenson's treating physician in the emergency department, indicated that it
was necessary to "rule out diabetic ketoacidosis." (Id. at 3-4, ¶12). The Hospital has not argued
-5-
that diabetic ketoacidosis is not an emergency medical condition or that it was unaware of
Stevenson's condition. See Macamaux, 2011 U.S. Dist. LEXIS 105449, at *18 ("EMTALA
requires stabilization of any known emergency medical conditions prior to discharge").
The plaintiff further alleges that although the Hospital performed various tests on
Stevenson, and provided him with certain types of treatment, Stevenson "was still in diabetic
ketoacidosis (DKA) and his condition was not stabilized upon his discharge." (Id. at 6, ¶30). "At
the pleading stage, [courts] consider only whether the complaint includes factual allegations
sufficient 'to raise a right to relief above the speculative level.'" Gonzalez v. Carestream Health,
Inc., 520 F. App'x 8, 10 (2d Cir. 2013) (quoting Bell Atlantic Corp. v. Twombly, 550 U.S. 544,
555 (2007)). The Court concludes that the amended complaint does include factual allegations
sufficient to raise the right claimed under EMTALA above the speculative level and that the
plaintiff has stated a plausible claim for relief under EMTALA.
CONCLUSION
For the reasons stated above, the defendant Hospital's motion to dismiss (doc. # 22) is
DENIED.
SO ORDERED this 12th
day of January, 2015.
_____/s/ DJS____________________________
Dominic J. Squatrito
United States District Judge
-6-
Disclaimer: Justia Dockets & Filings provides public litigation records from the federal appellate and district courts. These filings and docket sheets should not be considered findings of fact or liability, nor do they necessarily reflect the view of Justia.
Why Is My Information Online?