Danny Fewins v. CHS/Community Health Sys, I
662 F. App'x 327
| 5th Cir. | 2016Background
- On June 29, 2012, six-year-old D.A.F. presented to Lake Granbury Medical Center (LGMC) ER complaining of severe leg/hip pain after a prior fall; triage, vitals, exam, labs, and a CT were performed by Dr. Scott Jones.
- Dr. Jones diagnosed contusions/hematomas and muscle strain, reviewed labs and CT, consulted radiology, found no clinically significant abnormalities, and discharged D.A.F. with pain meds and follow-up.
- The next day D.A.F. was admitted to Cook Children’s with high fever and MRSA infection, underwent surgery, and sustained permanent bone damage.
- Plaintiffs (the Fewins) sued LGMC under EMTALA and alleged malpractice; district court granted summary judgment for LGMC on EMTALA claims and excluded plaintiffs’ expert; claims against LGMC were severed and judgment entered.
- On appeal, the Fifth Circuit affirmed summary judgment for LGMC (no EMTALA violation) and dismissed the separate interlocutory appeal as to exclusion of the expert for lack of jurisdiction.
Issues
| Issue | Plaintiff's Argument | Defendant's Argument | Held |
|---|---|---|---|
| Whether LGMC’s medical screening was so cursory it amounted to no screening | Fewins: Dr. Jones ignored mother; screening was inadequate/cursory | LGMC: prompt triage, physician exam, labs, CT, radiology consult and documentation show a full screening | Court: Screening was adequate; summary judgment for LGMC affirmed |
| Whether LGMC violated its pain-management policy as part of EMTALA screening | Fewins: Nurses did not follow pain policy, undermining screening | LGMC: pain policy is a nursing policy separate from physician-conducted EMTALA screening; nurses complied | Court: Pain policy not part of EMTALA screening; alleged violation immaterial to EMTALA claim |
| Whether D.A.F. received disparate screening compared to other patients with similar symptoms | Fewins: Expert identified three comparator patients who were admitted while D.A.F. was discharged | LGMC: Comparators were older, had different histories and were perceived to have infections; Dr. Jones did not perceive same condition | Court: Plaintiffs failed to show comparators were in a similar condition; no disparate-treatment issue under EMTALA |
| Whether LGMC failed to stabilize an emergency medical condition before discharge | Fewins: Dr. Jones’s chart entry of “certified medical emergency” shows an emergency condition existed and was unstabilized | LGMC: Dr. Jones distinguished a certified emergency (triage category) from an actual emergency medical condition and concluded D.A.F. was not unstable | Court: No evidence Dr. Jones had actual knowledge of an emergency medical condition; no stabilization duty triggered |
| Exclusion of plaintiffs’ expert and appealability of that order | Fewins: exclusion was erroneous and should be reviewable on appeal | Defendants: exclusion was separate, interlocutory, and not necessary to resolution of LGMC appeal | Court: Resolution of EMTALA claim rendered expert exclusion unnecessary to this appeal; separate appeal of exclusion dismissed for lack of jurisdiction |
Key Cases Cited
- QBE Ins. Corp. v. Brown & Mitchell, Inc., 591 F.3d 439 (5th Cir. 2009) (standard of review for summary judgment)
- Battle v. Mem. Hosp. at Gulfport, 228 F.3d 544 (5th Cir. 2000) (EMTALA duties: screening, stabilization, transfer restrictions)
- Marshall v. East Carroll Parish Hosp. Serv. Dist., 134 F.3d 319 (5th Cir. 1998) (EMTALA is not a federal malpractice statute; screening judged by parity with similar patients)
- Correa v. Hosp. S.F., 69 F.3d 1184 (1st Cir. 1995) (example of an extreme cursory-screening denial)
- Vickers v. Nash General Hosp., Inc., 78 F.3d 139 (4th Cir. 1996) (EMTALA disparate-treatment analysis requires patients perceived to have the same condition)