ANTOINE v.NAVICENT HEALTH INC. et al

Filing 69

ORDER granting 48 Motion to Dismiss Complaint and terminating as moot 33 Motion to Dismiss Complaint. Ordered by US DISTRICT JUDGE TILMAN E SELF, III on 12/12/2018. (ech)

IN THE UNITED STATES DISTRICT COURT
FOR THE MIDDLE DISTRICT OF GEORGIA
MACON DIVISION
ALTER ANTOINE,
Plaintiff,
v.
NAVICENT HEALTH, INC.; MEDICAL
CENTER OF CENTRAL GEORGIA, INC.;
HEALTH SERVICES OF CENTRAL
GEORGIA, INC.; NAVICENT
PHYSICIANS HEALTH GROUP;
TARNEISHA W. CHARLESTON;
MATTHEW C. SMITH, M.D.; JOHN D.
JILES; JENNIFER J. LOGAN; ANGIE
HARROD; ABC CORPORATION # 1 – 5;
and JOHN DOES # 1 – 5;

CIVIL ACTION NO.
5:18-cv-00048-TES

Defendants.
ORDER GRANTING DEFENDANTS’ MOTION TO DISMISS PLAINTIFF’S
SECOND AMENDED COMPLAINT

This matter is before the Court on Defendants’ Motion to Dismiss Plaintiff’s
Second Amended Complaint [Doc. 48]. In their motion, Defendants maintain that
Plaintiff’s Second Amended Complaint [Doc. 42] is subject to dismissal for a multitude of
reasons.
INTRODUCTION
Defendants contend that the core of Plaintiff’s Second Amended Complaint rests
on his dissatisfaction with being discharged from the Medical Center of Central Georgia,

Inc., 1 and his dissatisfaction with the legal proceedings in the Superior Court of Bibb
County, Georgia, permitting his discharge. [Doc. 48-1 at p. 2]. In addition to these central
points, Plaintiff’s Second Amended Complaint clearly displays his dissatisfaction with
the care he received as a patient in Defendants’ facility. In this case, Plaintiff asserts an
Emergency Medical Treatment and Active Labor Act, 42 U.S.C. § 1395dd (“EMTALA”),
claim and medical malpractice claims against the defendant hospital (all of which
Defendants argue are barred by res judicata and collateral estoppel) as well as claims for
libel and slander; harassment; emotional distress; and invasion of privacy. [Doc. 42 at
pp. 27-44]. In his final cause of action Plaintiff seeks to invalidate a lien filed by the
Medical Center of Central Georgia, Inc., in relation to Plaintiff’s time as a patient at the
“[D]efendants’ hospital facility.” [Id. at p. 44].
FACTUAL BACKGROUND AND PROCEDURAL HISTORY
The Court takes the following facts from Plaintiff’s Second Amended Complaint
(unless otherwise noted) and assumes them to be true for the purposes of ruling on
Defendants’ motion. See Bell Atl. Corp. v. Twombly, 550 U.S. 544, 556 (2007).
Phoebe Putney Memorial Hospital, located in Albany, Georgia, transferred
Plaintiff Alter Antoine (“Plaintiff”) to Navicent Health, Inc. (“Navicent Health”), in

Plaintiff’s Second Amended Complaint [Doc. 42] states that Navicent Health, Inc.; The Medical Center of
Central Georgia, Inc., also known as Medical Center Navicent Health; Health Services of Central Georgia,
Inc., are “all inter-related entities.” [Doc. 42 at ¶ 6].

1

2

Macon, Georgia, on March 29, 2017, following his involvement in a motor vehicle
accident. [Doc. 42 at ¶¶ 5-6]. 2 According to Plaintiff, the nature of the injuries were severe.
[Id. at ¶ 7]. The initial admitting diagnosis at Navicent Health included “a traumatic brain
injury (“TBI”), a shear injury, intracerebral hemorrhage, grade 4 torn spleen, and grade 4
liver injury as well as numerous fractures, tears and lacerations[,] and other injuries.”
[Id.]. Plaintiff claims that “a TBI is one of the most devastating events and injuries [] a
person can endure” and “patients can sustain permanent brain damage without proper
neurological care.” [Id. at ¶ 11]. Although Navicent Health supposedly knew of Plaintiff’s
traumatic brain injury, Plaintiff alleges that Navicent Health never provided neurological
care despite him being admitted as a patient for more than five months. [Id. at ¶¶ 9, 12,
23].
On June 17, 2017, Navicent Health first cleared Plaintiff for discharge. [Id. at ¶¶ 15,
17]. According to Plaintiff, Dr. Smith testified (at a hearing in the Superior Court 3 of Bibb
County) that Navicent Health’s discharge records were not accurate. [Id. at ¶ 16].
Specifically, Dr. Smith testified:
[Plaintiff] was unable to ambulate on his own, he was a serious risk to fall,
[Plaintiff] was still dependent on a PEG feeding tube which had been
surgically implanted into his stomach, [Plaintiff] was unable to medicate,
unable to hydrate or feed himself, unable to urinate other than into a
container thru [sic] a catheter attached to his penis, all while [Plaintiff] was
Defendants’ Brief [Doc. 48-1] confirms that the record shows Phoebe Putney Memorial Hospital in Albany,
Georgia, to be the “local hospital” referenced in Plaintiff’s Second Amended Complaint.

2

Throughout this Order, the Court uses the terms “state court” and “superior court” interchangeably with
the intention that both terms refer to the Superior Court of Bibb County, Georgia.

3

3

suffering from a severe stage 4 decubitus ulcer [ ], with severe ongoing
cognitive deficits affecting his comprehension, speech, memory, and
inability to even begin to make important independent decisions for
himself.
[Id. (internal record citation omitted)].
Plaintiff alleges that a video, taken four days after Navicent Health cleared
Plaintiff for discharge, shows that Plaintiff still required assistance from hospital
employees to help reduce Plaintiff’s risk of falling. [Id. at ¶ 17]. All in all, despite Plaintiff’s
allegations that he was nowhere near ready for discharge, Navicent Health still “wanted
[Plaintiff] to be out their door.” [Id. at ¶¶ 22, 23]. Plaintiff contends that beginning on June
17, 2017, and continuing through “and beyond” August 9, 2017, Navicent Health
conspired to evict Plaintiff. [Id. at ¶ 24].
On August 9, 2017, Navicent Health deemed Plaintiff safe for discharge for a
second time, a decision that, Plaintiff argues, was based on false grounds. [Id. at ¶¶ 32,
33]. According to Plaintiff, nursing and assisting staff conspired, and without direction
from a medical doctor, wheeled Plaintiff out of his hospital room “all the way down to
Navicent’s discharged patient pick-up area and dumped him there.” [Id. at ¶ 34]. In doing
so, Plaintiff contends that Defendants “recklessly and wantonly created a living

4

nightmare for Plaintiff.” [Id. at ¶ 39]. 4 Plaintiff states that he “was returned to the hospital
as a patient because the hospital feared publicity from a news reporter who was on her
way to Navicent having heard about what Navicent had done to [Plaintiff].” [Id. at ¶ 48].
Plaintiff claims that Defendants’ “stunningly reckless” and “uncaring” attitude
“permeated” each Defendant to the extent that they all “made significant effort” to
“illegally discharge [Plaintiff].” [Id. at ¶ 26]. For example, Plaintiff states that Navicent
Health did not contact Plaintiff’s brother before discharge, which, according to Dr.
Smith’s testimony (at the superior-court hearing), was not appropriate since Plaintiff’s
brother was “supposed to be the one helping him.” [Id. at ¶¶ 30, 31].
Eventually, given Plaintiff’s refusal to leave, Navicent Health sought an injunction
from the Superior Court of Bibb County to remove Plaintiff on the grounds of criminal
trespass. [Id. at ¶¶ 54-56, 60]. In what Plaintiff calls an “attempt to double down on
[Navicent Health’s] insatiable desire to lock [Plaintiff] out,” Navicent Health presented a
“false set of legal papers” for immediate review by the court system. [Id. at ¶¶ 54-55].
According to Plaintiff, Navicent not only sought court intervention, but also “proudly”

While the Court assuredly recognizes the passionate representation by Plaintiff’s attorney, his Second
Amended Complaint (as well as the previous iterations), was drafted more in the vein of a public relations
release or closing argument than a complaint that complied with the plain meaning of Federal Rule of Civil
Procedure 8(a). The Second Amended Complaint was teeming with certain words, phrases, and, on some
occasions, whole paragraphs that could not be and were not considered. Salacious word choices such as:
“created a living nightmare,” “[w]hat a ludicrous and perverse theory,” “an outrageous Goliath attempt,”
“the most glaring sign of the bottomless void,” and “to stick it to [Plaintiff] one more time” (just to note a
few) have no bearing on the actual substance pled in Plaintiff’s pleading and did little to assist the Court.
[Doc. 42 at ¶¶ 39, 54, 61, 104, 114].
4

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and “maliciously accused [Plaintiff] of being a criminal trespasser by remaining at
Navicent.” [Id. at ¶¶ 56, 74].
Plaintiff asserts that Navicent Health’s “slanderous injunction case was a
manipulation of the court system . . . so that [Plaintiff] would leave the hospital.” [Id. at
¶ 62]. Specifically, Plaintiff now claims that the injunction application “did not contain a
scintilla of records, evidence[,] nor medical statements to support their allegation of
irreparable harm, because there was none.” [Id. at ¶ 79]. To that end, Plaintiff concludes
that the motive behind evicting Plaintiff was purely out of financial concern. [Id. at ¶ 78].
In light of these events, Plaintiff takes issue with Navicent Health’s removal of
“their traumatic brain injured patient” from his hospital room to the exit with “no
medication,” “nowhere to go,” and “no one to pick him up.” [Id. at ¶ 59]. Plaintiff
characterizes Navicent Health’s actions as “grotesque” and “an outrageous Goliath
attempt to stomp out this 33[-]year[-]old man and to cover up their willful neglect and
abuse.” [Id. at ¶¶ 59, 61]. According to Plaintiff, Dr. Smith testified on several occasions
at the superior-court injunction hearing that this particular conduct was “wrong,”
“reprehensible,” and “unacceptable negligence.” [Id. at ¶¶ 66, 67].
On August 15, 2017, Navicent Health brought Dr. Smith into Plaintiff’s hospital
room for what Plaintiff argues was a means to “cook up” three lines in the record that
Plaintiff was “supposedly safe for discharge to Hemlock Street or out to a Macon
homeless shelter. [Id. at ¶¶ 81, 86]. Later, however, Plaintiff contends Dr. Smith recanted
6

on cross-examination and stated that his previous decision authorizing discharge was
“totally improper, dangerous, and life threatening.” [Id. at ¶ 87].
According to Plaintiff, the superior court ruled that Navient Health “could not
throw [Plaintiff] out the door.” [Id. at ¶ 93 (emphasis added)]. 5 After having heard
testimony from only two witnesses and after determining that the hospital’s case “had to
stop,” the superior court judge nevertheless granted Navicent Health’s injunctive relief
permitting Plaintiff’s discharge, but told “the hospital that they could not discharge
[Plaintiff] without the proper care in place.” [Id. at ¶¶ 105, 106 (emphasis omitted)].
Navicent Health had “to provide and pay for months of in-patient rehabilitation care at
Navicent Health’s own expense.” [Id. at ¶¶ 93-94]. Specially, the superior court ordered
that
[i]n order to provide a safe place for [Plaintiff] to continue his next level of
outpatient treatment after his discharge from The Medical Center, Navicent
Health, is ordered to pay up to $400.00 per day, or $12,000.00 per month,
for up to a maximum of one hundred (100) days for [Plaintiff] to be
admitted to a skilled nursing facility of [Navicent Health’s] choice for the
purpose of providing safe lodging and nutrition for [Plaintiff] as he
transitions from an acute care hospital.

The representation that is intended by this statement is undeniably misleading. In fact, according to the
Final Order of the Superior Court of Bibb County, the superior-court judge clearly granted Navicent
Health’s application for a permanent injunction. [Doc. 33-2 at p. 5, ¶ 1]. Plaintiff’s assertion to the Court in
his Second Amended Complaint that Navicent Health “clearly los[t]” is an egregious fabrication. The
Superior Court’s order unequivocally states that “Respondent shall be discharged from the Medical
Center.” [Id. at p. 5, ¶ 2]. However, despite the superior court’s permission to discharge Plaintiff, this
discharge (as Plaintiff does correctly state) was not without certain conditions. See [id. at pp. 5-8].
5

7

[Doc. 33-2 at pp. 5-6]. After 160 days, 6 Navicent discharged Plaintiff on September 5, 2017.
[Doc. 33-3]. But, in an attempt “to stick it to [Plaintiff] one more time,” Plaintiff alleges
that Navicent “secretly filed a purported lien for their alleged billing,” never letting
Plaintiff know of their plans. [Doc. 42 at ¶ 114].
Following his discharge, Plaintiff filed the instant lawsuit in the United States
District Court for the Southern District of New York on December 28, 2017. [Doc. 1]. The
next day, after receiving filing errors, Plaintiff re-filed his initial Complaint [Doc. 1]
against Defendants. See [Doc. 3]. Before its service, Plaintiff attempted to amend his initial
Complaint on January 29, 2018, but once again received a filing error with instructions
regarding how to properly label and file what would become his First Amended
Complaint [Doc. 26]. See [Doc. 24]. However, before correcting his filing errors the
following day, Plaintiff’s attorney, Mr. David Panitz, filed a letter dated January 29, 2018,
and addressed to the Southern District of New York district court judge assigned to his
client’s case. [Doc. 25]. In his letter, Mr. Panitz asked that Court “in lieu of a more formal
application to voluntarily transfer this case pursuant to 28 U.S.C. § 1404, from the District
Court for the Southern District of New York to the District Court for the Middle District

Plaintiff’s Second Amended Complaint provides that Plaintiff’s admission date to Navicent Health was
March 9, 2017. [Doc. 42 at ¶¶ 5-6]. While the Second Amended Complaint details what transpired up to the
date of Plaintiff’s discharge, it does not provide a date certain on which Navicent Health discharged
Plaintiff. However, the date of discharge, according to Defendants’ Notice of Filing Hospital Lien, was
September 5, 2017. [Doc. 33-3].

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of Georgia.” [Id. at p. 1]. Then, on January 30, 2018, Plaintiff filed his First Amended
Complaint. [Doc. 26].
On January 31, 2018, the District Court for the Southern District of New York
ordered that “th[is] action be transferred to the U.S. District Court for the Middle District
of Georgia.” [Doc. 27 at p. 2]. Having been served, 7 Defendants filed a Motion to Dismiss
[Doc. 33] Plaintiff’s First Amended Complaint on March 5, 2018. On March 26, 2018,
exactly 21 days after Defendants’ service of their motion under Federal Rule of Civil
Procedure 12(b), Plaintiff filed a Second Amended Complaint [Doc. 42]. However,
Plaintiff failed to seek leave of court regarding his second attempt to amend his
complaint. See Fed. R. Civ. P. 15. Plaintiff’s purported Second Amended Complaint could
not be an amendment as a matter of right because he previously filed his First Amended
Complaint on January 30, 2018, thereby exhausting Rule 15’s right to amend “once as a
matter of course.” Fed. R. Civ. P. 15(a)(1) (emphasis added); Stephens v. Atlanta Indep. Sch.
Sys., No. 1:13-cv-978-WSD, 2013 WL 6148099, at *2 (N.D. Ga. Nov. 22, 2013).
In an effort to clarify the controlling pleading in this case, the Court held a
telephone conference during which Defendants “consent[ed] that the Plaintiff may
amend his Complaint by the filing of this Second Amended Complaint, such already

The record reflects that electronic summonses were issued to each Defendant on January 3, 2018, and
given Defendants’ responsive pleading it appears that Defendants were definitively served. [Docs. 14-23].
7

9

being filed of record on March 26, 2018.” [Doc. 50 at p. 1]. Defendants now seek dismissal
of Plaintiff’s Second Amended Complaint in their re-filed Motion to Dismiss [Doc. 48].
DISCUSSION
A.

Standard of Review

Defendants seek to dismiss Plaintiff’s action against them for failure to state a
claim pursuant to Federal Rule of Civil Procedure 12(b)(6). When ruling on a 12(b)(6)
motion, district courts must accept the facts set forth in the complaint as true. Twombly,
550 U.S. at 572. A complaint survives a motion to dismiss only if it alleges sufficient
factual matter (accepted as true) that states a claim for relief that is plausible on its face.
McCullough v. Finley, 907 F.3d 1324, 1333 (11th Cir. 2018) (citing Ashcroft v. Iqbal, 556 U.S.
662, 678-79 (2009). In fact, a well-pled complaint “may proceed even if it strikes a savvy
judge that actual proof of those facts is improbable, and that a recovery is very remote
and unlikely.” Twombly, 550 U.S. at 556 (citations omitted).
Although Federal Rule of Civil Procedure 8 does not require detailed factual
allegations, it does require “more than [ ] unadorned, the-defendant-unlawfully-harmedme accusation[s].” McCullough, 907 F.3d at 1333 (citation omitted); see also n.4, supra. To
decide whether a complaint survives a motion to dismiss, district courts are instructed to
use a two-step framework. Id. The first step is to identify the allegations that are “no more
than mere conclusions.” Id. (quoting Iqbal, 556 U.S. at 679). “Conclusory allegations are
not entitled to the assumption of truth.” Id. (citation omitted). After disregarding the
10

conclusory allegations, the second step is to “assume any remaining factual allegations
are true and determine whether those factual allegations ‘plausibly give rise to an
entitlement to relief.’” Id. (quoting Iqbal, 556 U.S. at 679).
Furthermore, a complaint attacked by a 12(b)(6) motion is subject to dismissal
when it fails to “give the defendant fair notice of what the . . . claim is and the grounds
upon which it rests.” Twombly, 550 U.S. at 555 (citation omitted). “A plaintiff must plead
more than labels and conclusions or a formulaic recitation of the elements of a cause of
action.” McCullough, 907 F.3d at 1333 (internal quotations omitted); see also Twombly, 550
U.S. at 555. “To be sure, a plaintiff may use legal conclusions to structure his complaint,
but legal conclusions ‘must be supported by factual allegations.’” McCullough, 907 F.3d
at 1333 (quoting Iqbal, 556 U.S. at 679). While courts, in ruling on a motion to dismiss,
must take all of the factual allegations in the complaint as true; they are not bound to
accept a legal conclusion couched as a factual allegation. Iqbal, 556 U.S. at 678. Courts
must “identify conclusory allegations and then discard them—not ‘on the ground that
they are unrealistic or nonsensical’ but because their conclusory nature ‘disentitles them
to the presumption of truth.’” McCullough, 907 F.3d at 1333 (quoting Iqbal, 556 U.S. at 681).
The issue to be decided when considering a motion to dismiss is not whether the
claimant will ultimately prevail, but “whether the claimant is entitled to offer evidence
to support the claims.” Scheuer v. Rhodes, 416 U.S. 232, 236 (1974), overruled on other grounds
by Davis v. Scheuer, 468 U.S. 183 (1984). The factual allegations in a complaint “must be
11

enough to raise a right to relief above the speculative level” and cannot “merely create[]
a suspicion [of] a legally cognizable right of action.” Twombly, 550 U.S. at 545, 555 (second
alteration in original). Finally, complaints that tender “‘naked assertion[s]’ devoid of
‘further factual enhancement’” will not survive against a motion to dismiss. Iqbal, 556
U.S. at 678 (quoting Twombly, 550 U.S. at 557) (alteration in original). Stated differently,
the complaint must allege enough facts “to raise a reasonable expectation that discovery
will reveal evidence” supporting a claim. Twombly, 550 U.S. at 556. With the foregoing
standard in mind, and taking the facts asserted in Plaintiff’s Second Amended Complaint
as true, the Court rules on Defendants’ Motion to Dismiss.
B.

Defendants’ Motion to Dismiss [Doc. 48]

Defendants’ Brief in Support of its dismissal motion sets forth ten arguments
regarding Plaintiff’s claims. See generally [Doc. 48-1]. The first and third arguments are
based on procedural grounds—namely a lack of diversity jurisdiction, res judicata, and
collateral estoppel. [Id. at pp. 7, 10]. Defendants’ second argument, however, discusses
Plaintiff’s only federal law claim, his EMTALA claim against the defendant hospital. [Id.
at p. 9]. In that argument, Defendants assert that EMTALA, in regards to this case, is
inapplicable on the basis that EMTALA “does not apply to [the] discharge of a nonemergent, stable patient.” [Id.]. Next, as additional grounds for dismissal of Plaintiff’s
medical malpractice claims, Defendants argue that Plaintiff failed to file the
accompanying medical affidavit as required by Ga. Code Ann. § 9-11-9.1. [Id. at p. 12].
12

And, finally, Defendants’ remaining arguments as to Plaintiff’s medical malpractice; libel
and slander; harassment; emotional distress; invasion of privacy; invalidation of a
hospital lien; and attorney’s fees claims all incorporate the traditional motion-to-dismiss
standard of failure to state a claim under Federal Rule of Civil Procedure 12(b)(6). See
generally [id.].
C.

Jurisdiction

The Court must determine whether it has subject-matter jurisdiction over this case
before it can address any substantive arguments presented by the parties as to Plaintiff’s
claims. Henderson ex rel. Henderson v. Shinseki, 562 U.S. 428, 435 (2011) (“[F]ederal courts
have an independent obligation to ensure that they do not exceed the scope of their
jurisdiction, and therefore they must raise and decide jurisdictional questions that the
parties either overlook or elect not to press.”). The claims presented in this case
potentially invoke two avenues by which a case may be filed in federal court: federalquestion jurisdiction and diversity jurisdiction.
1.

Federal Question Jurisdiction Under 28 U.S.C. § 1331

As a preliminary matter, the Court rules on Plaintiff’s EMTALA claim before
discussing Defendants’ diversity of citizenship concerns and their other jurisdictional
and procedural arguments as to Plaintiff’s remaining state-law claims.

13

As previously alluded to, Plaintiff’s EMTALA claim is his only claim invoking
federal-question jurisdiction under 28 U.S.C. § 1331, 8 which would normally give the
Court original jurisdiction over this case. In light of this Court’s duty to undertake an
independent inquiry as to its jurisdiction, it finds that it lacks federal-question jurisdiction
as to Plaintiff’s EMTALA claim under Rooker v. Fidelity Trust Co., 263 U.S. 413 (1923) and
D.C. Court of Appeals v. Feldman, 460 U.S. 462 (1983). See Pate v. Chilton Cty. Bd. of Educ.,
853 F. Supp. 2d 1117, 1128 (M.D. Ala. Jan. 4, 2012) (citing Ebrahimi v. City of Huntsville Bd.
of Educ., 114 F.3d 162, 165 (11th Cir. 1997) (“Federal courts have an independent duty to
determine whether they have jurisdiction and to police the boundaries of their
jurisdiction.”)); see also Hoblock v. Albany Cty. Bd. of Elections, 422 F.3d 77, 83 (2d Cir. 2005)
(“The district court raised Rooker-Feldman sua sponte . . . .”).
“Where a federal suit follows a state suit, the former may be prohibited by the socalled Rooker-Feldman doctrine in certain circumstances.” Hoblock, 422 F.3d at 83. The
United States Supreme Court has observed that the Rooker-Feldman doctrine “recognizes
that [while] 28 U.S.C. § 1331 is a grant of original jurisdiction, [it] does not authorize
district courts to exercise appellate jurisdiction over state-court judgments, which
Congress has reserved to th[e] [United States Supreme Court].” Sophocleus v. Ala. Dep’t of
Transp., 170 F. App’x 608, 610 (11th Cir. 2005) (citing Exxon Mobil Corp. v. Saudi Basic Indus.

“The district courts shall have original jurisdiction of all civil actions arising under the Constitution, laws,
or treaties of the United States.” 28 U.S.C. § 1331.

8

14

Corp., 544 U.S. 280, 292 (2005)); see also 28 U.S.C. § 1257(a). After due consideration and
for the reasons that follow, the Court finds the Rooker-Feldman doctrine controls so that it
does not have federal subject-matter jurisdiction over Plaintiff’s EMTALA claim.
Rooker stands for the proposition that “a United States District Court has no
authority to review final judgments of a state court in judicial proceedings.” Wood v.
Orange Cty., 715 F.2d 1543, 1546 (11th Cir. 1983) (quoting D.C. Court of Appeals v. Feldman,
460 U.S. 462, 467 (1983)). Cases are subject to the Rooker-Feldman doctrine if: (1) the federalcourt plaintiff lost in state court; (2) the federal-court plaintiff complains of injuries
caused by a state-court judgment; (3) the plaintiff’s federal suit invites district-court
review and rejection of the state-court judgment; and, (4) the state-court judgment was
“rendered before the [district-court] proceedings commenced.” 9 Hoblock, 422 F.3d at 85.
Despite Plaintiff’s clear allegation that Navicent Health’s actions violated EMTALA, such
a claim raised in this Court (a United States District Court)—in light of the circumstances
surrounding Plaintiff’s state and federal cases—“complain[s] of [an] injury [caused] by”
the Superior Court of Bibb County (a state court) and prompts a Rooker-Feldman analysis.
Id. at 88.

The first and fourth of these requirements have been categorized as “procedural” while the second and
third requirements possess “substantive” characteristics. Hoblock, 422 F.3d at 85.

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a.

The Substantive Rooker-Feldman Requirements

At the outset, and in order to ensure Rooker-Feldman’s applicability to Plaintiff’s
EMTALA claim, the Court first details the doctrine’s substantive requirements.
Embedded in the Rooker-Feldman doctrine is the principle, expressed by Congress in 28
U.S.C. § 1257, that within the federal judicial system, only the United States Supreme
Court may review state-court decisions (aside from habeas review 10). Id. at 85; see also
Casale v. Tillman, 558 F.3d 1258, 1260 (11th Cir. 2009) (per curiam), infra. This principle
“animates the two substantive requirements for Rooker-Feldman’s application outlined in
Exxon Mobil: [(1)] the federal plaintiff must complain of injury from a state-court
judgment; and [(2)] the federal plaintiff must seek federal-court review and rejection of
the state-court judgment.” Hoblock, 422 F.3d at 85.
The Second Circuit Court of Appeals in Hoblock
points out that 28 U.S.C. § 1257 (and thus Rooker-Feldman) does not deprive
a district court of subject-matter jurisdiction simply because a party
attempts to litigate in federal court a matter previously litigated in state
court. If a federal plaintiff ‘present[s] some independent claim, albeit one that
denies a legal conclusion that a state court has reached in a case to which
he was a party . . . , then there is jurisdiction and state law determines whether
the defendant prevails under principles of preclusion.’
Id. at 86 (quoting Exxon Mobil, 544 U.S. at 293) (alteration in original) (emphasis added).
Stated differently, if the federal plaintiff presents an independent claim then the court can
exercise subject-matter jurisdiction and Rooker-Feldman cannot bar the claim. Independent

10

Habeas review is an exception to Rooker-Feldman principles. Id. at 85 n.5.

16

claims are outside of Rooker-Feldman’s reach even if they involve the identical subject
matter and parties as the previous state-court suit. Id. Nevertheless, the defendant may
still prevail, but state law will determine whether the plaintiff’s federal suit is subject to
preclusion. Id.; see also Section (C)(1)(c)(i) and (ii), infra.
By that same token, if the plaintiff presents, in federal court, a non-independent
claim, then Rooker-Feldman will, subject to the doctrine’s procedural requirements, bar the
plaintiff’s suit due to a lack of jurisdiction. See Hoblock, 422 F.3d at 86-87. A claim’s status
as either independent or non-independent is adjudicated using the “inextricably
intertwined” 11 standard. Id. “A claim is inextricably intertwined if it would effectively
nullify the [state-court] judgment, or if it succeeds only to the extent that the state court
wrongly decided the issues.” Antoine v. Vernin, No. 18-10645, ___ F. App’x ___, 2018 WL
3860477, at *2 (11th Cir. Aug. 14, 2018) (citing May v. Morgan Cty., 878 F.3d 1001, 1005
(11th Cir. 2017)).
Initially, a federal claim—like EMTALA—may seem independent because
Plaintiff did not assert such claim during his state-court proceedings. However, just
presenting a legal theory to a federal court that was not raised in state court cannot

Again, “[i]f the [federal] claims presented to a United States district court are inextricably intertwined with
the state court’s [decision] in a judicial proceeding . . . then the district court is in essence being called upon
to review the state-court decision. This the district court may not do.” Hoblock, 422 F.3d at 84 (emphasis in
original) (quoting Feldman, 460 U.S. at 483-84 n.16). The United States Supreme Court’s use of the phrase
“inextricably intertwined” means, “at a minimum, that where a federal plaintiff had an opportunity to
litigate a claim in a state proceeding . . . subsequent litigation of the claim will be barred under the RookerFeldman doctrine if it would be barred under the principles of preclusion.” Id.
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insulate the plaintiff’s federal suit from Rooker-Feldman if the federal suit complains of
injury resulting from a state-court judgment and effectively seeks to have that state-court
judgment reversed. Hoblock, 422 F.3d at 86. “[S]uch federal [] claims, even if not raised in
state court, are ‘inextricably intertwined’ with the challenged state-court judgment . . .
and therefore a federal district court lacks jurisdiction over such claims because ‘the
district court is in essence being called upon to review the state-court decision.’” Id. (citing
Feldman, 460 U.S. at 483-84 n.16). To that end, the Court is tasked with deciding whether
Plaintiff’s federal suit seeks “review and reversal” of the state-court judgment. Id. at 87.
In one sense, no: Plaintiff does not seem to want the Court to evaluate the state court’s
reasoning or review the substance of the state court’s ultimate decision permitting his
discharge from the hospital. See id. However, as explained above, a federal suit is not free
from Rooker-Feldman’s bar simply because the suit proceeds on legal theories not
addressed in state court. Id. at 87.
Even if what Plaintiff seeks is not a strict “review” of the state court’s final order,
he does—by virtue of the federal claim enumerated in his Second Amended Complaint—
effectively seek reversal. See id; see also [Doc. 42 at ¶ 79 (“The hospital’s injunction
application of August 9[th], 2017[,] did not include a scintilla of records, evidence[,] nor
medical statements to support their allegation of irreparable harm, because there was
none.”)]. The state court ordered that Plaintiff could be discharged, and now Plaintiff
ostensibly wants the federal court to rule that The Medical Center of Central Georgia, Inc.
18

(the petitioner in the earlier superior court case), violated EMTALA because it followed
the state-court order. Clearly, The Medical Center of Central Georgia, Inc., could not
comply with both the state-court order and Plaintiff’s desired federal-court ruling—that
he has sufficiently stated an EMTALA claim to withstand a motion to dismiss. Thus, the
relief sought in Plaintiff’s Second Amended Complaint, “if granted, would seem to
‘reverse’ the state-court judgment.” Hoblock, 422 F.3d at 87.
On the other hand, Hoblock notes that an independent and, therefore, non-barred
claim may “den[y] a legal conclusion” reached by a state court. Id. (citing Exxon Mobil,
544 U.S. at 293). The Hoblock court stresses that “[p]recisely what [‘deny a legal
conclusion’] means is not clear” from either Exxon Mobil or GASH Ass’ns v. Village of
Rosemont, 995 F.2d 726, 728 (7th Cir. 1993) (the original source of the language), “but it
suggests that a plaintiff who seeks in federal court a result opposed to the one he achieved
in state court does not, for that reason alone, run afoul of Rooker-Feldman.” Id. In hopes of
clarifying this phrase, and by extension clarifying the doctrine’s applicability, Hoblock
tells us that “the key to resolving this uncertainty lies in the second substantive RookerFeldman requirement: that federal plaintiffs are not subject to the Rooker-Feldman bar
unless they complain of an injury caused by a state judgment.” Id. (second emphasis in
original).

19

First, this requirement answers why a federal plaintiff cannot escape the RookerFeldman bar simply by relying on a legal theory not raised in the state court. Hoblock
provides the perfect illustration:
Suppose a state court, based purely on state law, terminates a father’s
parental rights and orders the state to take custody of his son. If the father
sues in federal court for the return of his son on grounds that the state
judgment violates his federal substantive due-process rights as a parent, he
is complaining of an injury caused by the state judgment and seeking its
reversal. This he may not do, regardless of whether he raised any
constitutional claims in state court, because only the Supreme Court may
hear appeals from state-court judgments.
422 F.3d at 87. This hypothetical scenario is markedly similar to the proceedings involved
in this case. “In effect, [Plaintiff],” by filing his EMTALA claim, “seeks to challenge
collaterally the state . . . court proceedings” that gave The Medical Center of Central
Georgia, Inc., the authority to discharge him, and this he may not do because “federal
courts are not a forum for appealing state[-]court decisions.” Staley v. Ledbetter, 837 F.2d
1016, 1017-18 (11th Cir. 1988) (per curiam); see also Wood, 715 F.2d at 1546 (“[F]ederal
review of [state-court] decisions is entrusted solely to the Supreme Court, [the lower
federal courts] may not decide federal issues that are raised in state proceedings and
‘inextricably intertwined’ with the state court’s judgment. Feldman, moreover, indicates
that the Rooker bar also operates where the plaintiff fails to raise his federal claims in state
court.”) (internal citation omitted)).
Further, by focusing on the requirement that the state-court judgment be the
source of the injury, it is clear how a suit potentially asking a federal court to “den[y] a
20

legal conclusion” could be deemed “independent,” and therefore unfit for Rooker-Feldman
adjudication. Hoblock, 422 F.3d at 87. Assuredly, the Court recognizes “[t]he fact that the
state court chose not to remedy the injury does not transform the subsequent federal suit
on the same matter into an appeal, [which is] forbidden by Rooker-Feldman, of the statecourt judgment.” Id. at 88. However, it does seem obvious that a federal plaintiff cannot
avoid Rooker-Feldman simply by clever pleading, such as alleging that actions taken
pursuant to a court order violate his rights without ever challenging the state-court order
itself. Id. Revisiting Hoblock’s child-custody scenario just discussed,
if the state has taken custody of a child pursuant to a state judgment, the
parent cannot escape Rooker-Feldman simply by alleging in federal court that
he was injured by the state employees who took his child rather than by the
judgment authorizing them to take the child. The example shows that in
some circumstances, federal suits that purport to complain of injury by
individuals in reality complain of injury by state-court judgments.
Id. Still the question remains: when does a federal suit complain of an injury caused by a
state-court judgment?
A federal suit complains of a state-court judgment even if it appears to only claim
a purported violation by a third party’s actions—in this case, The Medical Center of
Central Georgia, Inc.—when in fact, the third party’s actions were produced by the statecourt judgment. Id. “Where a state-court judgment causes the challenged third-party

21

action, any challenge to that third-party action is necessarily the kind of challenge to the
state judgment that only the Supreme Court can hear.” Id. 12
As briefly discussed above, presenting a legal theory in the federal suit that was
not raised in state court cannot insulate the federal plaintiff’s suit from Rooker-Feldman
when the federal suit complains of an injury from a state-court’s judgment. Id. at 87. In
this case, Plaintiff cannot escape Rooker-Feldman by alleging, via EMTALA, that he was
injured by hospital personnel (the party who actually discharged him) rather than by the
state-court judgment that permitted his discharge. See id. at 88. Plaintiff had every
reasonable opportunity to raise his alleged EMTALA violation during the fervid state
court proceedings. May, 878 F.3d at 1005 (“[Rooker-Feldman] does not apply, however,
where a party did not have a reasonable opportunity to raise his federal claim in state
proceedings.”).
In fact, a reasonable reading of Plaintiff’s Second Amended Complaint shows that
Plaintiff clearly made EMTALA arguments in the superior court. For example, Plaintiff
claims that The Medical Center of Central Georgia, Inc., “kn[ew] they had already
illegally discharged and forced [Plaintiff] out” and that “[i]t was only [Plaintiff], not

12 Hoblock states the obvious connection between this substantive requirement and Rooker-Feldman’s
procedural requirement concerning timing,
the requirement that the federal suit be initiated after the challenged state judgment. If
federal suits cannot be barred by Rooker-Feldman unless they complain of injuries produced
by state-court judgments, it follows that no federal suit that precedes a state-court
judgment will be barred; the injury such a federal suit seeks to remedy cannot have been
produced by a state-court judgment that did not exist at the federal suit’s inception.
Id. at 88.

22

Navicent, who had the emergency need for court intervention as a result of Navicent’s
wrongful discharge . . . .” [Doc. 42, at ¶¶ 55, 58]. Secondly, Plaintiff himself unequivocally
alleged that “defendants carelessly and without concern for [his] care, sabotaged [his]
personal circumstances, knowing that [he] would suffer irreparable harm by what they
were doing to him.” [Id. at ¶ 76 (emphasis added)]. Lastly, Plaintiff, at the time of the
proceedings in the Superior Court of Bibb County, even presented testimony in which
Dr. Matthew C. Smith, M.D., “conceded . . . that [the June 17, 2017,] discharge of [Plaintiff]
was totally improper, dangerous, and life threatening.” [Id. at ¶¶ 15, 87]. Without a doubt,
Plaintiff had every reasonable opportunity to file an EMTALA counterclaim, 13 as well as
his other state-law claims, against The Medical Center of Central Georgia, Inc., however,
he chose not to do so.
Notwithstanding

the

applicability

of

Rooker-Feldman’s

two

substantive

requirements, the doctrine’s true applicability will turn on whether Plaintiff’s federal suit
meets the remaining procedural requirements pertaining to timing and party identity as
outlined in Exxon Mobil. Hoblock, 422 F.3d at 89.
b.

The Procedural Rooker-Feldman Requirements

Even if a court, in examining Rooker-Feldman’s possible application, finds that a
federal plaintiff’s suit meets the second and third Rooker-Feldman requirements (that the

Whether such claims would have been successful at that time is irrelevant and therefore not before the
Court for consideration.
13

23

federal suit complains of state-court judgment and the federal suit seeks or invites review
or reversal of the state-court judgment) the inquiry cannot stop there. Because the
doctrine “does not automatically bar every federal suit that seeks review and rejection of
an injury-creating state decision,” federal suits—like this one—must also meet the first
and fourth “procedural” Rooker-Feldman requirements: (1) the federal suit must follow
the state judgment; and (2) the parties in the state and federal suits must be the same. Id.
(citing Exxon Mobil, 544 U.S. at 284).
In this case, the first requirement is straightforward. The Superior Court of Bibb
County entered its final order granting The Medical Center of Central Georgia, Inc.’s,
request for injunctive relief to discharge Plaintiff on August 31, 2017, and Plaintiff
commenced his federal suit on December 28, 2017. [Docs. 1; 33-2]. Thus, Rooker-Feldman’s
first procedural requirement is unquestionably satisfied. However, the second
requirement, common party identity, is less easily determined.
In his federal suit, Plaintiff named 11 other defendants in addition to The Medical
Center of Central Georgia, Inc., the original state-court petitioner. Therefore, the Court is
left with the question of whether these 11 additional defendants could nonetheless be
considered common parties for Rooker-Feldman purposes. See Hoblock, 422 F.3d at 89.
Because the Court finds that Plaintiff’s EMTALA claim is non-independent of his
state-court suit and because Rooker-Feldman is a doctrine of federal subject-matter
jurisdiction, the Court must look to federal law to determine whether the former state24

court petitioner, The Medical Center of Central Georgia, Inc., should be treated, for
Rooker-Feldman purposes, as if it and its agents were parties to the state-court suit in which
Plaintiff was the respondent. See id. at 89. The Court admits that claim and issue
preclusion are distinct from the Rooker-Feldman doctrine, but because Plaintiff’s EMTALA
claim is non-independent, federal preclusion laws guide the federal jurisdictional issue
at hand. Id. at 90.
To help guide lower-courts’ decisions on this issue, the United States Supreme
Court uses the term “privity” to discuss when “a nonparty may be bound by an earlier
judgment.” Id. (citing Richards v. Jefferson Cty., 517 U.S. 793, 798 (1996)). Using Richards,
the Hoblock court posed the party-identity question this way: “is there sufficient privity,
as a matter of federal law, between the [11 additional defendants] and [The Medical
Center of Central Georgia, Inc.] that the [11 additional defendants] should be considered
parties to, and bound by, [The Medical Center of Central Georgia, Inc.’s] state lawsuit
against [Plaintiff]?” Id. In Aerojet Gen. Corp. v. Askew, the Fifth Circuit said, “under the
[f]ederal law of res judicata a person may be bound by a judgment even though not a
party if one of the parties to the suit is so closely aligned with his interests as to be his
virtual representative.” 511 F.2d 710, 719 (5th Cir. 1975). 14 Going further,

“[T]he decisions of the United States Court of Appeals for the Fifth Circuit (the “former Fifth” or the “old
Fifth”), as that court existed on September 30, 1981, handed down by that court prior to the close of business
on that date, shall be binding as precedent in the Eleventh Circuit, for this court, the district courts, and the
bankruptcy courts in the circuit.” Bonner v. City of Pritchard, 661 F.2d 1206, 1207 (11th Cir. 1981).

14

25

one who prosecutes or defends a suit in the name of another to establish or
protect his own right or who assists in the prosecution or defense of an
action in aid of some interest of his own, and who does this openly to
knowledge of the opposing party, is as much bound by the judgment and
is fully entitled to avail himself of it as estoppel against an adverse party, as
he would be if he had been a party to the record.
Cotton v. Fed. Land Bank of Columbia, 676 F.2d 1368, 1371 (11th Cir. 1982) (quoting Souffront
v. La Compagnie des Sucreries de Porto Rico, 217 U.S. 475, 486-87 (1910)); see also Weitz Co. v.
Tremco Inc. of Ohio, No. 10-22409-CIV-JORDAN, 2011 WL 13185725, at *4 (S.D. Fla. Mar.
28, 2011) (same). This Circuit’s preclusion standards reflect the longstanding and deeplyrooted principle of American law that a party cannot be bound by a judgment in a prior
suit in which it was neither a party nor in privity with a party. EEOC v. Pemco Aeroplex,
Inc., 383 F.3d 1280, 1286 (11th Cir. 2004) (citing Martin v. Wilks, 490 U.S. 755, 761-62 (1989)).
“‘Privity’ is a flexible term, comprising several different types of relationships and
generally applying when a person, although not a party, has his interests adequately
represented by someone with the same interests who is a party.” Id. (citation omitted).
The crucial point to note in this case is federal law’s requirement of identity of
interests and adequate representation. See, e.g., Hoblock, 422 F.3d at 92. While the 11
additional defendants were not named in the state-court suit, their interests as agents
within the hospital were represented by The Medical Center of Central Georgia, Inc., the
sole-named, state-court petitioner. Therefore, it is axiomatic that if the state-court
judgment had been in Plaintiff’s favor, then each of the 11 additional defendants named
in this case would undoubtedly be bound by that judgment and thus, could not have
26

discharged Plaintiff from the hospital. Therefore, Plaintiff’s case also satisfies the second
procedural element of the Rooker-Feldman doctrine.
In consideration of the foregoing, it is clear that to permit Plaintiff’s EMTALA
claim to continue, a claim that alleges that The Medical Center of Central Georgia, Inc.,
should not have discharged him in the manner it did, would be a fundamental
desecration of federalism. See Lance v. Dennis, 546 U.S. 459, 463 (2006) (per curiam)
(holding that the Rooker-Feldman doctrine prevents the lower federal courts from
exercising appellate jurisdiction over cases brought by “state-court losers” effectively
challenging “state-court judgments rendered before the district court proceedings
commenced”). Any attempt by Plaintiff to unwind the superior court’s ruling, due to his
dissatisfaction with those proceedings and the outcome from the superior court, must
have been brought in the appropriate appellate court. See Casale, 558 F.3d at 1260 (“The
Rooker-Feldman doctrine makes clear that federal district courts cannot review [statecourt] final judgments because that task is reserved for state appellate courts or, as a last
resort, the United States Supreme Court.”).
In light of this analysis, Rooker-Feldman principles defeat federal jurisdiction under
28 U.S.C. § 1331 in this case, and Plaintiff’s EMTALA claim is barred. Consequently, the
Court is not required to address the parties’ substantive contentions regarding Plaintiff’s
EMTALA claim.

27

c.

Ordinary Principles of Preclusion

However, in order to ensure the soundness and completeness of its ruling, the
Court now turns to whether Plaintiff’s EMTALA claim is barred by ordinary principles
of preclusion. Exxon Mobil explains that the narrow Rooker-Feldman inquiry is distinct
from the question of whether res judicata (claim preclusion) or collateral estoppel (issue
preclusion) will also defeat a plaintiff’s suit. Thus, if by some fashion Plaintiff’s EMTALA
claim could be characterized as an independent claim, an analysis apart from RookerFeldman is warranted and the Court looks to state-preclusion law to determine whether
Plaintiff’s claims would nonetheless be barred. Hoblock, 422 F.3d at 92-93. Because the Full
Faith and Credit Act, 28 U.S.C. § 1738, requires federal courts to accord state judgments
the same preclusive effect those judgments would have in the courts of the rendering
state, Georgia preclusion law applies. Id.
i.

Res Judicata (Claim Preclusion)

First, under Georgia law, “[t]he doctrine of res judicata prevents the re-litigation
of all claims which have already been adjudicated, or which could have been adjudicated,
between identical parties or their privies in identical causes of action.” Smith v. Bell, 816
S.E.2d 698, 701 (Ga. Ct. App. 2018) (quoting Setlock v. Setlock, 688 S.E.2d 346, 347 (Ga.
2010)). While res judicata began as a common law rule in Georgia, the Georgia Supreme
Court has held that Ga. Code Ann. § 9-12-40 is a codification of Georgia’s basic common

28

law rule of res judicata. Coen v. CDC Software Corp., 816 S.E.2d 670, 672 (Ga. 2018). This
code section provides:
A judgment of a court of competent jurisdiction shall be conclusive between
the same parties and their privies as to all matters put in issue or which
under the rules of law might have been put in issue in the cause wherein
the judgment was rendered until the judgment is reversed or set aside.
Id.
As Plaintiff aptly states, Georgia’s highest court has explained that in regards to
“cause of action” terminology, factual linkage in the subject matter between two cases
does not mean that that the second lawsuit will automatically be barred by Ga. Code Ann.
§ 9-12-40. Coen, 816 S.E.2d at 674; see also [Doc. 61 at p. 5]. “For [res judicata] to act as a
bar, ‘the cause of action in each suit must be identical.’” Coen, 816 S.E.2d at 674 (citations
omitted). The Georgia Supreme Court defines “cause of action” as being
the entire set of facts which give rise to an enforceable claim. Where . . .
some of the operative facts necessary to the causes of action are different in
the two cases, the later suit is not upon the same cause [of action] as the
former, although the subject matter may be the same, and even though the
causes [of action] arose out of the same transaction.
Id. (alterations in original) (emphasis added). Specifically, Georgia law looks to the
“entire set of facts which give rise to an enforceable claim to determine whether res
judicata has been triggered.” Id. (internal quotations omitted). Ultimately under Georgia
law, to solidify res judicata’s applicability, “three prerequisites must be satisfied—(1)
identity of the cause of action, (2) identity of the parties or their privies, and (3) previous
adjudication on the merits by a court of competent jurisdiction.” Id. at 675.
29

Taking these three requirements into consideration, the same parties (or their
privies) are undoubtedly at play in both the state-court action and this case, and the
second prong of Georgia’s res judicata requirements is satisfied. Id.; see Section (C)(1)(b),
supra. Furthermore, the Superior Court of Bibb County, Georgia, is unquestionably “a
court of competent jurisdiction.” Coen, 816 S.E.2d at 675. As a superior court, it has the
authority “[t]o exercise the powers of a court of equity” and as such is vested with the
authority to hear injunctive claims of the kind presented in the state-court proceeding as
well as “all causes, both civil and criminal.” Ga. Code Ann. § 15-6-8; see also Ga. Const.
Art. VI, § 1, ¶ 4 (“Each court may exercise such powers as necessary in aid of its
jurisdiction or to protect or effectuate its judgments; but only the superior and appellate
courts shall have the power to issue process in the nature of mandamus, prohibition,
specific performance, quo warranto, and injunction. Each superior court, state court, and
other courts of record may grant new trials on legal grounds.”).
Lastly, and what seems to be the most contested prong of res judicata’s
prerequisites, is an examination of “identity of the cause of action.” Coen, 816 S.E.2d at
675. Where some of the operative facts between two cases “are different,” the second suit
is not founded upon the same cause of action as the first, despite the possibility that the
two cases arose from the same transaction and contain identical subject matter. Id. at 674
(emphasis added).

30

Here, the facts presented in Plaintiff’s federal suit are not different from the facts
presented in the state-court proceeding, despite Plaintiff’s contention to the contrary. See
[Doc. 61 at p. 6]. Succinctly put, Plaintiff, in both cases argues that discharge is improper.
His Second Amended Complaint presents nothing different from what occurred in the
state-court case. In fact, as discussed above, see Section (C)(1)(a), supra, Plaintiff clearly
presented EMTALA-based arguments in an attempt to prevent his discharge in the earlier
state-court proceeding. There is simply nothing different from the operative facts
presented in this action when compared to the operative facts previously litigated in state
court. Under Georgia law, the cause of action in both suits is identical and, this latter suit
is barred by res judicata. 15
Furthermore, Georgia’s codification of its basic common law rule of res judicata
provides additional support and guidance on this narrow preclusion issue. Plaintiff’s
EMTALA claim is one “which under the rules of law might have been put in issue.” Ga. Code
Ann. § 9-12-40 (emphasis added). Accordingly, his EMTALA claim is also barred as a
compulsory counterclaim that he was required to bring in the state-court proceeding to
preserve it. See Bell, 816 S.E.2d at 702. The Georgia Civil Practice Act provides in pertinent
part:

To the extent Plaintiff, in his federal case, inserted claims based on a lack of neurological care; libel and
slander; harassment; emotional distress; and invasion of privacy in an attempt to differentiate this case’s
facts from the facts of his previous state-court case, it is exceedingly clear that each of these potential claims
were known to him at the time of the state-court proceeding and as such should have been presented there.
See, Section (2)(a), infra.
15

31

A pleading shall state as a counterclaim any claim which at the time of
serving the pleading the pleader has against any opposing party, if it arises
out of the transaction or occurrence that is the subject matter of the
opposing party’s claim and does not require for its adjudication the
presence of third parties of whom the court cannot acquire jurisdiction.
Ga. Code Ann. § 9-11-13(a).
In support of his argument, Plaintiff argues that res judicata should not apply
because he was “denied the opportunity to submit a responsive pleading, . . . denied the
opportunity to testify, . . . denied the chance to present witnesses, . . . and denied
discovery.” [Doc. 61 at p. 6]. He contends that the state proceeding was “so limited and
streamlined” that he could not “have even begun to assert affirmative claims.” [Id.].
However, as Defendants point out, Plaintiff cannot show and offers nothing to support
that he ever attempted to serve any subpoena, attempted to serve formal discovery, filed
a motion to compel the allegedly requested discovery, 16 or ever sought a continuance
from the state-court proceedings to prepare his “affirmative claims.” [Doc. 63 at p. 3].
Clearly, by his own argument, Plaintiff, at the time of the state-court proceeding had
certain “affirmative claims” to present. [Doc. 61 at p. 6].

In his Response to Defendants’ Motion to Dismiss [Doc. 48], Plaintiff states, “We asked multiple times in
that proceeding for production of documents related to the hospital’s allegations that they needed
[Plaintiff’s] bed, or that even one patient had been turned away as alleged by Navicent in their petition. No
discovery was ordered.” [Doc. 61 at p. 6]. However, Plaintiff offers nothing besides mere conclusory
allegations to support this contention, and without more, statements of this nature are “not entitled to the
assumption of truth.” McCullough v. Finley, No. 17-11554, 2018 WL 5318146, at *5 (11th Cir. Oct. 29, 2018).
The Court notes that the superior court specifically found that Plaintiff was no longer “in need of acute
care” and that his actions were “harming” Defendants by “preventing it from meeting its public duty by
the loss of a hospital bed, by adding to overcrowding at its facility, and by straining its ability to care for
other patients.” [Doc. 33-2 at p. 4].

16

32

While the Court lacks sufficient knowledge to determine what transpired in the
state-court proceeding (aside from the transcript excerpts throughout Plaintiff’s Second
Amended Complaint), it is clear that Plaintiff had the unequivocal ability and absolute
right to bring his EMTALA claim as an “affirmative claim” in the earlier state-court
proceeding. In fact, the Second Amended Complaint presents Dr. Smith’s testimony
demonstrating Plaintiff’s arguments against his discharge on EMATALA grounds. See
[Doc. 42 at pp. 15-17]. By Plaintiff’s own admission, “[a]n EMTALA violation occurs
when a hospital discharges a patient in a manner which exposes the patient to imminent
material deterioration in their condition.” [Doc. 61 at p. 3 (citing Quinney v. Phoebe Putney
Mem. Hosp., Inc., 751 S.E.2d 874, 881 n.8 (Ga. Ct. App. 2013) (citing 42 U.S.C. §
1395dd(e)(3)(A)))]. While it is true that Plaintiff did not formally raise an EMTALA
violation as a defense, he certainly made countless arguments surrounding this standard.
Plaintiff’s own filings demonstrate that the state court in no way prevented him from
arguing and presenting certain defenses or denied him the opportunity to file any
counterclaims. But, even if such scenario is in fact true, Plaintiff’s remedy is not in a
federal district court, but rather in the appropriate state appellate court or the United
States Supreme Court. 17

There is nothing in the record to indicate that Plaintiff either filed a motion for a new trial in the statecourt case or appealed the state court’s ruling to either of Georgia’s appellate courts.
17

33

Consequently, assuming that Plaintiff’s EMTALA claim is not barred by the
Rooker-Feldman doctrine, it is nonetheless clearly a compulsory counterclaim because it
involves the same “cause of action” and “transaction or occurrence that [wa]s the subject
matter of the opposing party’s [(The Medical Center of Central Georgia, Inc.)] claim.”
Coen, 816 S.E.2d at 674; Ga. Code Ann. § 9-11-13(a). As such, Plaintiff was required to
address his alleged EMTALA violation in state court given that the actions he complained
about arose from the transaction or occurrence that was the subject of the state-court
proceeding.
ii.

Collateral Estoppel (Issue Preclusion)

Having determined that res judicata, under Georgia law, and Georgia’s
compulsory counterclaim statute both apply to bar Plaintiff’s EMTALA claim, the Court
must determine whether the related doctrine of collateral estoppel (issue preclusion) also
applies. The doctrine of collateral estoppel
precludes the re-adjudication of an issue that has previously been litigated
and adjudicated on the merits in another action between the same parties
or their privies. Like res judicata, collateral estoppel requires the identity
of the parties or their privies in both actions. However, unlike res judicata,
collateral estoppel does not require identity of the claim—so long as the
issue was determined in the previous action and there is identity of the
parties, that issue may not be re-litigated, even as part of a different claim.
Salem Crossing Townhomes Homeowners Ass’n, Inc. v. Wagner, ___S.E.2d___, 2018 WL
4998235, at *2-3 (Ga. Ct. App. 2018) (quoting Fulton Cty. Tax Comm’r v. Gen. Motors Corp.
507 S.E.2d 772, 778-79 (Ga. Ct. App. 1998)). Going further, Georgia case law provides that
34

collateral estoppel applies to “those issues that actually were litigated and decided in the
previous action, or that necessarily had to be decided in order for the previous judgment
to have been rendered.” Salem Crossing, 2018 WL 4998235, at *3 (citation omitted).
Accordingly, even though Plaintiff did not bring his EMTALA claim in the statecourt proceeding, it is clear that the state-court judge found sufficient cause to permit
Plaintiff’s conditional discharge. See generally [Doc. 33-2]. The Second Amended
Complaint presents relevant excerpts from the state-court hearing for the court to
determine that the “issue” of EMTALA “was decided in the previous action.” See, e.g.,
[Doc. 42 at pp. 3-11, 15-23]; see also Salem, supra. As Defendants argue and Plaintiff admits,
and considering the available excerpts, it is clear that the state-court judge “was
concerned about what had happened” and “gave wide latitude for [P]laintiff to assert
claims relating to his discharge.” [Doc. 63 at p. 3]; see also [Doc. 42 at ¶ 89]. 18 Taking into
consideration what Plaintiff could have conceivably presented in his defense at the statecourt hearing or in his post-hearing brief, the state-court judge still ruled in favor of The

Most notably to show the superior court judge’s careful oversight of the state-court case, Plaintiff’s Second
Amended Complaint quotes the superior-court hearing as follows:
18

Court:

Panitz:
Court:

[T]his [is] a very serious application.
A very serious application.
I am giving this the great weight it deserves. Okay? This is a very serious
allegation.
Thank you, Judge. I’ll need the transcript before I brief but thank you.
No, of course you will.

[Doc. 42 at ¶ 89 (transcript citations omitted)]. The Court is without the knowledge to know whether
Plaintiff actually submitted any post-hearing brief, but what is evident, by Plaintiff’s own admission, is that
before the superior court judge issued his ruling, he was undoubtedly given the opportunity to do so.

35

Medical Center of Central Georgia, Inc., but with the certain conditions as outlined above.
Thus, the state-court decision clearly contains issues that show an EMTALA issue
“necessarily had to be decided” in order for the state-court judge to even render a
decision as to the injunctive relief sought by The Medical Center of Central Georgia, Inc.
Salem Crossing, 2018 WL 4998235, at *3 (citation omitted). Again, to permit Plaintiff’s
EMTALA claim to proceed in this federal lawsuit could invite potential reversal of the
state-court decision. In order to reach his ruling, the state-court judge effectively
“decided” that any discharge would not violate EMTALA, and Plaintiff, dissatisfied with
that judgment, now seeks a different ruling in federal court. Salem Crossing, 2018 WL
4998235, at *3 (citation omitted). This simply is not allowed.
Moreover, Plaintiff (as the defendant/respondent in the state-court proceeding)
could have filed his EMTALA counterclaim and then, given the presence of a federal
question, removed The Medical Center of Central Georgia, Inc.’s, case to federal court.
This he did not do, and as stated numerous times, if Plaintiff felt he had been wronged
by the state court’s decision, his relief rested with state appellate courts or the United
States Supreme Court—not the lower federal courts. See Casale, 558 F.3d at 1260. In
addition to the doctrine of res judicata, the issue of an EMTALA claim “was determined
in the previous action,” thus, collateral estoppel’s appositeness under Georgia law,
further shows that Plaintiff’s EMTALA claim is barred. Salem Crossing, 2018 WL 4998235,
at *3 (citation omitted).
36

In light of the foregoing, the Court rules that Rooker-Feldman defeats the Court’s
exercise of federal-question jurisdiction. See Wood, 715 F.2d at 1546, supra, Section (C)(1).
Additionally, Plaintiff’s EMTALA claim is also subject to the procedural bars related to
the ordinary principles of preclusion under Georgia law regarding res judicata and
collateral estoppel. Accordingly, the Court must DISMISS Plaintiff’s EMTALA claim,
and thus, need not consider the parties’ additional substantive arguments regarding
Plaintiff’s EMATALA claim pursuant to the traditional standard under Federal Rule of
Civil Procedure 12(b)(6).
2.

Diversity Jurisdiction Under 28 U.S.C. § 1332

Having determined that the Court cannot exercise federal-question jurisdiction
over this case, the Court must consider Defendants’ certain jurisdictional concerns related
to diversity of citizenship between the parties as to Plaintiff’s remaining state-law claims.
[Docs. 48-1; 63]. Defendants contend that “it would be appropriate for the Court to
conduct a factual inquiry to confirm the existence of facts establishing Plaintiff’s domicile
in New York.” In light of these concerns and because “it is fundamental that parties may
not stipulate to federal jurisdiction,” the Court held a telephone conference 19 inquiring

When it comes to diversity jurisdiction, “[d]istrict courts have the discretion to resolve parties’ motions
without an evidentiary hearing” and “[a] court does not abuse its discretion when it decides a motion to
dismiss for lack of jurisdiction without an evidentiary hearing ‘when neither party makes a timely and
unequivocal request for a [ ] hearing.’” Antoine v. Verin, ___ F. App’x ___, No. 18-10645, 2018 WL 3860477,
at *3 (11th Cir. Aug. 14, 2018) (quoting Sunseri v. Macro Cellular Partners, 412 F.3d 1247, 1251 (11th Cir.
2005)).

19

37

into Plaintiff’s domicile. Travaglio v. Am. Exp. Co., 735 F.3d 1266, 1269-70 (11th Cir. 2013);
[Doc. 48-1 at pp. 8-9]; [Doc. 38].
Under 28 U.S.C. § 1332:
(a) The district courts shall have original jurisdiction of all civil actions
where the matter in controversy exceeds the sum or value of $75,000,
exclusive of interest and costs, and is between—
(1) citizens of different States;
(2) citizens of a State and citizens or subjects of a foreign state, except
that the district courts shall not have original jurisdiction under
this subsection of an action between citizens of a State and
citizens or subjects of a foreign state who are lawfully admitted
for permanent residence in the United States and are domiciled
in the same State; . . .
28 U.S.C. § 1332(a)(1)-(2). The Eleventh Circuit has held that
the law is clear regarding a federal court’s limited subject matter
jurisdiction; specifically, [federal courts] only have the authority to decide
certain types of cases. Further, the party invoking the court’s jurisdiction
bears the burden of proving, by a preponderance of the evidence, facts
supporting the existence of federal jurisdiction.
McCormick v. Aderholt, 293 F.3d 1254, 1257 (11th Cir. 2002) (internal citations omitted); see
also Scoggins v. Pollock, 727 F.2d 1025, 1026 (11th Cir. 1984). During the telephone
conference, Plaintiff’s counsel stated that Plaintiff is not a natural-born citizen of the
United States, but he also assured both the Court and opposing counsel that Plaintiff had
met the requirements for consideration as an individual “lawfully admitted for
permanent residence in the United States.” 28 U.S.C. § 1332(a)(2). Plaintiff further stated
that he has a residence in New York as reflected by an address listed on this case’s civil
cover sheet [Doc. 2 at p. 2]. Given that Defendants’ counsel took Plaintiff’s counsel at his
38

word and offered nothing to refute or disprove the proffered statements, Defendants, as
well as the Court, accepted Plaintiff’s contentions regarding his resident alien status.
Accordingly, the Court found that Plaintiff’s domicile 20 lies in New York. As such, there
is complete diversity among the parties in this case and the Court possesses diversity
jurisdiction to rule on Plaintiff’s state-law claims.
a.

Plaintiff’s State-Law Tort Claims

In addition to his EMTALA claim, Plaintiff brings a litany of state-law claims. First,
Plaintiff asserts two causes of action (Counts 2 & 3) involving alleged medical malpractice
against various medical professionals. [Doc. 42 at pp. 30-34]. The remaining state-law
claims include: libel and slander; harassment; emotional distress; and invasion of privacy.
[Doc. 42 at pp. 35, 37, 40-42]. However, while these state-law claims arguably do not
“complain of a state-court judgment” and therefore, may not prompt a Rooker-Feldman
analysis, they most certainly complain of tortious actions allegedly committed by
Defendants that arose from the same set of operative facts that gave rise to the previous
state-court proceedings. As such, these claims—brought against Defendants in this
federal suit—present comparable procedural complexities.
Given the lack of federal-question jurisdiction in this case, the Court (sitting in
diversity as to these remaining state-law claims) must apply federal procedural law to

“State citizenship, or ‘domicile’ for purposes of diversity jurisdiction, is determined by two factors:
residence [(physical presence)] and intent to remain.” Las Vistas Villas, S.A. v. Petersen, 778 F. Supp. 1202,
1204 (M.D. Fla. 1991).

20

39

determine the claims’ preclusive effect. Esfeld v. Costa Crociere, S.P.A., 289 F.3d 1300, 1306
(11th Cir. 2002) (“A federal court sitting in diversity must apply state substantive law and
federal procedural law.”). Federal procedural law provides the same points as those
contained in Georgia’s Civil Practice Act. Specifically,
[a] pleading must state as a counterclaim any claim that—at the time of its
service—the pleader has against an opposing party if the claim: (A) arises
out of the transaction or occurrence that is the subject matter of the
opposing party’s claim; and (B) does not require adding another party over
whom the court cannot acquire jurisdiction.
Fed. R. Civ. P. 13(a).
This circuit’s predecessor, the Fifth Circuit Court of Appeals, “adopted the ‘logical
relationship’ test for determining whether a counterclaim was compulsory. Republic
Health Corp. v. Lifemark Hosps. of Fl., Inc., 755 F.2d 1453, 1455 (11th Cir. 1985) (citation
omitted). “Under this test, there is a logical relationship [between the opposing party’s
claim and a potential counterclaim] when ‘the same operative facts serve as the basis of
both claims or the aggregate core of facts upon which the claim rests activates additional
legal rights, otherwise dormant, in the [counterclaimant].’” Id. (citation omitted).
1.

Medical Malpractice

First, Defendants seek dismissal of Plaintiff’s medical malpractice claims (Counts
2 & 3) on the grounds that he failed to file the affidavit required by Ga. Code Ann. § 9-119.1. “In federal courts, ‘state law governs substantive issues, . . . while federal law governs
pleading requirements.’” Durden v. Newton Cty., No. 1:14-CV-01163-RWS, 2015 WL 71446,
40

at *2 (N.D. Ga. Jan. 5, 2015) (quoting Brown v. Nichols, 8 F.3d 770, 773 (11th Cir. 1993)).
Because the Georgia affidavit requirement for medical malpractice claims is a procedural
vehicle, and “not substantive state law,” it does not apply in federal courts. Id. (citation
omitted). Thus, the Court rejects this argument as a basis for dismissal.
However, it is of vital importance to note that Plaintiff’s medical malpractice
claims only surround allegations that occurred during the 160-day period he was admitted
as a patient. Nothing in Plaintiff’s Second Amended Complaint could reasonably be
construed as a medical malpractice claim against Defendants, or another third party (such
as the skilled nursing facility to which Plaintiff was purportedly discharged) for that
matter, after the date of his discharge. Consequently, Plaintiff’s allegations that
Defendants breached “the[ir] duty under federal law, the law[s] of Georgia, and other
applicable laws and medical standards” all arose from the “occurrence” that was the
subject matter of The Medical Center of Central Georgia, Inc.’s, original claim in state
court. Fed. R. Civ. P. 13(a); [Doc. 42 at p. 30].
Therefore, Plaintiff should have sought to pause the state-court case against him,
requested a continuance, regrouped, and then asserted in state court the two medical
malpractice claims he now seeks to bring in this lawsuit because they involved “the same
operative facts” as those presented in state court. Republic Health Corp., 755 F.2d at 1455;
Fed. R. Civ. P. 13(a). Accordingly, the Court DISMISSES Plaintiff’s medical malpractice

41

claims (Counts 2 & 3) against Defendants on the grounds that they should have been
asserted in state court and are therefore barred as compulsory counterclaims.
2.

Libel, Slander, and Harassment

Second, Plaintiff’s Second Amended Complaint sets forth claims of libel and
slander (Counts 5 & 8, presumably) and a claim of harassment (Count 4). [Doc. 42 at pp
35-40, 42-44]. As structured, Plaintiff’s Second Amended Complaint intermingles each of
these actions (plus “further emotional distress”) within Counts 4, 5, and 8. [Id.].
Specifically, Plaintiff complains that Defendants “maliciously accused [Plaintiff] of being
a criminal trespasser” and that Defendants actions “publicly smear[ed] [Plaintiff] as a
means to “harass and embarrass” him. [Id. at ¶¶ 166-67]. However, as Plaintiff states, the
accusations labeling Plaintiff as a “criminal trespasser” were asserted in The Medical
Center of Central Georgia, Inc.’s, state-court petition. [Id. at ¶ 74 (“In their baseless
petition, the hospital proudly called [Plaintiff] a criminal trespasser, . . . .” (italics in
original))]. Irrespective of Plaintiff’s “buzzword-pleading,” it is clear that the accusations
contained within these claims enjoy absolute privilege 21 because they were allegedly
made within the course of a legal proceeding. Williams v. Stepler, states:
[a]ll charges, allegations, and averments contained in regular pleadings
filed in a court of competent jurisdiction, which are pertinent and material
to the relief sought, whether legally sufficient to obtain it or not, are
According to the Georgia Court of Appeals, “[t]he privilege is intended ‘for the promotion of the public
welfare, the purpose being that . . . judges of courts, . . . lawyers, and witnesses may speak their minds freely
and exercise their respective functions without incurring the risk of a criminal prosecution or an action for
the recovery of damages.’” Williams v. Stepler, 490 S.E.2d 167, 171 (Ga. Ct. App. 1997) (emphasis added)
(citation omitted).
21

42

privileged. However false and malicious such charges, allegations, and
averments may be, they shall not be deemed libelous.
490 S.E.2d 167, 171 (Ga. Ct. App. 1997) (citing Ga. Code Ann. § 51-5-8). In response,
Plaintiff stresses that “privilege extends only to allegations ‘which are pertinent and
material to the relief sought.’” [Doc. 61 at p. 17, n.13 (citing Vito v. Paley, 604 S.E.2d 620,
621 (Ga. Ct. App. 2004)]. However, notwithstanding Plaintiff’s argument that
Defendants’ reliance on Vito is misplaced and that Plaintiff’s doctors testified that Plaintiff
“was just trying to get better,” Plaintiff fails to articulate any reason why such accusations
were not “pertinent and material” to the issues presented in the earlier state-court
pleadings. 604 S.E.2d at 621; see also [Docs. 33-1; 61 at p. 17 n.13]. Plaintiff’s claims include
accusations made by The Medical Center of Central Georgia, Inc., that were undoubtedly
made within “official court documents” or include “acts of ‘legal process.’” Stepler, 490
S.E.2d at 171 (citations omitted).
Furthermore, Plaintiff was fully aware of The Medical Center of Central Georgia,
Inc.’s, accusations in the earlier proceeding, and under the rules of compulsory
counterclaims outlined above, he must have addressed these claims in state court because
“the same operative facts serve as the basis” of any claim he should have brought in state
court and the claims he currently brings in this action. Republic Health Corp., 755 F.2d at
1455; Fed. R. Civ. P. 13(a). Therefore, the Court finds that Defendants’ accusations,
including their labeling Plaintiff as a “criminal trespasser,” are deemed privileged and,
as an additional and alternative basis, barred as compulsory counterclaims. Accordingly,
43

the Court DISMISSES Plaintiff’s libel and slander claims (Counts 5 & 8, presumably) as
well as his claim for harassment 22 (Count 4) given that such claim cannot stand absent
some other legally recognized claim.
3.

Emotional Distress

Third, Plaintiff’s Second Amended Complaint sets forth a claim for emotional
distress (Count 6). [Doc. 42 at p. 40]. Notably, this count only makes allegations related
to Defendants’ alleged “failure to exercise due care” and their knowledge that such a level
of care “would cause Plaintiff to suffer severe emotional distress . . . .” [Id. at ¶ 173].
Plaintiff clearly states that “[a]s direct and proximate result of said conduct [he] was
caused to sustain serious[] permanent, personal injuries and suffering, including pain,
suffering, progressive cognitive decline, distress, depression, mental anguish,
humiliation, and other physical and personal losses.” [Id. at ¶ 174].
Additionally, it is worth noting that Plaintiff’s emotional distress claim stems
from, what he describes as a “4-prong conspiracy.” [Doc. 61 at p. 13]. Plaintiff argues that
Defendants engineered a 4-prong conspiracy to get [Plaintiff] out—
denying him neurological oversight for [five] months[;] trying to
wrongfully evict him in June 2017[,] despite all of his acute conditions;
dumping him out to the hospital exit on August 9, 2017[;] and suing
[Plaintiff], falsely alleging that he was a criminal trespasser.

Defendants argue that there is not a civil cause of action for “‘harassment’ divorced from some other
legally recognized claim.” Plaintiff does not address or refute this contention in his Response. [Doc. 48-1 at
p. 19 (citing Robinson v. McDonald, No. 1:16-CV-3486-TWT, 2016 WL 9308020, at * 1 (N.D. Ga. Nov. 22,
2016)].
22

44

[Id. (emphasis in original)]. To support his four-pronged conspiracy theory, Plaintiff
directs the Court to Crisp Reg’l Nursing & Rehab. Ctr. v. Johnson, for the proposition that
“displacing [a] patient out of [his] room” constitutes a “[h]ospital staff[’s] deliberate
disregard for a patient’s basic needs and concerns [and] support[s] a finding of
intentional infliction of emotional distress.” 574 S.E.2d 650 (Ga. Ct. App. 2002). While the
court in Crisp Reg’l. found that whether such outrageous conduct caused severe and
emotional distress was for determination by “[a] reasonable jury,” Defendants, in reply
argue that their conduct was “not outrageous” and therefore is not subject to jury
determination. Id. at 655; [Doc. 63 at p. 9].
Specifically, Defendants contend that their conduct does not fall within the ambit
of the disapproving conduct discussed in Crisp Reg’l. because “[Navicent Health] took
the reasonable step of seeking [c]ourt intervention when [Plaintiff] refused discharge
plans that the staff presented.” [Doc. 63 at p. 9]. As to Plaintiff’s first prong—five months
of neurological oversight—Defendants show that “[w]hether [Plainitff] needed
additional specialists or tests was addressed by [the state court]” which “[would] not
substitute its own judgment for that of the medical providers caring for [Plaintiff].” [Id.
quoting [Doc. 33-2 at p. 8]]. Taking this into consideration, it appears that the state-court
judge already passed ruling as to Plaintiff’s emotional distress claim regrading
Defendants’ purported “failure to exercise due care.” [Doc. 42 at p. 40]. Thus, Plaintiff’s
request of asking this Court to deny dismissal of his emotional distress claim, once again
45

treads the waters of Rooker-Feldman and cannot be adjudicated here as federal district
courts cannot exercise appellate jurisdiction over state-court judgments. Sophocleus, 170
F. App’x at 610 (citing Exxon Mobil Corp., 544 U.S. at 292); see also 28 U.S.C. § 1257(a).
Crucially, Plaintiff’s allegations, regarding his emotional distress claim like his
other tort claims against Defendants, do not present any facts occurring after the
discharge itself. In other words, Plaintiff only pleads that what occurred in the events
leading up to the discharge created a viable emotional distress claim. Therefore, this statetort claim, like the others, would have been an appropriate counterclaim in the state-court
action given that “the same operative facts serve as the basis” for any emotional distress
claim, whether asserted in the earlier state-court proceeding, or here. Republic Health
Corp., 755 F.2d at 1455; Fed. R. Civ. P. 13(a). Accordingly, the Court DISMISSES
Plaintiff’s emotional distress claim (Count 6).
4.

Invasion of Privacy

Last, Plaintiff brings an invasion of privacy claim (Count 7). [Doc. 42 at pp. 41-42].
The presentment of this claim states that Defendants violated both “Georgia and federal
privacy laws” but, as Defendants note, fails to identify neither the state nor the federal
law upon which Plaintiff rests his claim. [Id. at p. 42]. As stated above, in the Court’s
Standard of Review, see Section (A), supra, a complaint attacked by a 12(b)(6) motion is
subject to dismissal when it fails to “give the defendant fair notice of what the . . . claim
is and the grounds upon which it rests.” Twombly, 550 U.S. at 555.
46

It is true that a Plaintiff may certainly use legal conclusions such as, “the
[D]efendants did invade and violate [Plaintiff’s] privacy rights,” and “th[e] conduct by
the [D]efendants was specious in violation of both Georgia and federal privacy laws,” to
structure his complaint, but he must support such conclusions with factual allegations.
McCullough, 907 F.3d at 1333 (quoting Iqbal, 556 U.S. at 679). Because Plaintiff’s Second
Amended Complaint fails to assert on which state and/or federal privacy laws he brings
his invasion of privacy claim, it is subject to dismissal under Federal Rule of Civil
Procedure 12(b)(6).
Furthermore, as with Plaintiff’s other state-tort claims, his invasion of privacy
claim should have also been brought as a counterclaim in the earlier state-court
proceeding given that it arises from “the same operative facts” under which The Medical
Center of Central Georgia, Inc., asserted its claims. Republic Health Corp., 755 F.2d at 1455;
Fed. R. Civ. P. 13(a). Therefore, Plaintiff’s invasion of privacy claim is subject to dismissal
not only because it fails to give Defendants fair notice of what law, either state or federal,
they are charged with violating and the factual bases upon which the alleged violation
rests (and thereby fails to state a claim under Federal Rule of Civil Procedure 12(b)(6)),
but also because the claim is a compulsory counterclaim under Federal Rule of Civil
Procedure 13(a). Accordingly, the Court DISMISSES Plaintiff’s invasion of privacy claim
(Count 7).

47

b.

Plaintiff’s Arguments Regarding the Hospital Lien Filed in Bibb,
Dougherty, 23 and Worth Counties

In his Second Amended Complaint, Plaintiff’s ninth cause of action seeks to
invalidate a hospital lien “asserting purported claims upon causes of action accruing to
the Plaintiff on account of injuries caused by unnamed third parties who caused Plaintiff[]
to need care in the [D]efendants’ hospital facility.” [Doc. 42 at p. 44]. This ninth cause of
action rests on the premise that the lien should be invalidated because notice was not
provided as required by statute. [Doc. 48-1 at p. 19]. Plaintiff’s Second Amended
Complaint makes no mention of the county or counties in which The Medical Center of
Central Georgia, Inc., filed its lien. However, Defendants, for the sake of clarity—in the
instant motion—referenced “Exhibit C,” from their first Motion to Dismiss [Doc. 33]
Plaintiff’s Amended Complaint [Doc. 26]. [Doc. 48-1 at p. 19], In that exhibit, the “Notice
of Filing of Hospital Lien” indicates that the liens are filed in Bibb, Dougherty, and Worth
counties. [Doc. 33-3].
To start, The Medical Center of Central Georgia, Inc., “provided notice of its intent
to claim a lien” “[a]s provided in” Ga. Code Ann. § 44-14-470, on September 19, 2017.
[Doc. 33-1 at p. 1]. However, Plaintiff argues that The Medical Center of Central Georgia,
Inc., failed to provide written notice to him, and therefore, failed to follow the

Defendants’ Brief In Support states that the “lien [was] filed in Bibb, Daugherty [sic], and Worth
counties.” [Doc 48-1 at p. 19]. Whereas the “Notice of Filing Hospital Lien” shows that the relevant counties
are “Bibb, Dougherty, [and] Worth” counties.” [Doc. 33-3 at p. 1].

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48

requirements for perfection of the lien as outlined in Ga. Code Ann. § 44-14-471(a). [Doc.
61 at p. 17]. The method of perfecting an existing lien is as follows:
(a) In order to perfect the lien provided for in Code Section 44-14-470, the
operator of the hospital, nursing home, physician practice, or provider of
traumatic burn care medical practice:
(1) Shall, not less than 15 days prior to the date of filing the statement
required under paragraph (2) of this subsection, provide written notice
to the patient and, to the best of the claimant’s knowledge, the persons,
firms, corporations, and their insurers claimed by the injured person or
the legal representative of the injured person to be liable for damages
arising from the injuries and shall include in such notice a statement that
the lien is not a lien against the patient or any other property or assets
of the patient and is not evidence of the patient’s failure to pay a debt.
Such notice shall be sent to all such persons and entities by first-class
and certified mail or statutory overnight delivery, return receipt
requested; and
(2) Shall file in the office of the clerk of the superior court of the county
in which the hospital, nursing home, physician practice, or provider of
traumatic burn care medical practice is located and in the county
wherein the patient resides, if a resident of this state, a verified
statement setting forth the name and address of the patient as it appears
on the records of the hospital, nursing home, physician practice, or
provider of traumatic burn care medical practice; the name and location
of the hospital, nursing home, physician practice, or provider of
traumatic burn care medical practice and the name and address of the
operator thereof; the dates of admission and discharge of the patient
therefrom or with respect to a physician practice, the dates of treatment;
and the amount claimed to be due for the hospital, nursing home,
physician practice, or provider of traumatic burn care medical practice
care, which statement must be filed within the following time period:
(A) If the statement is filed by a hospital, nursing home, or provider
of traumatic burn care medical practice, then the statement shall be
filed within 75 days after the person has been discharged from the
facility; or
49

(B) If the statement is filed by a physician practice, then the statement
shall be filed within 90 days after the person first sought treatment
from the physician practice for the injury.
(b) The filing of the claim or lien shall be notice thereof to all persons, firms,
or corporations liable for the damages, whether or not they received the
written notice provided for in this Code section. The failure to perfect such
lien by timely complying with the notice and filing provisions of
paragraphs (1) and (2) of subsection (a) of this Code section shall invalidate
such lien, except as to any person, firm, or corporation liable for the
damages, which receives prior to the date of any release, covenant not to
bring an action, or settlement, actual notice of a notice and filed statement
made under subsection (a) of this Code section, via hand delivery, certified
mail, return receipt requested, or statutory overnight delivery with
confirmation of receipt.
Ga. Code Ann. § 44-14-471 (2006) (emphasis added).
The Medical Center of Central Georgia, Inc., undoubtedly filed its lien within 75
days of Plaintiff’s discharge (Sept. 5, 2017) in Bibb (Oct. 24, 2017), Dougherty (Oct. 23,
2017), and Worth (Oct. 24, 2017) counties. [Doc. 33-3]. Plaintiff’s issue is that The Medical
Center of Georgia, Inc., “never provided written notice of said or any lien as required by
said statute.” [Doc. 42 at p. 44]. However, despite the scarce case law regarding validity
of hospital liens, the Court concludes that Plaintiff’s argument is somewhat misguided
and, therefore, premature.
Plaintiff is undoubtedly correct that the lien statute clearly necessitates that
“written notice” “shall” be given “to the patient” and “to . . . the persons, firms,
corporations, and their insurers claimed by the injured person or the legal representative
of the injured person to be liable for damages arising from the injuries.” Ga. Code Ann. §
50

44-14-471(a)(1) (emphasis added). A plain reading of this portion of the statute clearly
shows that notice must be given to two different sets of people: the patient and those who
may be liable for Plaintiff’s injuries. Id. Plaintiff contends that Defendants never gave him
notice, and the lien is therefore unenforceable.
However, subsection (b) provides that “[t]he filing of the claim or lien shall be
notice thereof to all persons, firms, or corporations liable for the damages, whether or not
they received the written notice provided for in [subsection (a)].” Ga. Code Ann. § 44-14471(b). This subsection acts as somewhat of a saving grace for the lien as to those
“persons, firms, or corporations” who may be liable for the damages, but, based on the
plain text of the statute, this savings clause does not provide a safe harbor for a hospital’s
failure to notify the patient of its intent to file a lien.
Moreover, even if it is true that Defendants never provided Plaintiff notice of the
lien, there is currently no cause of action against which the lien would operate.
Effectively, Plaintiff is asking the Court invalidate a hospital lien that is merely sitting
idle with no sign of enforceability on the horizon. 24 Because Plaintiff seeks a declaratory
judgment that the hospital lien “and any other lien” is invalid (as to him) given
Defendants failure to provide written notice to him under Ga. Code Ann. § 44-14471(a)(1), “[s]trict application of the ripeness doctrine prevents federal courts from

There is nothing in the record to indicate that Plaintiff has filed any claim against the driver who allegedly
struck the automobile in which he was a passenger on March 29, 2017 or the driver of the car in which he
was riding. [Doc. 42 at ¶ 5].

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51

rendering impermissible advisory opinions and wasting resources through review of
potential or abstract disputes.” Nat’l Advertising Co. v. City of Miami, 402 F. 3d 1335, 1339
(11th Cir. 2005); [Doc. 42 at p. 44]. Accordingly, for the reasons stated above and until
such time as the hospital actually attempts to enforce its lien against a pending settlement
between Plaintiff and one liable to him for his damages, the Court is constrained to leave
the question of whether Plaintiff has a direct cause of action to invalidate the lien for a
later date.25
Therefore, as it stands now, because no such resolute action has been taken, and
until such time as The Medical Center of Central Georgia, Inc., seeks to enforce the lien
against those who may be liable for damages, its mere filing constitutes notice to those

An additional basis for the Court’s conclusion—that Plaintiff’s attempt to invalidate the lien is
premature—is based on the fact that there is nothing in the record to indicate that anyone in this case
entered into “any release, covenant not to bring an action, or settlement.” Ga. Code Ann. § 44-14-471(b).
Moreover, this statute could only be invoked as a defense against the lienholder when the lienholder attempts
to enforce its lien—and recover on unpaid medical bills—from a separate action in which Plaintiff
recovered some amount of damages. The cause of action afforded by this statute allows a “hospital, nursing
home, physician practice, or provider of traumatic burn care medical practice” to collect on a judgment.
Ga. Code Ann. § 44-14-470. It does not appear to create a cause of action for Plaintiff to invalidate a lien,
and the Court will not read an implied right of action into the statute. See Bellsouth Telecomm., LLC v. Cobb
Cty., 802 S.E.2d 686, 690 (Ga. Ct. App. 2017) (“Georgia has longstanding precedential authority rejecting
the creation of implied private rights of action.”), cert. granted, S17G2011 (Ga. Apr. 16, 2018). The Georgia
Court of Appeals further explains:
In 2010, the General Assembly codified this presumption in [Ga. Code Ann.] § 9-2-8(a),
which provides that ‘[n]o private right of action shall arise from any Act enacted after July
1, 2010, unless such right is expressly provided therein.’ Our Supreme Court has noted that
the creation of [Ga. Code Ann.] § 9-2-8 revealed the General Assembly’s concern over
‘judicial creation of implied civil causes of action.’ Although [Ga. Code Ann.] § 9-2-8(a)
‘would not apply to the pre-existing [§ 44-14-471] at issue in this case, . . . it certainly
counsels against deviating from our established precedent to find new implied civil causes
of action.’
Bellsouth Telecomm., LLC v. Cobb Cty., 802 S.E.2d 686, 690 (Ga. Ct. App. 2017).
25

52

“persons, firms, or corporations” and that is all that is required at this point. Ga. Code
Ann. § 44-14-471(b). To put a finer point on the Court’s decision, there is simply no “case
or controversy” between the Plaintiff and Defendants regarding the validity of the
hospital lien because there is no settlement or judgment against which the hospital could
attempt to enforce its lien. Thus, Plaintiff’s declaratory judgment count is not ripe,
assuming that he has a direct cause of action to contest the lien’s validity.
In Response to Defendants’ attempt to uphold the validity of the hospital lien,
Plaintiff argues that “[i]f the defense of res judicata argument has merit, it would bar . . .
[D]efendants’ own counterclaim for payment of their hospital bill. Under [their] own
argument, . . . [D]efendants would be barred from ever litigating their alleged unpaid bill
since [they] did not pursue payment in the state court in 2017.” [Doc. 61 at p. 9]. This
argument, especially considering the contents of this order, merits discussion.
To this point, it is axiomatic that a hospital lien may not be filed until “after the
person has been discharged from the facility.” Ga. Code Ann. § 44-14-471(a)(2)(A).
Clearly, The Medical Center of Central Georgia, Inc., could not have filed its lien at the
time of the state-court proceeding based on the fact that Plaintiff had not yet been
discharged. As a result, there is nothing to support a res judicata-based argument that
Defendants should have litigated the hospital bills in the earlier proceeding.
As explained above, the Court DISMISSES Plaintiff’s demand for a declaratory
judgment (Count 9) that the hospital lien is invalid because it is not yet ripe.
53

c.

Plaintiff’s Claims Regarding Attorney’s Fees, Punitive Damages, and
Treble Damages

Given the Court’s ruling on Defendants’ motion, Plaintiff’s claims for attorney’s
fees, punitive damages, and treble damages are likewise due to be dismissed because
they are derivative of his underlying Georgia tort law claims. See Love v. WEECCO(TM),
No. 1:18-CV-540-TWT, 2018 WL 5044639, at *3 n.28 (N.D. Ga. Oct. 17, 2018) (citing Perkins
v. Thrasher, 701 F. App’x 887, 891 (11th Cir. 2017)); see also Lilliston v. Regions Bank, 653
S.E.2d 306, 311 (Ga. Ct. App. 2007) (explaining that dismissal of underlying substantive
claims warrants dismissal of derivative claims for punitive damages); Gilmour v. Gates,
McDonald & Co., 382 F.3d 1312, 1316 (11th Cir. 2004) (per curiam) (establishing that a claim
for attorney’s fees under Ga. Code Ann. § 13-6-11 requires an underlying claim).
Therefore, Plaintiffs’ claims for punitive damages, treble damages, and attorney’s fees are
also dismissed in light of the Court’s ruling.
CONCLUSION
Based on the reasoning described above, the Court DISMISSES Plaintiff’s
EMTALA claim on the grounds that it is barred by the Rooker-Feldman doctrine and, in
the alternative, the doctrines of res judicata and/or collateral estoppel. Furthermore, the
Court GRANTS 26 Defendants’ Motion to Dismiss [Doc. 48] Plaintiff’s Second Amended
Complaint [Doc. 42] and DISMISSES Plaintiff’s state-law claims for medical malpractice;

As a result of the Court’s ruling, the Court also TERMINATES Defendants’ Motion to Dismiss Complaint
[Doc. 33] as moot.
26

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libel and slander; harassment; emotional distress; and invasion of privacy on the grounds
that they are barred as compulsory counterclaims under Federal Rule of Civil Procedure
13(a). Finally, Plaintiff’s claim to invalidate the lien filed in Bibb, Dougherty, and Worth
counties is DISMISSED without prejudice as it is not yet ripe. Consequently, the Court
DIRECTS the Clerk of Court to ENTER JUDGMENT for all Defendants and CLOSE this
case.
SO ORDERED, this 12th day of December, 2018.
S/ Tilman E. Self, III
TILMAN E. SELF, III, JUDGE
UNITED STATES DISTRICT COURT

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